Analysis of Clinical Outcome and Predictors of Mortality in Pediatric Trauma Population: Evidence from a 10 Year Analysis in a Single Center
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Inclusion Criteria
2.2. Shock Index and Pediatric Age-Adjusted Shock Index
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Age | Heart Rate | Systolic Blood Pressure | Shock Index Cutoff Value |
---|---|---|---|
≤3 years | 70–110 | 90–110 | 1.2 |
4–6 years | 65–110 | 90–110 | 1.2 |
7–12 years | 60–100 | 100–120 | 1.0 |
>12 years | 55–90 | 100–135 | 0.9 |
Characteristics | All Pediatric Population |
---|---|
N = 1265 | |
Age (years), mean ± SD | 14.27 ± 5.51 |
Male, n (%) | 912(72.1%) |
Underlying diseases, n (%) | 70(5.5%) |
Vital sign | |
SBP, mean ± SD | 126.73 ± 23.48 |
DBP, mean ± SD | 75.33 ± 13.67 |
RR, mean ± SD | 19.17 ± 2.58 |
HR, mean ± SD | 93.56 ± 19.57 |
Triage | |
I | 96(7.6%) |
II | 698(55.2%) |
III | 467(36.9%) |
IV + V | 4(0.3%) |
Consciousness level | |
15 | 1152(91.1%) |
8–15 | 88(7.0%) |
≤8 | 24(1.9%) |
Injury site | |
Home | 160(12.6%) |
Street | 760(60.1%) |
Public site | 268(21.2%) |
Others | 77(6.1%) |
Mechanism | |
Motor Vehicle Collision | 672(53.1%) |
Fall | 387(30.6%) |
Crushing injury | 76(6.0%) |
Sharp object | 55(4.3%) |
Others | 75(5.9%) |
Injured area | |
Head and neck | 251(18.8%) |
Face | 199(15.7%) |
Thorax | 82(6.5%) |
Abdomen | 91(7.2%) |
Extremity | 920(72.7%) |
Activation of trauma team | 58(4.6%) |
Trauma scores | |
Shock index | 0.77 ± 0.24 |
Shock index ≥ 0.9 | 305(24.1%) |
SIPA | 0.86 ± 0.34 |
Elevated SIPA | 171(13.5%) |
ISS, (mean; SD) | 6.51 ± 5.80 |
ISS ≥ 16, (%) | 78(6.2%) |
RTS, (mean; SD) | 7.70 ± 0.63 |
NISS, (mean; SD) | 7.36 ± 6.89 |
TRISS, (mean; SD) | 0.98 ± 0.10 |
Clinical outcome | |
LOS days, (median; IQR) | 5.0 (3.0–9.0) |
ICU Admission, (%) | 177(14.0%) |
ICU Readmission, (%) | 2(0.2%) |
ICU days, (median; IQR) | 4.0 (2.0–6.0) |
Need for surgery (%) | 867(68.5%) |
Reoperation (%) | 49(3.9%) |
Death, (%) | 7(0.6%) |
Characteristics | SI < 0.9 | SI ≥ 0.9 | p-Value | Normal SIPA | Elevated SIPA | p-Value |
---|---|---|---|---|---|---|
N = 960 | N = 305 | N = 1094 | N = 171 | |||
Age (years), mean ± SD | 15.91 ± 4.04 | 9.09 ± 6.27 | <0.001 | 14.63 ± 5.22 | 11.97 ± 6.69 | <0.001 |
Male, n (%) | 727(75.73%) | 185(60.66%) | <0.001 | 808(73.86%) | 104(60.82%) | <0.001 |
Underlying diseases, n (%) | 58(6.04%) | 12(3.93%) | 0.161 | 63(5.76%) | 7(4.09%) | 0.376 |
Vital sign | ||||||
SBP, mean ± SD | 133.69 ± 20.63 | 104.83 ± 17.78 | <0.001 | 130.67 ± 21.64 | 101.53 ± 18.74 | <0.001 |
DBP, mean ± SD | 78.07 ± 12.24 | 66.70 ± 14.33 | <0.001 | 77.01 ± 12.87 | 64.54 ± 13.69 | <0.001 |
RR, mean ± SD | 18.78 ± 2.0 | 20.39 ± 3.61 | <0.001 | 19.01 ± 2.23 | 20.17 ± 4.06 | <0.001 |
HR, mean ± SD | 87.19 ± 14.53 | 113.62 ± 19.85 | <0.001 | 90.05 ± 16.83 | 116.06 ± 20.90 | <0.001 |
Injury site | ||||||
Home | 72(7.50%) | 88(28.85%) | <0.001 | 125(11.43%) | 35(20.47%) | <0.001 |
