Timing of mortality in pediatric trauma patients: A National Trauma Data Bank analysis.

Abstract

BACKGROUND/PURPOSE:

The classic "trimodal" distribution of death has been described in adult patients, but the timing of mortality in injured children is not well understood. The purpose of this study was to define the temporal distribution of mortality in pediatric trauma patients.

METHODS:

A retrospective cohort of patients with mortality from the National Trauma Data Bank (2007-2014) was analyzed. Categorical comparison of 'dead on arrival', 'death in the emergency department', and early (≤24h) or late (>24h) inpatient death was performed. Secondary analyses included mortality by pediatric age, predictors of early mortality, and late complication rates.

RESULTS:

Children (N=5463 deaths) had earlier temporal distribution of death compared to adults (n=104,225 deaths), with 51% of children dead on arrival or in ED compared to 44% of adults (p<0.001). For patients surviving ED resuscitation, children and adolescents had a shorter median time to death than adults (1.2 d and 0.8 days versus 1.6 days, p<0.001). Older age, penetrating mechanism, bradycardia, hypotension, tube thoracostomy, and thoracotomy were associated with early mortality in children.

CONCLUSIONS:

Injured children have higher incidence of early mortality compared to adults. This suggests that injury prevention efforts and strategies for improving early resuscitation have potential to improve mortality after pediatric injury.

LEVEL OF EVIDENCE:

Level III: Retrospective cohort study.

• Authors: Cory McLaughlin, Jessica A Zagory, Michael Fenlon, Caron Park, Christianne J Lane, Daniella Meeker, Randall S Burd, Henri R Ford, Jeffrey S Upperman, Aaron R Jensen
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 53 Issue 2 Pg. 344-351 (Feb 2018) ISSN: 1531-5037 [Electronic] United States
• PMID: 29111081 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Age Factors
• Child
• Child, Preschool
• Databases, Factual
• Emergency Service, Hospital
• Female
• Humans
• Incidence
• Infant
• Infant, Newborn
• Male
• Middle Aged
• Resuscitation
• Retrospective Studies
• Risk Factors
• Time Factors
• Trauma Centers
• United States (epidemiology)
• Wounds and Injuries (etiology, mortality, therapy)
• Young Adult