Functional status of pediatric patients with trauma and risk factors for mortality from a single center in China

Frontiers in Pediatrics

Pediatrics

Shan-Yan Gao¹  Wei Xu²  Tie-Ning Zhang²  Li-Jie Wang²  Chun-Feng Liu²  Yu-Hang Yang²  Ni Yang² 

[1] Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China;Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China;

关键词: wounds and injuries;    mortality;    functional status;    injury severity score;    motor disorders;   

DOI  :  10.3389/fped.2023.1051759

 received in 2022-09-23, accepted in 2023-04-17,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionThe influence of reduced functional status has become increasingly relevant because of the gradual decline in mortality rate over the recent years. Nonetheless, only a few studies investigating the functional status of patients with trauma at hospital discharge have been conducted. This study aimed to identify the risk factors influencing the mortality rate in pediatric trauma survivors at a pediatric intensive care unit and analyze their functional status using the Functional Status Scale (FSS).MethodsA retrospective analysis was conducted at Shengjing Hospital of China Medical University. Children admitted to the pediatric intensive care unit between January 2015 and January 2020 who met the trauma diagnostic criteria were included. The FSS score and the Injury Severity Score (ISS) were recorded upon admission and discharge, respectively. Clinical data were compared between the survival and non-survival groups to identify the risk factors for poor prognosis. The risk factors for mortality were identified using multivariate and univariate analyses.ResultsA total of 246 children {59.8%, male; median [interquartile range (IQR)] age: 3 [1–7] years} were diagnosed with trauma (including head trauma, chest trauma, abdominal trauma, and extremity trauma). Of these patients, 207 were discharged, 11 dropped out mid-treatment, and 39 died (hospital mortality rate, 15.9%). Upon admission, the median FSS and trauma scores were 14 (IQR, 11–18) and 22 (IQR, 14–33) points, respectively. At discharge, the FSS score was 8 (IQR, 6–10) points. The patient clinical status improved with a ΔFSS score of −4 (IQR, −7, 0) points. At hospital discharge, 119 (48.3%), 47 (19.1%), 27 (11.0%), 12 (4.8%), and 2 (0.9%) survivors had good, mildly abnormal, moderately abnormal, severely abnormal, and very severely abnormal function, respectively. Reduced functional status in patients was categorized as follows: motor, 46.4%; feeding, 26.1%; sensory, 23.2%; mental, 18.4%; and communication, 17.9%. In the univariate analysis, ISS >25 points, shock, respiratory failure, and coma were independently associated with the mortality rate. Multivariate analysis revealed that the ISS was an independent risk factor for mortality.ConclusionThe mortality rate of patients with trauma was high. ISS was an independent risk factor for mortality. Mildly reduced functional status remained at discharge and was reported in nearly half of the discharged patients. Motor and feeding functions were the most severely impacted domains.

【 授权许可】

Unknown   
© 2023 Yang, Zhang, Yang, Xu, Wang, Gao and Liu.