Beyond ISS : The Impact of Injury Combination on Pediatric Trauma Mortality - A National Trauma Databank (NTDB) 2011-2015 Study
Radu Filipescu, MD; Colin Powers, MD; David Rothstein, MD; Caroll Harmon, MD; Kathryn Bass, MD
John Oishei Children's Hospital, Buffalo, NY
BACKGROUND According to Center for Disease Control and Prevention, in the past 15 years, trauma mortality has decreased by 40% in children aged 5-18 and only by 10% in 0-4 age group (AG). We sought to comparatively characterize trauma related mortality across pediatric AG and identify the major determinants for mortality in the 0-4 AG.
657,771 children from NTDB 2011-2015 were included. Injury Severity Score (ISS), Abbreviated injury Scale (AIS), Revised Trauma Score (RTS), age and mechanism of injury (MOI) were used in descriptive and multivariate analysis as predictors for mortality.
Head injury (HI) accounted for 77% of the mortality across all age groups. 60% of mortality in 0-4 AG occurred in the first year of life. Non-accidental trauma (NAT) was the most frequent lethal MOI (41.5%). In non-survivors, the 0-4 AG had the lowest mean ISS (29.02±13.61; p<0.001) and RTS (2.85±2.24; p<0.001). When compared to isolated HI, the combination of moderate to severe HI (AIS=3-5) with mild extra-cranial injury (ECI, AIS=1-2) doubled the mortality in the 0-9 AG (OR=2.04, p<0.001) while in the 10-18 AG it did not (OR=0.57, p<0.001). Adding a second mild ECI further doubled the mortality in the 0-9 AG(OR=1.94, p<0.001) while in the 10-18 AG it increased it by a factor of 1.3(p<0.001).
Decreased physiologic reserve and high incidence of NAT account for the increased mortality in the 0-4 AG. ISS may not accurately reflect mortality in young age groups, as addition of a second ECI to existing HI increases mortality exponentially.
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