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

Schoeneberg C, Schilling M, Keitel J, Burggraf M, Hussmann B, Lendemans S - BMC Pediatr (2014)

Bottom Line: Decedents had a worse head trauma with associated coagulopathy.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.

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Affiliation: Department of Trauma Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, Essen, Germany. carsten.schoeneberg@uk-essen.de.

ABSTRACT

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.

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Related in: MedlinePlus

Time between admission and death; Mean value 14.58 h; standard deviation: 18.4; N = 11.
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Figure 1: Time between admission and death; Mean value 14.58 h; standard deviation: 18.4; N = 11.

Mentions: Although no death was classified as preventable, an error analysis was performed. Five children received a fluid volume of more than 1500 ml. In one child, intubation was not possible at the scene until 20 minutes after responders arrived. In three children, no coagulation medication was substituted, so one child had insufficient coagulation for 10 hours. In one patient, the first surgical treatment lasted 175 minutes and in another a second surgical intervention was necessary in the first 24 hours, because of increased cerebral swelling after initial decompressive craniotomy. In one child, no concentrated red cells were available in the trauma room, although signs for bleeding existed and so the first transfusion was performed two-and-a-half hours after arrival. In one patient, the intubation had to be redone in the trauma room because of bleeding. In three children, the time from accident to hospital was longer than 60 minutes.Only three of the patients who died survived the first day after admission. Figure 1 show the time of death and the average time of survival after admission.


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

Schoeneberg C, Schilling M, Keitel J, Burggraf M, Hussmann B, Lendemans S - BMC Pediatr (2014)

Time between admission and death; Mean value 14.58 h; standard deviation: 18.4; N = 11.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4121010&req=5

Figure 1: Time between admission and death; Mean value 14.58 h; standard deviation: 18.4; N = 11.
Mentions: Although no death was classified as preventable, an error analysis was performed. Five children received a fluid volume of more than 1500 ml. In one child, intubation was not possible at the scene until 20 minutes after responders arrived. In three children, no coagulation medication was substituted, so one child had insufficient coagulation for 10 hours. In one patient, the first surgical treatment lasted 175 minutes and in another a second surgical intervention was necessary in the first 24 hours, because of increased cerebral swelling after initial decompressive craniotomy. In one child, no concentrated red cells were available in the trauma room, although signs for bleeding existed and so the first transfusion was performed two-and-a-half hours after arrival. In one patient, the intubation had to be redone in the trauma room because of bleeding. In three children, the time from accident to hospital was longer than 60 minutes.Only three of the patients who died survived the first day after admission. Figure 1 show the time of death and the average time of survival after admission.

Bottom Line: Decedents had a worse head trauma with associated coagulopathy.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Trauma Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, Essen, Germany. carsten.schoeneberg@uk-essen.de.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus