Pattern and outcome of severe childhood unintentional injuries from pediatric intensive care unit

Abstract

Introduction: Childhood unintentional injuries (CUI) carry high morbidity and mortality. Little is known about epidemiology of CUI in PICU, their course and outcome. We report experience of CUI at our center.Methods: Retrospective review of medical records of children (1 mo- 16 years) admitted in PICU between Jan 2009- Dec 2014 with admitting diagnosis of unintentional injury was done. Data collected included age, gender, category and mechanism of injury, type of trauma, body region affected, place of injury, presentation, initial baseline laboratory workup, intervention done in the ER and PICU, length of stay and outcome. Results are presented as frequency/ percentages and mean ±SD.Results: A total 103 patients were admitted with the diagnosis of severe injury, 67% (69/103) were males and mean age was 90±55 months. Trauma was the major category (88%, 91/103) with road traffic accidents (RTA) comprising 37% (38/91) and fall 29% (30/91). 8 patients had poisoning, 91% (83/91) blunt trauma and 70% (64/91) had single body region involvement, isolated head being involved in 55% (50/94). 78% (81/103) of the injuries were witnessed. Coma was the main presentation in 36% (37/103) children, shock in 25% (26/103), respiratory problem in 22% (23/103), and, 67% were intubated in ER, CPR was done in 2 patient, 83.5% (86/103) patients needed mechanical ventilation, 77% (80/103) needed inotropic support and surgical intervention was done 64% of patients. PICU length of stay was 6±3 days and case fatality rate was 21% (22/103) compared to overall mortality rate of 12% during the same period.Conclusion: Severe injuries consume a lot of PICU resources and are associated with high mortality.