Predictors of the outcome of severe polytrauma in children: a retrospective cohort multicenter study

Abstract

Introduction. Severe polytrauma is the most common cause of deaths in children, but there are currently no objective criteria for predicting the outcome of severe polytrauma in pediatric ICU patients and identifying a high-risk group. Objectives of the study is to identify the features of clinical and laboratory status and intensive care measures in children with severe polytrauma, which determine the outcome of a critical condition. Materials and methods. Design: A retrospective cohort multicenter uncontrolled study. 230 children were examined. The age of patients was 9.5 (4–14) years. The score on the Abbreviated Injury Score (AIS) was 34 points, the Pediatric Traumatic Score (PTS) — 5 (2–8) points. As a primary outcome, the duration of control mechanical ventilation and ICU length of stay were evaluated. Secondary outcome was divided into recovery, presence of neurological deficiency and death. Results. Minimum duration of treatment in ICU is noted with short-term sedation during the day, an AIS score of less than 30 points and a PTS score of more than 5 points. The presence of intracranial hematoma (ICH) is associated with a doubling of treatment duration in ICU. The maximum statistically significant difference in mean values was revealed when assessing the effect on the outcome of the following features: catecholamine index (F = 109.4; p = 0.000); transfusion volume of freshly frozen plasma (F = 42.0; p = 0.000) and transfusion volume of erythrocytes (F = 33.4; p = 0.000). Conclusions. The need for prolonged sedation, an AIS score of more than thirty points, a PTS score of more than five points, and the presence of ICH is associated with an increase ICU length of stay and adverse outcome. The use of high doses of catecholamines and massive blood transfusion on the first day of treatment in ICU are independent predictors of the death of polytrauma in children.