PAEDIATRIC TRAUMA: URBAN EPIDEMIOLOGY AND AN ANALYSIS OF METHODS FOR ASSESSING THE SEVERITY OF TRAUMA IN 598 INJURED CHILDREN

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Abstract
This study is based on a 12 month prospective analysis of 598 paediatric trauma admissions, drawn principally from an urban environment. The spectrum of trauma is described, highlighting the minor nature of most injuries and the rarity of penetrating trauma. A subgroup of seriously injured children was identified and further analysed. All deaths were examined. The predictive value of the Trauma Score (TS) and Method of Injury (MOI) were assessed in terms of eventual injury severity using the Injury Severity Score (ISS), and morbid outcome. Most of the patients were not seriously injured, and sustained single system injury only. The injuries were related principally to falls (62%). Seventy-nine children (13%) were identified as seriously injured (ISS .gtoreq. 16). In this group pedestrian injuries were the major cause of injury (29%). Amongst seriously injured children, cranial injury was identified in 91%, followed by abdominal injury in 33%. There were nine deaths in the series, representing 1.5% of all paediatric trauma admissions, and 11% of seriously injured patients. All deaths were associated with a significant head injury. Although the TS had a specificity of 99% in predicting serious injury and a positive predictive value of 94%, its sensitivity was only 26%. The MOI was associated with an overtriage rate of 200%. Of children admitted following pedal cycle accidents, 86% of the total and 91% of seriously injured children were not wearing a helmet. Of passengers in a motor car, 37% of the total number were unrestrained. The results suggest triage in children requires more than a physiological measure (TS) or MOI. A detailed history, especially of abdominal injury, should be included in triage protocols. It remains to be proven whether trauma scoring and mechanism of injury triage methods will prove superior to as careful history and detailed examination performed by experienced personnel. Detailed documentation of injured children using trauma sheets and stratification of the severity of the injury remains important as a teaching guide, for the valid comparison between trauma centres and for assessing treatment interventions.

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