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Pediatric Trauma: Enabling Factors, Social Situations, and Outcome
Author(s) -
Hartzog Timothy H.,
Timerding Beverly L.,
Alson Roy L
Publication year - 1996
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.1996.tb03423.x
Subject(s) - medicine , neglect , injury prevention , medical record , injury severity score , poison control , occupational safety and health , retrospective cohort study , trauma center , emergency medicine , human factors and ergonomics , pediatric trauma , suicide prevention , abbreviated injury scale , medical emergency , intensive care unit , pediatrics , psychiatry , surgery , pathology
Objectives: 1) To determine, for severely injured pediatric patients, which enabling factors and social situations are associated with the most severe and costly injuries; 2) to determine which subsets of patients are affected by particular enabling factors; and 3) to determine which enabling factors are associated with death. Methods: Retrospective chart review of patients included in a pediatric trauma registry at a level I trauma center, plus review of medical examiner reports for deaths declared at the scene for one year. Abstracted data included age, gender, enabling factors (e. g., abuse/assault, neglect, endangerment, and nonuse of safety measures), mechanisms of injury, Injury Severity Scale (ISS) score, length of stay, need for intensive care unit (ICU) care, and expense. Results: Records were reviewed for 336 identified children. There was a 2: 1 male‐to‐female ratio; 9. 5% died, 3. 5% at the scene. Active endangerment or neglect was associated with death (p = 0. 0004). However, the nonuse of safety devices was more common and resulted in a higher absolute number of deaths. Similarly, while inadvertent gunshot wounds, intentional injury, and environmental mishaps were more commonly lethal, motor vehicle crashes (MVCs) were more common and claimed the most lives. Cost was highest for the patients aged 14–16 years, in part reflecting the larger number of MVCs. Conclusion: The severity of pediatric trauma is largely influenced by the mechanism of injury. Our data highlight the importance of enabling factors for such injuries overall and as a function of age group (reflecting developmental status). While injury prevention education for caregivers is necessary, the incorporation of passive safety measures also is vital for decreasing injuries and their severity.