Epidemiology Of Pediatric Trauma Research Articles

The epidemiology of pediatric trauma in the emergency department of a trauma center: An observational study

The epidemiology of pediatric trauma in the emergency department of a trauma center: An observational study

Epidemiology of Paediatric Trauma During National Lockdown: A Retrospective Study With 12 Months of Follow-Up.

Introduction The COVID-19 pandemic and its associated preventative measures such as national lockdown dramatically changed the daily activities of children. This paper aims to compare the epidemiology of paediatric orthopaedic trauma presentation, management and outcomes during the school closure period with the matched pre-pandemic period in 2019. Methods This was a retrospective cohort study of data collected from the West Yorkshire Trauma Network, comprising a major trauma centre, Leeds General Infirmary, and five peripheral trauma units. All patients aged 0-18 years who required trauma unit management during the school closure period (18 March 2020-25 May 2020) were included. Cases for the matched period in 2019 were analysed for baseline comparison. Patient demographics, mechanism and anatomical location of injury, management and follow-up were assessed. Results In the 2020 and 2019 cohorts, 286 and 575 injuries were observed, respectively. In the 2020 cohort, we observed a 50.3% (n=289) fall in paediatric trauma presentation and a significant proportional reduction in referrals from the emergency department (22% (n=63) versus 53% (n=305); p<0.001).There was also a significant reduction in the average age at presentation by more than one year (p<0.001). Sports-related injuries decreased significantly (n=16 (5.6%) versus n=127 (22.1%); p<0.001). While the proportion of ride-on injuries increased significantly, overall numbers remained similar (n=63 (22%) versus n=61 (10.6%); p<0.0001). Non-accidental injury (NAI) concerns rose significantly (n=9 (3.1%) versus n=4 (0.7%); p=0.01), but the absolute number of confirmed NAI cases stayed the same (n=2). There was a proportional increase in upper limb injuries (64.3% (n=184) versus 58.4% (n=336); p>0.05) and a proportional reduction in lower limb injuries (32.1% (n=92) versus 35.5% (n=204); p>0.05). However, the rate of tibial shaft injuries rose significantly (10.1% (n=29) versus 5.2% (n=30); p=0.02). The use of conservative management increased with a significant delay in average time to surgery from the date of injury (8.5 days versus 3.1 days; p=0.01). Patients who were only followed up with a telephone consultation rose significantly (23% (n= 66) versus 6% (n=35); p<0.001). Re-presentation rate increased significantly (1.4% (n=4) versus 0.2% (n=12); p=0.04). Conclusion Our study showed a reduction in paediatric trauma presentations during the pandemicand a significant reduction in the average age at presentation. This change has been accompanied by a shift in the mechanism and anatomical location of injury, management and subsequent follow-up.

Patterns, mechanism of injury and outcome of pediatric trauma at a level 1 trauma centre: a descriptive retrospective analysis.

There is a gap in knowledge on the epidemiology of pediatric trauma in the developing countries. We aimed to describe the injury pattern, mechanism of injury (MOI), and outcomes of pediatric trauma in a level 1 trauma centre in one of the Arab Middle Eastern countries. A retrospective analysis of pediatric injury data was conducted. All trauma patients (<18 years old) requiring hospitalization between 2012 and 2021 were included. Patients were categorized and compared based on the MOI, age-group and injury severity. A 3,058 pediatric patients (20% of the total trauma admissions) were included in the study. The incidence rate in 2020 was 86 cases per 100,000 pediatric population in Qatar. The majority were male (78%) and the mean age was 9.3 ± 5.7 years. Nearly 40% had head injuries. The in-hospital mortality rate was 3.8%. The median injury severity score (ISS) (interquartile range; IQR) was 9 (4-14) and Glasgow coma scale (GCS) was 15 (IQR 15-15). Almost 18% required Intensive Care admission. Road Traffic Injuries (RTI) were more frequent in 15-18 years old whereas ≤4 years group was mostly injured by falling objects. The case fatality rate was higher among females (5.0%), and in 15-18 years (4.6%) and <4 years (4.4%) group. Pedestrian injuries were more lethal among the MOI. One fifth had severe injury with a mean age of 11 ± 6 and 9.5% had ISS of ≥25. Predictors of severe injury were age (10 years old and above) and RTI. Almost one-fifth of the trauma admissions at the level 1 trauma centre in Qatar is due to traumatic injuries among the pediatric population. Developing strategies that are based on understanding the age- and mechanism-specific patterns of traumatic injuries among the pediatric population remains crucial.

Epidemiology of trauma-related paediatric limb fracture using a unique classification: A 10-year retrospective, single-centre study

IntroductionResearch regarding the epidemiology of paediatric trauma is limited. Using our unique classification, we describe paediatric trauma cases in a 10-year single-centre study to improve paediatric care. Materials and methodsData regarding all paediatric trauma cases were extracted using a computerised medical record system that detected fracture diagnosis and epiphyseal injury. Registry search identified cases from January 2008 to December 2017. Age, sex, type of fracture, and details of injury mechanism were analysed, and we categorised the ‘falls/turnover’ mechanism using a new trauma energy classification based on speed and height. ResultsA total of 1379 cases (953 boys and 426 girls) were included. The highest number of injuries (553 cases, 40%) was seen in school children (aged 6 to 10 years). Forearm fracture occurred most frequently, followed by humeral fracture. The most frequent injury mechanism in falls/turnover (969 cases, 70%) was sports in 272 cases (28%), playground equipment in 179 cases (18%), furniture in 102 cases (11%), and bicycling in 87 cases (9%). We classified 956 cases of falls/turnover using our trauma energy classification scheme. Most cases (29%) were classified into the L2 category (low height and high speed), followed by the L1 category (low height and low speed) (p < 0.01). Subcategory analysis using the classification revealed that younger children were more likely to be injured by falling from high places because of their physique, whereas older children were more likely to be injured by a turnover from lower places and at higher speed. ConclusionWe describe the epidemiology of fractures in detail and present a new classification system, which may aid in understanding the injury mechanism independent of children's height. The fact that paediatric fractures occur at relatively low energy levels and are trended by age, activity, and sex, could be of potential universal use for their prevention and parent education.

Epidemiology of pediatric trauma during the coronavirus disease-2019 pandemic

Background/purposeWe aimed to describe the epidemiology of trauma activations and variations in injury patterns, injury severity, and hospital length-of-stay for injured children in Los Angeles (LA) County during the coronavirus-disease-19 (COVID-19) pandemic. MethodsWe conducted a retrospective cross-sectional study of children aged < 18-years evaluated in 15 trauma centers from 2019 to 2020 and entered in the LA County trauma registry. We defined 01/01/2019–03/18/2020 as pre-pandemic and 03/19/2020–12/31/2020 as the pandemic period. Our primary outcome was pediatric trauma activations. We analyzed demographic and clinical data, including types and severity of injuries sustained. We conducted unadjusted bivariate analyzes of injury patterns between periods. Segmented linear regression models were used to test rates (per 100,000 LA County children) of trauma activations pre-pandemic versus the pandemic period. ResultsWe studied 4399 children with trauma activations, 2695 of which occurred pre-pandemic and 1701 in the pandemic period. Motor vehicle collisions, gunshot wounds, and burns increased during the pandemic (all p-values< 0.05), while sports injuries decreased (p < 0.001). Median injury severity scores (p = 0.323) and Glasgow Coma Scales (p = 0.558) did not differ between periods, however mortality (p = 0.023) decreased during the pandemic. Segmented linear regression estimates demonstrated that rates of trauma activations pre-pandemic were similar to the pandemic period (p = 0.384). ConclusionPediatric trauma activations in LA County did not significantly differ during the COVID-19 pandemic, but types and severity of injuries varied between pre-pandemic and pandemic periods. With lockdown restrictions being lifted and novel SARS-CoV-2 variants circulating, our investigation describes this recent epidemiologic phenomenon to aid future preparation for healthcare systems. Level of evidenceLevel III Type of studyRetrospective cross-sectional study

