Profile of Pediatric Trauma among the Patients Attending Emergency Department in a Tertiary Care Hospital in South India

A Retrospective Study to Compare the Glasgow Coma Score, Pediatric Trauma Score, and Injury Severity Score and Outcomes in 118 Pediatric Trauma Patients at a Single Emergency Center in Turkey

BACKGROUND The main causes of accidental trauma in children include road traffic accidents (RTAs) and falling from height (FFH). Rapid and accurate assessment of severity of injury is required to guide effective management. This retrospective study aimed to compare the Glasgow Coma Score (GCS), Pediatric Trauma Score (PTS), and Injury Severity Score (ISS) and outcomes for 118 pediatric trauma patients at a single Emergency Department (ED) in Turkey. MATERIAL AND METHODS Patients admitted to Ankara City Hospital due to high-energy trauma between November 1, 2019 and April 30, 2020 were analyzed retrospectively. Data for 118 patients with trauma by major mechanisms, aged 0-17, were collected. Demographic characteristics, trauma-related characteristics, outcomes, and GCS, PTS, and ISS values were compared. It was examined whether there was a relationship between trauma severity and prognosis. In this context, trauma severity was defined by these scores. RESULTS Of the 118 admitted patients, 66 (55.9%) were discharged from the ED, 33 (28%) were transferred to the intensive care unit (ICU), and 19 (16.1%) were admitted to non-ICU departments in the hospital. With hospitalization, patients with thoracic trauma (P<0.001; OR 11.1; 95% CI 3.0-40) and patients with abdominal trauma (P=0.003; OR 4.0; 95% CI 1.5-10.8) were discharged significantly less frequently than patients with other types of trauma. Patients with low ISS (P<0.001) and high PTS (P<0.001) were discharged more often. The relationship between diagnosis and hospitalization was significant (P<0.001). CONCLUSIONS RTA and FFH are the leading trauma mechanisms in children. Boys experience more trauma. ISS and PTS provide accurate predictions of severe and poor prognosis in pediatric trauma cases.

Pediatric Trauma - A Silent Epidemic

Trauma is the leading cause of preventable deaths in children all over the world. In the majority of cases, children are innocent victims of road traffic accidents. They suffer from both short-term and long-term impacts of trauma. Deaths from road traffic accidents can be prevented by adopting simple road safety measures and the use of protective equipment. Worldwide programs have been initiated to curb this ever-rising menace; however, the success of these programs depends on their outreach and acceptance among the population in general. Golden hours in trauma management is the initial hour post-trauma, the success of resuscitation depends on the appropriate management of pediatric trauma victims in hospitals dedicated to the management of pediatric trauma victims. The current review highlights the epidemiology, pattern of injury, road safety measures, and global health initiatives for the prevention of accident-related injury in children. The shortcomings of this review are as follows- Firstly pediatric trauma is an exhaustive topic, it is impossible to cover all aspects of pediatric trauma. Thus, the review might have missed some important aspects of pediatric trauma. Secondly, the concept of a pediatric trauma registry is nonexistent in almost all developing countries; hence a true picture of pediatric trauma epidemiology and injury patterns is missing. Thirdly not much work has been done on pediatric trauma in developing countries leading to insufficient data from these countries.

Epidemiology of Pediatric Musculoskeletal Trauma Patients Admitted to a Trauma Center in Northern India: A Prospective Cohort Study

Background Pediatric injuries are the leading cause of death and disability worldwide and place a considerable burden on nations with limited resources. A careful investigation of the epidemiology of pediatric musculoskeletal trauma can provide insight into its causation and the demography of the affected children and help us devise preventive strategies to reduce the burden of pediatric musculoskeletal trauma. Methodology Musculoskeletal trauma patients up to the age of 18 years were included in this prospective cohort study. Information about age, sex, time since the injury to presentation to a trauma center, mode of injury, the site where the injury was suffered, and the exact injury were recorded. Age was further recorded as 0 to 3 years, >3 to 6 years, >6 to 12 years, and >12 to 18 years. A subgroup analysis of the mode of injury was done using age group and sex.  Results A total of 201 patients were enrolled in the study. The age (mean ± standard deviation [SD]) of the enrolled patients was 12.48 ± 4.71 years. Of the 201 patients enrolled, 146 (72.63%) were males. The mean time since the injury to the reception in the emergency department of the King George's Medical University trauma center (a tertiary care center) was 19.13 ± 33.86 hours. The common mechanisms of injury observed were road traffic accidents (RTAs, 55.22%), falls from height (29.35%), and falls at ground level. There was a significant difference in the mode of injury in the age groups (P = 0.0297) and among males and females (P = 0.0034). Injuries to the lower limbs were most common in all age groups. Conclusions Our study presents the baseline epidemiological data on pediatric musculoskeletal injuries distributed by age groups, gender, mode of injury, site of injury, and region-wise distribution of injuries. The data may be used by policymakers in planning a pediatric trauma care system in India.

THE RELATIONSHIP BETWEEN FRACTURES IN PEDIATRIC POLYTRAUMA PATIENTS: EVALUATION OF CLINICAL OUTCOMES

Objective

To evaluate children and adolescents with polytrauma and fractures of the pelvis and proximal and diaphyseal femur and correlate the impact of these conditions and clinical outcomes.

Methods

Retrospective study carried out in a public hospital in Taboão da Serra (SP), with pediatric patients with polytrauma from January 2012 to December 2021. In total, 44 patients were evaluated, 70.44% boys and 29.55% girls, aged from 12 to 17 years.

Results

Diaphyseal fracture of the femur affected 70.44% of the patients, mainly caused by a fall from a height (56.81%). Linear external fixation was the most used treatment (45.45%). All patients were discharged from hospital.

Conclusion

We found essential sociodemographic information: 84.11% of patients did not have associated injuries; 88.63% were hospitalized from 3 to 11 days; 90.91% did not need to be admitted to an ICU, 77.27% did not need reoperation, and 22.73% underwent another surgery; 45.45% used the external fixator to stabilize injuries; 11.36% converted the external fixator to the intramedullary nail; 9.09% needed an intramedullary nail remover; 2.27% converted to a plate (bilateral) and 2.27% to a rigid nail; 2.27% had loss of reduction and revision with rod; 2.27% underwent corrective osteotomy; 2.27% had clinical hospitalization; 2.27% had osteonecrosis of the femoral head and screws removed; 2.27% removed the plate. No deaths were recorded. Level of Evidence II, Retrospective Study.

Effect of the COVID-19 Outbreak on Pediatric Patients' Admissions to the Emergency Department in an Italian Orthopedic Trauma Hub

Background: The rapid diffusion of Coronavirus disease (COVID-19) in Northern Italy led the Italian government to dictate a national lockdown from 12 March 2020 to 5 May 2020. The aim of this observational cohort study is to analyze the differences in the number of pediatric patients’ admission to the Emergency Room (ER) and in the type and causes of injury. Methods: The pediatric population during the pandemic was compared to a similar group of patients admitted to the ER in 2019. Sex, age, triage color-code at admission, cause of trauma and presence of symptoms related to COVID-19 infection, discharge diagnosis and discharge modes were investigated. Results: The lockdown period led to a reduction of 87.0% in ER admissions with a particular decrease in patients older than 12 years old. Moreover, a trend towards more severe codes and an increase in home-related injuries were observed during the pandemic, whereas the diagnosis of fracture was less frequent in the pre-pandemic group (p < 0.0001). Conclusions: A significant decrease in the ER attendances was reported during the lockdown. A shift in the cause and type of injury was observed; only the most serious traumas sought medical care with a higher percentage of severe triage codes and fractures.