Abstract
Injury is a leading cause of morbidity and mortality in the paediatric population and exhibits complex injury patterns. This study aimed to identify homogeneous groups of paediatric major trauma patients based on their profile of injury for use in mortality and functional outcomes risk-adjusted models. Data were extracted from the population-based Victorian State Trauma Registry for patients aged 0–15 years, injured 2006–2016. Four Latent Class Analysis (LCA) models with/without covariates of age/sex tested up to six possible latent classes. Five risk-adjusted models of in-hospital mortality and 6-month functional outcomes incorporated a combination of Injury Severity Score (ISS), New ISS (NISS), and LCA classes. LCA models replicated the best log-likelihood and entropy > 0.8 for all models (N = 1281). Four latent injury classes were identified: isolated head; isolated abdominal organ; multi-trauma injuries, and other injuries. The best models, in terms of goodness of fit statistics and model diagnostics, included the LCA classes and NISS. The identification of isolated head, isolated abdominal, multi-trauma and other injuries as key latent paediatric injury classes highlights areas for emphasis in planning prevention initiatives and paediatric trauma system development. Future risk-adjusted paediatric injury models that include these injury classes with the NISS when evaluating mortality and functional outcomes is recommended.
Highlights
Injuries in children make a considerable contribution to disease burden globally, being a leading cause of mortality for children over one year of age and causing varying levels of disability affecting their development into adulthood [1]. a 10-year review of the injury outcomes of children in Australia found that injury was the leading cause of death in children aged 1 to 16 years [2]
Of the 1285 patients meeting the inclusion criteria, four were excluded due to no injury profile classified from the Abbreviated Injury Scale (AIS)
New ISS (NISS) has been shown to outperform the Injury Severity Score (ISS) for mortality in more severely injured adults [44], and this study showed that the NISS outperforms the ISS for mortality in more severely injured children
Summary
Injuries in children make a considerable contribution to disease burden globally, being a leading cause of mortality for children over one year of age and causing varying levels of disability affecting their development into adulthood [1]. a 10-year review of the injury outcomes of children in Australia found that injury was the leading cause of death in children aged 1 to 16 years [2]. Injuries in children make a considerable contribution to disease burden globally, being a leading cause of mortality for children over one year of age and causing varying levels of disability affecting their development into adulthood [1]. A 10-year review of the injury outcomes of children in Australia found that injury was the leading cause of death in children aged 1 to 16 years [2]. The effects of rising globalisation, urbanisation, motorisation and environmental changes all impact on the risks and nature of childhood injuries around the world [3]. Regardless of age or country, traumatic injuries can be debilitating, affect a variety of regions of the body, cause future physical and/or mental impairment, and can be fatal. Res. Public Health 2020, 17, 892; doi:10.3390/ijerph17030892 www.mdpi.com/journal/ijerph
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