An Analysis of Injury Patterns of Blunt Abdominal Trauma in Pediatric Population

Background: Blunt abdominal trauma is a common cause for presentation of children to the Emergency Department. Because of their peculiar body habitus and relatively immature musculoskeletal system children are more prone to sustain injuries to intra-abdominal organs after blunt abdominal trauma. This retrospective study is done to determine the epidemiological parameters of blunt trauma abdomen in pediatric population. Methods: The present retrospective study was carried out in 89 blunt abdominal trauma patients of both sexes aged up to 15 years, over a period of 3 years. The parameters such as age group, sex, mode of trauma, type of injury, and the overall morbidity as well as mortality were assessed. Results: Total 89 blunt abdominal trauma patients were enrolled in the study. The majority of the patients were aged between 6-12 years (48.31%)] with male predominant (66.29%). The mean age of presentation was 6.8 years. Conclusions: The present study gives an idea about the epidemiology of pediatric trauma. Liver and Spleen was the most commonly injured organ. Road traffic accidents and fall from height were the most common mechanisms of injuries. The majority of pediatric injuries are preventable and pediatric epidemiological trends differ from those in adults.

Epidemiology of pediatric trauma during the COVID-19 pandemic shelter in place

IntroductionThe first COVID-19 cases occurred in the US in January of 2020, leading to the implementation of shelter in place. This study seeks to define the impact of shelter in place on the epidemiology of pediatric trauma. MethodsWe examined pediatric trauma admissions at 5 Level 1 and 1 Level 2 US pediatric trauma centers between January 1 and June 30, 2017–2020. Demographic and injury data were compared between pre– and post–shelter in place patient cohorts. ResultsA total of 8772 pediatric trauma activations were reviewed. There was a 13% decrease in trauma volume in 2020, with a nadir at 16 days following implementation of shelter in place. Injury severity scores were higher in the post–shelter in place cohort. The incidence of nonmotorized vehicle accidents and gunshot wounds increased in the post–shelter in place cohort. ConclusionWe found an overall decrease in pediatric trauma volume following shelter in place. However, injuries tended to be more severe. Our findings help inform targeted injury prevention campaigns during future pandemics.

An epidemiological study on pediatric trauma in tertiary care hospitals

Aims and Objectives 1. To assess the frequency of inpatient care in cases of pediatric trauma. 2. To assess the sex distribution of pediatric trauma. 3. To assess the mechanisms of injury most often leading to significant pediatric trauma 4. To assess the mechanisms of injury most likely to cause trauma in each pediatric age group 5. To assess the frequency of emergency operative interventions in cases of pediatric trauma. Materials and Methods: A retrospective study was performed at MGM Medical College and Hospital, Kamothe, using data gathered over the previous five years (January 2014- December 2018) regarding the age group, sex, and mode of injury. Results 1. Of 6810 pediatric admissions in the five year period, 1310 patients were admitted after suffering some form of trauma (19.2%). 2. The ratio of male to female patients was 2:1. 3. A fall from height was the most common mode of injury(43%), followed by accidental trauma from sharp/blunt objects(32%), Road Traffic accidents(11%), and 14% were from miscellaneous causes such as burns, animal bites etc. 4. Pediatric trauma was found to be most prevalent in the school going age group (6-16 years), with 54% of patients reporting in that age group. Conclusion: We conclude that most injuries in the pediatric age group are preventable, and the epidemiology of injury in the pediatric age group differs from that of adults. Therefore, preventive strategies should be designed around the epidemiology of pediatric trauma.

Profile of Pediatric Trauma among the Patients Attending Emergency Department in a Tertiary Care Hospital in South India.

Background:Pediatric trauma is emerging as an epidemic worldwide; the epidemiology of pediatric trauma is different in different parts of the world. There are very few studies describing the pediatric trauma in developing countries.Objectives:The objectives of this study were to assess the type, mechanism, and extent of trauma among pediatric trauma patients and its association with clinical outcome.Methodology:This was a prospective observational study conducted in the department of emergency medicine and trauma at a tertiary care hospital in South India from September 2015 to March 2017. All children aged <12 years with a history of injuries irrespective of the cause for attending our trauma center were included in the study.Observations and Results:Of the 911 children enrolled, 63.9% sustained injuries at home. The leading modes of injury were fall at level ground (26.9%), road traffic accidents (RTAs) (25.5%), and fall from height (16.8%). Majority of RTA victims were two-wheeler pillion riders (40.5%) and pedestrians (31.9%). Nearly 49% of children had head and maxillofacial injuries. Polytrauma was found in 3.6% of children. Based on the Pediatric Trauma Score (PTS), 72.6% of children had mild trauma and 6.1% severe trauma. Totally, 18.9% of children required inpatient management, 7.5% surgical intervention, and 1.8% expired.Conclusions:Most of injuries in children occurred at home. This was followed by injuries on road. The leading cause of polytrauma was RTA. RTA victims were more likely to have severe injuries and poor outcome. They were more likely to require inpatient management compared to those who fell from height or fell at level ground. Glasgow Coma Scale and PTS may be used reliably to assess the severity of injuries sustained by children.

