Abstract
Objectives
To establish the demographics, injury patterns, management and outcomes of paediatric major trauma patients at Cork University Hospital (CUH).
Methods
This was a retrospective, descriptive study. Data from all CUH paediatric major trauma cases that were recorded in the Trauma Audit and Research Network (TARN) database from January 2014 to July 2018 were examined. All patients were under the age of sixteen and fulfilled NOCA’s Major Trauma Audit inclusion criteria (Appendix).
Results
A total of 163 patients were included, with a mean age of 9 years (standard deviation 4.8 years); 33% (n = 54) had an Injury Severity Score (ISS) > 15. The majority (62%) was male. Paediatric trauma accounts for 6% of TARN eligible cases at CUH. The most common mechanism of injury was falls < 2 m (35%) followed by road trauma (26%). Fifty-one percent were brought by ambulance; 45% self presented. Six percent were transferred out of CUH for definitive care. Limb injuries occurred in 45% of patients (n = 74) and head injury in 29% (n = 47). Head injuries were isolated in 62% (n = 29). Injuries to chest or face were rarely isolated. The mean ISS was 12 (SD 7). The majority of patients (62%) presented out of hours. The median length of stay was 5 days (Interquartile range 3–8 days). Four patients died (mortality rate 2%), all male, two due to head injury and two due to asphyxia by hanging.
Conclusions
Paediatric trauma is of low volume, creating challenges in terms of preparedness. The annual number of paediatric major trauma presentations to CUH, including road trauma cases, remains roughly constant.
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Availability of data and material
All data included was extracted from the Trauma Audit and Research Network (TARN) database (https://www.tarn.ac.uk/) and analysed using Excel for Mac 2011.
Code availability
Not applicable.
Change history
18 November 2021
A Correction to this paper has been published: https://doi.org/10.1007/s11845-021-02856-0
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Acknowledgements
We thank Ms. Karina Caine and Ms. Ann Deasy (Cork University Hospital and Mercy University Hospital TARN data collectors) for their dedicated assistance with data provision and clarification of TARN processes. We thank Mr. James Clover, TARN clinical lead at CUH. We thank the TARN support team and Louise Brent, National IHFD and MTA Coordinator. Finally, we would like to express gratitude to all those involved in the care of major trauma patients at CUH. We hope that the system in Ireland will soon work as efficiently and successfully as those individuals on the frontline.
Author information
Authors and Affiliations
Contributions
Dr. Conor Deasy and Dr. Íomhar O’Sullivan contributed to the study conception and design. Literature search, material preparation, data collection and analysis were performed by Dr. Liadan O’Sullivan. The first draft of the manuscript was written by Dr. Liadan O’Sullivan. This was critically revised by Dr. Conor Deasy and Dr. Íomhar O’Sullivan. All authors read and approved the final manuscript.
Ethics declarations
Ethics approval
Ethical approval was granted by the Clinical Research Ethics Committee of the Cork Teaching Hospitals.
Consent to participate
All patient information was anonymised and extracted from the established European trauma registry TARN. No patient consent was required.
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We the authors give full consent for publication of this paper, should the Journal accept it. I can confirm that this paper has not been published previously, is not under consideration for publication elsewhere and that, if accepted, will not be published elsewhere in the same form, in English or in any other language, without the written consent of the publisher.
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The authors declare no competing interests.
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Highlights
• The majority of children with major trauma who presented to this emergency department were male and presented out of hours.
• Limb injuries, followed by head injuries, were most common. Mechanisms of injury and the injuries sustained differ across paediatric age bands.
• Road trauma was the second most common mechanism of injury, after low falls. More than twice as many boys were injured in road trauma than girls.
• Further urban/rural, mixed/paediatric hospital studies would inform the development of an integrated trauma network for children in Ireland.
The original online version of this article was revised: The corresponding author would like to correct his affiliation from his home address to "Emergency Department, Cork University Hospital, Wilton, Cork, Ireland".
Appendix Inclusion criteria
Appendix Inclusion criteria
(a) Trauma patients.
(b) < 16 years of age who.
(c) Fulfil one of the length of stay criteria and.
(d) Whose isolated injuries meet one of the following criteria:
Body region/specific injury | Included — in isolation (except where specified) | Excluded — in isolation (except where specified) |
|---|---|---|
Head | All brain or skull injuries | LOC or injuries to scalp |
Thorax | All internal injuries | |
Abdomen | All internal injuries | |
Spine | Cord injury, fracture, dislocation or nerve root injury | Spinal strain or sprain |
Face | Fractures documented as: significantly displaced, open, compound or comminuted All LeFort fractures All panfacial fractures All orbital blowout fractures | Fractures documented as closed and simple or stable |
Neck | Any organ or vascular injury or hyoid fracture | Nerve injuries Skin injuries |
Femoral fracture | All shaft, distal, head or subtrochanteric fractures, regardless of age Isolated neck of femur or inter/ greater trochanteric fractures < 65 years old | Isolated neck of femur or inter/greater trochanteric fractures ≥ 65 years |
Foot or hand: joint or bone | Crush or amputation only | Any fractures and/or dislocations, even if open and/or multiple |
Finger or toe | None | All injuries to digits, even if open fractures, amputation or crush and/or multiple injuries |
Limb — below knee (except feet/toes) | Any open injury Any 2 limb fractures and/or dislocations | Any closed unilateral injury fractures (including multiple closed fractures and/or dislocations or the same limb) |
Limb — below knee (except feet/toes) | Any open injury Any 2 limb fractures and/or dislocations | Any closed unilateral injury fractures (including multiple closed fractures and/or dislocations or the same limb) |
Pelvis | All isolated fractures to ischium, sacrum, coccyx, ileum, acetabulum Multiple pubic rami fractures Single pubic rami fracture < 65 years old Any fracture involving SIJ or symphysis pubis | Single pubic rami fracture > 65 years old |
Nerve | Any injury to sciatic, facial, femoral or cranial nerve | All other nerve injuries, single or multiple |
Vessel | All injuries to femoral, neck, facial, cranial, thoracic or abdominal vessels Transection or major disruption of any other vessel | Intimal tear or superficial laceration or perforation to any limb vessel |
Skin | Laceration or penetrating skin injuries with blood loss > 20% (1000 ml) Major degloving injury (> 50% body region) | Simple skin lacerations or penetrating injuries with blood loss < 20% (1000 ml); single or multiple Contusions or abrasions: single or multiple Minor degloving injury (< 50% body region) |
Burn | Any full thickness burn or partial/superficial burn > 10% body surface area | Partial or superficial burn < 10% body surface area |
Inhalation | All | None |
Frostbite | Severe frostbite | Superficial frostbite |
Asphyxia | All | None |
Drowning | All | None |
Explosion | All | None |
Hypothermia | Accompanied by another TARN eligible injury | Hypothermia in isolation |
Electrical | All | None |
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O’Sullivan, L., Deasy, C. & O’Sullivan, Í. Paediatric major trauma: demographics, management and outcomes at Cork University Hospital. Ir J Med Sci 191, 2343–2350 (2022). https://doi.org/10.1007/s11845-021-02848-0
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DOI: https://doi.org/10.1007/s11845-021-02848-0