Mechanism of injury predicts case fatality and functional outcomes in pediatric trauma patients: the case for its use in trauma outcomes studies.
Document Type
Article
Publication Date
8-1-2011
Identifier
DOI: 10.1016/j.jpedsurg.2011.04.055
Abstract
BACKGROUND/PURPOSE: The mechanism of injury (MOI) may serve as a useful adjunct to injury scoring systems in pediatric trauma outcomes research. The objective is to determine the independent effect of MOI on case fatality and functional outcomes in pediatric trauma patients.
METHODS: Retrospective review of pediatric patients ages 2 to 18 years in the National Trauma Data Bank from 2002 through 2006 was done. Mechanism of injury was classified by the International Classification of Diseases, Ninth Revision, E codes. The main outcome measures were mortality, discharge disposition (home vs rehabilitation setting), and functional impairment at hospital discharge. Multiple logistic regression was used to adjust for injury severity (using the Injury Severity Score and the presence of shock upon admission in the emergency department), age, sex, and severe head or extremity injury.
RESULTS: Thirty-five thousand ninety-seven pediatric patients in the National Trauma Data Bank met inclusion criteria. Each MOI had differences in the adjusted odds of death or functional disabilities as compared with the reference group (fall). The MOI with the greatest risk of death was gunshot wounds (odds ratio [OR], 3.52; 95% confidence interval [CI], 2.23-5.54 95). Pediatric pedestrians struck by a motor vehicle have the highest risk of locomotion (OR, 3.30; 95% CI, 2.89-3.77) and expression (OR, 1.65; 95% CI, 1.22-2.23) disabilities.
CONCLUSION: Mechanism of injury is a significant predictor of clinical and functional outcomes at discharge for equivalently injured patients. These findings have implications for injury prevention, staging, and prognosis of traumatic injury and posttreatment planning.
Journal Title
Journal of pediatric surgery
Volume
46
Issue
8
First Page
1557
Last Page
1563
MeSH Keywords
Accidental Falls; Accidents; Traffic; Adolescent; Child; Child; Preschool; Databases; Factual; Female; Humans; Injury Severity Score; Logistic Models; Male; Odds Ratio; Patient Discharge; Prognosis; Retrospective Studies; United States; Wounds and Injuries; Wounds; Gunshot
Keywords
Injuries; Guns; Motor Vehicles; Falls; Mortality; Disability; Child; Teen; National Trauma Data Bank; NTDB; Mechanism of Injury
Recommended Citation
Haider, A. H., Crompton, J. G., Oyetunji, T. A., Risucci, D., DiRusso, S., Basdag, H., Villegas, C. V., Syed, Z. U., Haut, E. R., Efron, D. T. Mechanism of injury predicts case fatality and functional outcomes in pediatric trauma patients: the case for its use in trauma outcomes studies. Journal of pediatric surgery 46, 1557-1563 (2011).
Comments
Grant support