Epidemiology of paediatric trauma in Norway: a single-trauma centre observational study

BackgroundTrauma is a major cause of mortality and morbidity in children globally. The burden of injury shows substantial geographical differences, with a significant mortality reduction in children in Norway during the last four decades. The aim was to describe the current epidemiology, resource use and outcome for all potential severely injured paediatric patients admitted to a Norwegian trauma centre.MethodsThis was a single-centre retrospective observational study. All patients aged 0–17 years received by a trauma team between 01 January 2004 and 31 December 2016 (13 years) at St. Olav’s University Hospital were included. Severe injury was defined as Injury Severity Score > 15.ResultsA total of 873 patients were included, of which 536 (61%) were male. The median age was 13 years (IQR 7–16). Six per cent (n = 52) of the patients were transferred from other hospitals. Blunt trauma constituted 98%, with traffic (n = 532/61%) and falls (n = 233/27%) as the most common mechanisms. Eight patients (1%) died within 30 days of hospital admission. Fifteen per cent (n = 128) were severely injured. Among the patients transferred from another hospital, 46% (n = 24) had severe injuries. Helicopter Emergency Medical Services (HEMS) were more used in younger age groups and in patients more severely injured.ConclusionsIn a developed healthcare system, the number of potentially severely injured children is small and with very few deaths following trauma. Transport and falls represent the most common causes of injury throughout all age groups, though with a tendency towards more transport-related injuries with increasing age. In-hospital trauma care is characterized by a low threshold for a multidisciplinary reception, low use of intensive care and need for emergency surgical procedures, though with increased need in the older children.

Epidemiology of pediatric trauma at a tertiary hospital in Riyadh, Saudi Arabia

Objective: To evaluate the pattern of pediatric traumas at a tertiary hospital in Riyadh, Saudi Arabia, based on gender, age groups, mechanisms of injury, and anatomical regions. Methods: This retrospective observational study used the trauma registry of King Abdulaziz Medical City Trauma Center to review the data of all pediatric patients aged <14 years who were admitted to the hospital following trauma from January 2009 to April 2014. Demographic characteristics, date and time of admission, injury type and mechanism, body area involved, and the mortality rates were analyzed. Results: A total of 1762 patients were included, 68% of who were males. The most common mechanism of injury was blunt trauma (73%), followed by burns (17%) and penetrating injuries (10%). Road traffic injuries were the most common cause (50%) of blunt trauma, followed by fall (40%) and those caused by a physical object (10%). During the study, 305 patients with burns were treated with scalds accounting for the highest proportion (68%) of burn injuries. Sharp objects (79%) were the most frequent cause of penetrating injuries. A total of 50 mortality cases were recorded, which most commonly occurred among the school-aged group (40%) and male patients (78%). The leading cause of deaths among patients was blunt injury (92%). Conclusion: This study has shown the patterns of pediatric trauma injuries in a tertiary hospital in Riyadh, Saudi Arabia, illustrating the local variability across genders, age groups, injury types, and injury mechanisms. Such demographic data will be valuable for optimally resourcing health-care system locally.

Epidemiology of Pediatric Trauma at a Tertiary Hospital in Riyadh, Saudi Arabia

Epidemiology of Pediatric Trauma at a Tertiary Hospital in Riyadh, Saudi Arabia

Epidemiology of Pediatric Trauma and its Pattern in Urban India: A Tertiary Care Hospital-Based Experience.