Street | 631(65.73%) | 129(42.30%) | <0.001 | 666(60.88%) | 94(54.97%) | 0.143 |
Public site | 86(8.96%) | 29(9.51%) | 0.771 | 104(9.51%) | 11(6.43%) | 0.194 |
Others | 165(17.19%) | 56(18.36%) | 0.638 | 191(17.46%) | 30(17.54%) | 0.978 |
ISS, (mean; SD) | 6.33 ± 5.28 | 7.10 ± 7.20 | 0.084 | 6.22 ± 5.08 | 8.39 ± 8.98 | 0.002 |
ISS ≥ 16, (%) | 46(4.79%) | 32(10.49%) | <0.001 | 52(4.75%) | 26(15.20%) | <0.001 |
RTS, (mean; SD) | 7.75 ± 0.52 | 7.53 ± 0.87 | <0.001 | 7.74 ± 0.55 | 7.42 ± 0.94 | <0.001 |
NISS, (mean; SD) | 7.17 ± 6.32 | 7.97 ± 8.42 | 0.126 | 7.04 ± 6.08 | 9.40 ± 10.49 | 0.005 |
TRISS, (mean; SD) | 0.98 ± 0.09 | 0.97 ± 0.13 | 0.091 | 0.98 ± 0.09 | 0.97 ± 0.12 | 0.152 |
LOS days, (median; IQR) | 5.0 (3.0–9.0) | 3.0 (2.0–7.0) | <0.001 | 5.0(3.0–9.0) | 4.0(2.0–10.0) | 0.204 |
ICU admission, (%) | 137(14.27%) | 40(13.11%) | 0.612 | 162(14.81%) | 15(8.77%) | 0.034 |
ICU readmission, (%) | 2(0.21%) | 0(0.00%) | 1.000 | 2(0.18%) | 0(0.00%) | 1.000 |
ICU days, (median; IQR) | 4.0 (3.0–6.0) | 3.5 (2.0–6.0) | 0.556 | 4.0(2.0–6.0) | 3.0(2.0–5.0) | 0.411 |
Need for surgery (%) | 664(69.17%) | 203(66.56%) | 0.363 | 753(68.83%) | 114(66.67%) | 0.571 |
Reoperation (%) | 35(3.65%) | 14(4.59%) | 0.457 | 44(4.02%) | 5(2.92%) | 0.489 |
Death, (%) | 4(0.42%) | 3(0.98%) | 0.369 | 4(0.37%) | 3(1.75%) | 0.056 |
Characteristics | Crude OR of Mortality | Crude OR of ICU Admission | Crude OR of Need for Surgery | ||||||
---|---|---|---|---|---|---|---|---|---|
OR | 95% CI | p-Value | OR | 95% CI | p-Value | OR | 95% CI | p-Value | |
Age | 1.245 | 0.943–1.644 | 0.121 | 1.000 | 0.971–1.029 | 0.987 | 1.022 | 1.001–1.044 | 0.040 |
Male | 0.967 | 0.187–5.008 | 0.968 | 1.082 | 0.756–1.550 | 0.666 | 0.928 | 0.711–1.211 | 0.584 |
Underlying diseases, n (%) | 13.332 | 2.925–60.777 | <0.001 | 1.156 | 0.595–2.246 | 0.669 | 0.765 | 0.464–1.261 | 0.294 |
Vital sign | |||||||||
SBP | 0.985 | 0.953–1.018 | 0.355 | 0.999 | 0.992–1.006 | 0.716 | 1.003 | 0.998–1.009 | 0.190 |
DBP | 0.937 | 0.885–0.991 | 0.023 | 0.992 | 0.980–1.003 | 0.153 | 1.002 | 0.993–1.010 | 0.732 |
RR | 0.850 | 0.617–1.170 | 0.319 | 1.026 | 0.968–1.088 | 0.384 | 1.023 | 0.976–1.073 | 0.338 |
HR | 1.006 | 0.971–1.043 | 0.726 | 0.998 | 0.989–1.006 | 0.565 | 1.003 | 0.997–1.009 | 0.309 |
Shock index | 7.991 | 1.033–61.838 | 0.047 | 0.853 | 0.434–1.674 | 0.644 | 0.945 | 0.577–1.545 | 0.820 |
Shock index > 0.9 | 2.375 | 0.529–10.668 | 0.259 | 0.907 | 0.621–1.324 | 0.612 | 0.887 | 0.674–1.167 | 0.393 |
Elevated SIPA | 4.867 | 1.080–21.937 | 0.039 | 0.553 | 0.317–0.964 | 0.038 | 0.906 | 0.643–1.276 | 0.571 |
ISS | 1.135 | 1.084–1.189 | <0.001 | 0.996 | 0.968–1.025 | 0.785 | 0.987 | 0.967–1.006 | 0.180 |
ISS ≥ 16 | 98.833 | 11.741–831.938 | <0.001 | 0.791 | 0.388–1.615 | 0.520 | 0.719 | 0.448–1.153 | 0.171 |
RTS | 0.521 | 0.395–0.689 | <0.001 | 1.028 | 0.788–1.341 | 0.840 | 1.173 | 0.980–1.405 | 0.083 |
NISS | 1.107 | 1.069–1.145 | <0.001 | 1.002 | 0.979–1.024 | 0.896 | 0.993 | 0.977–1.010 | 0.425 |
