Mortality in severely injured children: experiences of a German level 1 trauma center (2002 – 2011)

BMC Pediatrics

Sven Lendemans¹  Bjoern Hussmann¹  Manuel Burggraf¹  Judith Keitel¹  Marc Schilling¹  Carsten Schoeneberg¹ 

[1] Department of Trauma Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, Essen, Germany

关键词: Mortality;    Pediatric;    Errors;    Severely injured;    Trauma;   

Others  :  1138532
DOI  :  10.1186/1471-2431-14-194

 received in 2014-03-14, accepted in 2014-07-22,  发布年份 2014

【 摘 要 】

Background

Trauma in pediatric patients is a major cause of death. This study investigated differences between decedents and survivors. Furthermore, an analysis of preventable and potential preventable trauma deaths was conducted and errors in the acute trauma care were investigated.

Methods

All patients aged less than 16 years with an Injury Severity Score (ISS) ≥ 16 upon primary admission to the hospital between July 2002 and December 2011 were included in this study. Decedents were compared with survivors and an analysis of deceased children for preventable and potential preventable deaths was conducted. The acute trauma care was investigated regarding errors in treatment.

Results

Significant differences were found in Glasgow Coma Scale, Injury Severity Score, Revised Trauma Score, New ISS, Revised Injury Severity Classification, and Trauma and Injury Severity Score. Decedents had a worse head trauma with associated coagulopathy. The overall mortality rate was 13.4%. The majority of death occurred soon after arrival. No long term intensive care unit stay was found.

No preventable but one potential preventable death was analyzed. Most errors occurred in fluid volume management and in a delay of starting the therapy for hemorrhage and coagulopathy.

Prolonged preclinical rescue time and surgery time within the first 24 hours was found.

Conclusions

Head trauma is the determinant factor for mortality in severely injured pediatric patients. Death occurred shortly after arrival and long term intensive care stays might be an exception. In treatment of severely injured children volume management, hemorrhage and coagulopathy management, rescue time, and total surgery time should receive more attention.

【 授权许可】

   
2014 Schoeneberg et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Statter M, Schuble T, Harris-Rosado M, Liu D, Quinlan K: Targeting pediatric pedestrian injury prevention efforts: teasing the information through spatial analysis. J Trauma 2011, 71:S511-S516.
• [2]Potoka DA, Schall LC, Gardner MJ, Stafford PW, Peitzman AB, Ford HR: Impact of pediatric trauma centers on mortality in a statewide system. J Trauma 2000, 49:237-245.
• [3]Potoka DA, Schall LC, Ford HR: Improved functional outcome for severely injured children treated at pediatric trauma centers. J Trauma 2001, 51:824-832. discussion 832–4
• [4]Hussmann B, Lefering R, Kauther MD, Ruchholtz S, Moldzio P, Lendemans S: Influence of prehospital volume replacement on outcome in polytraumatized children. Crit Care 2012, 16:R201.
• [5]Gruen RL, Jurkovich GJ, McIntyre LK, Foy HM, Maier RV: Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. Ann Surg 2006, 244:371-380.
• [6]Pfeifer R, Pape H: Missed injuries in trauma patients: a literature review. Patient Saf Surg 2008, 2:20.
• [7]Settervall CH, Domingues Cde A, Sousa RM, Nogueira Lde S: Preventable trauma deaths. Rev Saude Publica 2012, 46:367-375.
• [8]Teixeira PG, Inaba K, Hadjizacharia P, Brown C, Salim A, Rhee P, Browder T, Noguchi TT, Demetriades D: Preventable or potentially preventable mortality at a mature trauma center. J Trauma 2007, 63:1338-1346. discussion 1346–7
• [9]Do HQ, Steinmetz J, Rasmussen LS: In-hospital mortality pattern of severely injured children. Injury 2012, 43:2060-2064.
• [10]Dykes EH, Spence LJ, Young JG, Bohn DJ, Filler RM, Wesson DE: Preventable pediatric trauma deaths in a metropolitan region. J Pediatr Surg 1989, 24:107-110. discussion 110–1
• [11]Diamond IR, Parkin PC, Wales PW, Bohn D, Kreller MA, Dykes EH, McLellan BA, Wesson DE: Preventable pediatric trauma deaths in Ontario: a comparative population-based study. J Trauma 2009, 66:1189-1194. discussion 1194–5
• [12]Esposito TJ, Sanddal ND, Dean JM, Hansen JD, Reynolds SA, Battan K: Analysis of preventable pediatric trauma deaths and inappropriate trauma care in Montana. J Trauma 1999, 47:243-251. discussion 251–3
• [13]German Society of Trauma Surgery: Whitebook medical care of the severely injured. 2nd revised and updated edition. Orthopaedics and traumatology Communications and News 2012 (Supplement 1) http://www.dgu-online.de/qualitaet-sicherheit/schwerverletzte/weissbuch-schwerverletztenversorgung.html webcite
• [14]Reason JT: Human Error. Cambridge [England], New York: Cambridge University Press; 1990.
• [15]German Society of Trauma Surgery: Treatment of Patients with Severe and Multiple Injuries. http://www.awmf.org/leitlinien/detail/ll/012-019.html webcite]; accessed 22.07.2014
• [16]Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Filipescu D, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Vincent J, Rossaint R: Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care 2013, 17:R76.
• [17]Schoeneberg C, Schilling M, Keitel J, Kauther MD, Burggraf M, Hussmann B, Lendemans S: TraumaNetwork, trauma registry of the DGU (R), whitebook, S3 guideline on treatment of polytrauma/severe injuries - an approach for validation by a retrospective analysis of 2304 patients (2002–2011) of a level 1 trauma centre. Zentralbl Chir 2014. epub ahead of print
• [18]MacKenzie EJ: Review of evidence regarding trauma system effectiveness resulting from panel studies. J Trauma 1999, 47:S34-S41.
• [19]Shackford SR, Hollingsworth-Fridlund P, McArdle M, Eastman AB: Assuring quality in a trauma system–the Medical Audit Committee: composition, cost, and results. J Trauma 1987, 27:866-875.
• [20]World Health Organization: Guidelines for Trauma Quality Improvement Programmes. http://www.who.int/violence_injury_prevention/services/traumacare/traumaguidelines/en/index.html webcite]; accessed 22.07.2014
• [21]Courville XF, Koval KJ, Carney BT, Spratt KF: Early prediction of posttraumatic in-hospital mortality in pediatric patients. J Pediatr Orthop 2009, 29:439-444.
• [22]Diamond IR, Parkin PC, Wales PW, Bohn D, Kreller MA, Dykes EH, McLellan BA, Wesson DE: Pediatric blunt and penetrating trauma deaths in Ontario: a population-based study. J Pediatr Surg 2009, 44:981-986.
• [23]Kipfmueller F, Wyen H, Borgman MA, Spinella PC, Wirth S, Maegele M: Epidemiology, risk stratification and outcome of severe pediatric trauma. Klin Padiatr 2013, 225:34-40.
• [24]Narotam PK, Burjonrappa SC, Raynor SC, Rao M, Taylon C: Cerebral oxygenation in major pediatric trauma: its relevance to trauma severity and outcome. J Pediatr Surg 2006, 41:505-513.
• [25]Chiaretti A, Pezzotti P, Mestrovic J, Piastra M, Polidori G, Storti S, Velardi F, Di Rocco C: The influence of hemocoagulative disorders on the outcome of children with head injury. Pediatr Neurosurg 2001, 34:131-137.
• [26]Affonseca CA, Carvalho , Luis Fernando A, Guerra SD, Ferreira AR, Goulart , Eugenio MA: Coagulation disorder in children and adolescents with moderate to severe traumatic brain injury. J Pediatr (Rio J) 2007, 83:274-282.
• [27]Pathak A, Dutta S, Marwaha N, Singh D, Varma N, Mathuriya SN: Change in tissue thromboplastin content of brain following trauma. Neurol India 2005, 53:178-182.
• [28]Joseph B, Aziz H, Zangbar B, Kulvatunyou N, Pandit V, O'Keeffe T, Tang A, Wynne J, Friese RS, Rhee P: Acquired coagulopathy of traumatic brain injury defined by routine laboratory tests: which laboratory values matter? J Trauma Acute Care Surg 2014, 76:121-125.
• [29]Carrick MM, Tyroch AH, Youens CA, Handley T: Subsequent development of thrombocytopenia and coagulopathy in moderate and severe head injury: support for serial laboratory examination. J Trauma 2005, 58:725-729. discussion 729–30
• [30]Jung J, Eo E, Ahn K, Noh H, Cheon Y: Initial base deficit as predictors for mortality and transfusion requirement in the severe pediatric trauma except brain injury. Pediatr Emerg Care 2009, 25:579-581.
• [31]Hindy-Francois C, Meyer P, Blanot S, Marque S, Sabourdin N, Carli P, Orliaguet G: Admission base deficit as a long-term prognostic factor in severe pediatric trauma patients. J Trauma 2009, 67:1272-1277.
• [32]Cooke WH, Salinas J, Convertino VA, Ludwig DA, Hinds D, Duke JH, Moore FA, Holcomb JB: Heart rate variability and its association with mortality in prehospital trauma patients. J Trauma 2006, 60:363-370. discussion 370
• [33]Walia S, Sutcliffe AJ: The relationship between blood glucose, mean arterial pressure and outcome after severe head injury: an observational study. Injury 2002, 33:339-344.
• [34]Baker CC, Oppenheimer L, Stephens B, Lewis FR, Trunkey DD: Epidemiology of trauma deaths. Am J Surg 1980, 140:144-150.
• [35]Pape H, Grimme K, van Griensven M, Sott AH, Giannoudis P, Morley J, Roise O, Ellingsen E, Hildebrand F, Wiese B, Krettek C: Impact of intramedullary instrumentation versus damage control for femoral fractures on immunoinflammatory parameters: prospective randomized analysis by the EPOFF Study Group. J Trauma 2003, 55:7-13.
• [36]Schoeneberg C, Schilling M, Burggraf M, Fochtmann U, Lendemans S: Reduction in mortality in severely injured patients following the introduction of the “Treatment of patients with severe and multiple injuries” guideline of the German society of trauma surgery–a retrospective analysis of a level 1 trauma center (2010–2012). Injury 2014, 45:635-638.