Aim:To assess the epidemiology, pattern, and outcome of trauma in pediatric population.Materials and Methods:A total of 1148 pediatric patients below 15 years of age presenting in the emergency department of our hospital were studied over a period of 3 years. The patients were categorized into four age groups of <1 year, 1–5 years, 6–10 years, and 11–15 years. The data were compared regarding mode of trauma, type of injury, place of injury among different age groups and both sexes.Results:The majority of the pediatric trauma cases were seen in males 69.86%, (n = 802) and females comprised only 30.13% (n = 346). Road traffic accident (RTA) was the most common mode of trauma in male children, i.e. 59.47% (n = 477) followed by fall injuries, i.e. 29.42% (n = 236). In females, fall was the most common mode of trauma, i.e. 52.31% (n = 181) followed by RTA (36.70%, n = 127). Fall injuries occurred mostly at homes. Among RTA, hit by vehicle on road while playing was most common followed by passenger accidents on two wheelers, followed by hit by vehicle while walking to school. Among fall, fall while playing at home was the most common. Out of total 1148 patients, 304 (26.48%) comprised the polytrauma cases (involvement of more than two organ systems), followed by abdominal/pelvic trauma (20.99%, n = 241), followed by head/face trauma (19.86%, n = 228). Out of total 1148 patients admitted over a period of 36 months, 64 died (5.57%). 75 (6.5%) patients had some kind of residual deformity or disability.Conclusion:The high incidence of pediatric trauma on roads and falls indicate the need for more supervision during playing and identification of specific risk factors for these injuries in our setting. This study shows that these epidemiological parameters could be a useful tool to identify burden and research priorities for specific type of injuries. A comprehensive trauma registry in our set up seems to be important for formulating policies to reduce pediatric trauma burden.

Epidemiology of Pediatric Trauma and Its Patterns in Western Iran: A Hospital Based Experience.

Background and Objective:Trauma is a major cause of mortality in children aged 1 to 14 years old and its patterns differs from country to country. In this study we investigated the epidemiology and distribution of non-intentional trauma in the pediatric population.Materials and Methods:The archives of 304 children below 10 years old who presented to Taleghani trauma care center in Kermanshah, Iran from March to September 2008, were reviewed. Patients’ demographic and injury related information were registered. The participants were categorized into three age groups of 0-2, 3-6 and 7-10 years old and the data was compared among age groups and between both sexes.Findings:The most common cause for trauma was falling from heights (65.5%) and road traffic accidents (16.4%). The most common anatomical sites of injury were the upper limbs followed by the head and neck (36.8% and 31.2%, respectively). Injuries mostly occurred in homes (67.4%). The injuries were mostly related to the orthopedics and the neurosurgery division (84.1% and 13.1%, respectively). Accident rates peaked during the hours of 18-24 (41.3%). Male and female patients did display any difference regarding the variables. Children between the ages of 0-2 years old had the highest rate of injury to the head and neck area (40.3%) (p=0.024). Falls and road traffic accidents displayed increasing rates from the ages of 0-2 to 3-6 and decreasing rates to the ages of 7-10 years old (p=0.013). From the ages of 0-2 to 3-6 years old, street accidents increased and household traumas decreased. After that age household trauma rates increased and street accidents decreased (p=0.005). Children between the ages of 7-10 years old had the highest rate of orthopedic injury (p=0.029).Conclusion:Special planning and health policies are needed to prevent road accidents especially in children between the ages of 3-6 years old. Since homes were the place where children between the ages of 0-2 were mostly injured, parents should be educated about the correct safety measures that they need to take regarding their children’s environments. The orthopedics department needs to receive the most training and resources for the management of pediatric trauma.

Epidemiological trends of pediatric trauma: A single-center study of 791 patients.

Aim:To assess the various epidemiological parameters that influence the causation of trauma as well as the consequent morbidity and mortality in the pediatric age group.Materials and Methods:A prospective study of 791 patients of less than 12 years age, was carried out over a period of 1 year (August 2009 to July 2010), and pediatric trauma trends, with regards to the following parameters were assessed: Age group, sex, mode of trauma, type of injury, place where the trauma occurred and the overall mortality as well as mortality.Results:Overall trauma was most common in the school-going age group (6-12 years), with male children outnumbering females in the ratio of 1.9:1. It was observed that orthopedic injuries were the most frequent (37.8%) type of injuries, whereas fall from height (39.4%), road traffic accident (27.8%) and burns (15.2%) were the next most common modes of trauma. Home was found out to be the place where maximum trauma occurred (51.8%). Maximum injuries happened unintentionally (98.4%). Overall mortality was found out to be 6.4% (n = 51).Conclusions:By knowing the epidemiology of pediatric trauma, we conclude that majority of pediatric injuries are preventable and pediatric epidemiological trends differ from those in adults. Therefore, preventive strategies should be made in pediatric patients on the basis of these epidemiological trends.

Chest Trauma in Children: A Local Experience

Chest trauma in childhood is relatively uncommon in clinical practice, and has been the subject of few reports in the literature. This study was undertaken to examine our experience in dealing with chest trauma in children. This was a retrospective study of 74 children who sustained chest trauma, and were referred to King Fahad Hospital in Medina over a two-year period. The age, cause of injury, severity of injury, associated extrathoracic injuries, treatment and outcome were analyzed. The median age of the patients was nine years. Fifty-nine of them (80%) sustained blunt trauma, and 15 (20%) were victims of penetrating injuries. Road traffic accident was the cause of chest trauma in 62% of the children, gun shot wounds were seen in five, and stab wounds in 10 children. Head injury was the most common injury associated with thoracic trauma, and was seen in 14 patients (19%), and associated intraabdominal injuries were seen in nine patients. Chest x-ray of the blunt trauma patients revealed fractured ribs in 24 children, pneumothorax in six, hemothorax in four, hemopneumothorax in three, and pulmonary contusions in 22 patients. Fifty-one percent of children were managed conservatively, 37% required tube thoracostomy, 8% were mechanically ventilated, and 4% underwent thoracotomy. The prevalence of chest trauma in children due to road traffic accidents is high in Saudi Arabia. Head injury is thought to be the most common associated extrathoracic injuries, however, most of these patients can be managed conservatively.

Epidemiology of pediatric trauma: Importance of population-based statistics

To determine the validity of using hospital-based pediatric trauma registry data to draw specific inferences with regard to regional pediatric trauma system design, we compared statistical data on the incidence and mortality of pediatric and adult injuries and burns calculated by the New York State Department of Health, based on legally mandated reports of injury deaths and hospital discharges for 1989. During this year, some 488 children, aged 0 to 14 years, died as a result of injuries, a rate of 13.8 per 100,000 annually, of whom 408 ( 11.6 100,000 ) died as a result of traumatic injuries or burns, a population-based rate 20% of that observed in adults. During the same period, 16,402 children were hospitalized for treatment of traumatic injuries and burns, a rate of 465 per 100,000 annually, a population-based rate 56% of that observed in adults; and of this number, some 90 children died, yielding an in-hospital mortality “rate” (ie, case fatality ratio) of 0.55%, and a population-based rate of 2.6 per 100,000 annually. Thus, 9.0 of the 11.6 per 100,000 children who died in New York State in 1989 as a result of traumatic injuries and burns were not admitted to the hospital and, therefore, were unknown to the statewide hospital reporting system. Detailed analysis of data by specific cause of injury was limited by the fact that hospitals in New York State did not begin reporting data on etiology (ICD-9 E-codes) as well as anatomic nature (ICD-9 N-codes) of serious injury until 1990; however, although it appears that no single injury subtype is responsible for the large number of not-in-hospital deaths statewide, homicide predominates in the metropolitan area, and motor vehicle-related injuries in others. Our results indicate that: (1) although death is a less common outcome of major trauma among children than adults, the need for in-hospital treatment of serious injuries approaches that of adults; and (2) in missing large numbers of not-in-hospital deaths (78% of the total in New York State in 1989), hospital-based data (on which most pediatric trauma registries throughout this nation are based) substantially underestimate the extent and severity of childhood traumatic injuries and burns as public health problems. We conclude that although pediatric trauma registry data are invaluable in judging treatment outcome, they should be used in guiding regional pediatric trauma system design only when considered together with population-based mortality and morbidity data derived from state or local vital statistics. Thus, collaboration with regional governmental health agencies is essential to ensure both proper data collection, and that the needs of the public for pediatric injury prevention education and pediatric trauma and burn care are optimally met.