TRISS | 0.016 | 0.002–0.106 | <0.001 | 3.741 | 0.303–46.183 | 0.304 | 1.173 | 0.360–3.823 | 0.791 |
Activation of trauma team | 56.839 | 10.778–299.750 | <0.001 | 1.136 | 0.548–2.355 | 0.732 | 0.548 | 0.322–0.933 | 0.027 |
LOS days | 1.004 | 0.972–1.037 | 0.803 | 1.035 | 1.021–1.049 | <0.001 | 0.995 | 0.986–1.004 | 0.272 |
Characteristics | Age ≤ 8 year | 8 ≤ Age < 12 year | 12 ≤ Age < 16 year | 16 ≤ Age < 20 year | p-Value |
---|---|---|---|---|---|
N = 236 | N = 165 | N = 237 | N = 627 | ||
Age (years), mean ± SD | 4.69 ± 2.38 | 10.65 ± 1.11 | 14.74 ± 1.16 | 18.65 ± 1.03 | |
Male, n (%) | 150(36.4%) | 113(31.5%) | 183(22.9%) | 466(25.7%) | 0.003 |
Underlying diseases, n (%) | 9(3.8%) | 10(6.1%) | 13(5.5%) | 38(6.1%) | 0.624 |
Vital sign | |||||
SBP, mean ± SD | 108.82 ± 19.87 | 120.5 ± 18.30 | 131.50 ± 21.56 | 133.29 ± 22.80 | <0.001 |
DBP, mean ± SD | 69.36 ± 15.90 | 74.52 ± 11.33 | 75.59 ± 12.35 | 77.69 ± 13.11 | <0.001 |
RR, mean ± SD | 20.78 ± 3.83 | 18.99 ± 2.05 | 18.73 ± 1.85 | 18.76 ± 2.08 | <0.001 |
HR, mean ± SD | 109.40 ± 21.23 | 93.45 ± 15.53 | 88.93 ± 16.31 | 89.38 ± 17.91 | <0.001 |
Injury site | |||||
Home | 92(39.0%) | 28(17.0%) | 16(6.8%) | 24(3.8%) | <0.001 |
Street | 64(27.1%) | 51(30.9%) | 129(54.7%) | 516(82.3%) | <0.001 |
Public site | 26(11.0%) | 25(15.2%) | 41(17.4%) | 23(3.7%) | <0.001 |
Others | 51(21.6%) | 61(37.0%) | 50(20.8%) | 59(9.4%) | <0.001 |
ISS, (mean; SD) | 5.34 ± 3.40 | 4.90 ± 2.89 | 6.70 ± 6.71 | 7.31 ± 6.54 | <0.001 |
ISS ≥ 16, (%) | 12(5.1%) | 5(3.0%) | 16(6.8%) | 45(7.2%) | 0.210 |
RTS, (mean; SD) | 7.59 ± 0.83 | 7.80 ± 0.20 | 7.70 ± 0.55 | 7.70 ± 0.64 | <0.001 |
NISS, (mean; SD) | 5.88 ± 3.98 | 5.67 ± 3.39 | 7.72 ± 8.05 | 8.24 ± 7.75 | <0.001 |
TRISS, (mean; SD) | 0.97 ± 0.15 | 1.00 ± 0.00 | 0.98 ± 0.10 | 0.98 ± 0.09 | <0.001 |
Shock index | 1.04 ± 0.27 | 0.79 ± 0.17 | 0.69 ± 0.17 | 0.69 ± 0.19 | <0.001 |
Shock index > 0.9 | 167(70.8%) | 44(26.7%) | 29(12.3%) | 65(10.4%) | <0.001 |
Elevated SIPA | 53(22.5%) | 24(14.5%) | 29(12.3%) | 65(10.4%) | <0.001 |
LOS days, (median; IQR) | 3(2–5) | 3(2–5) | 5(3–8) | 6(4–11) | <0.001 |
ICU admission, (%) | 33(14.0%) | 20(12.1%) | 36(15.3%) | 88(14.0%) | 0.858 |
ICU readmission, (%) | 0(0.0%) | 0(0.0%) | 0(0.0%) | 2(0.3%) | 0.564 |
ICU days, (median; IQR) | 4(2–6) | 4(3–5.75) | 4(3–7) | 3(2–6) | 0.303 |
Need for surgery (%) | 148(62.7%) | 114(69.1%) | 165(69.9%) | 440(70.2%) | 0.200 |
Reoperation (%) | 13(5.5%) | 6(3.6%) | 10(4.2%) | 20(3.2%) | 0.461 |
Death, (%) | 0(0.0%) | 0(0.0%) | 3(1.3%) | 4(0.6%) | 0.212 |
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Yang, Y.-C.; Hsieh, T.-H.; Liu, C.-Y.; Chang, C.-Y.; Hou, Y.-T.; Lin, P.-C.; Chen, Y.-L.; Chien, D.-S.; Yiang, G.-T.; Wu, M.-Y. Analysis of Clinical Outcome and Predictors of Mortality in Pediatric Trauma Population: Evidence from a 10 Year Analysis in a Single Center. Children 2021, 8, 688. https://doi.org/10.3390/children8080688
Yang Y-C, Hsieh T-H, Liu C-Y, Chang C-Y, Hou Y-T, Lin P-C, Chen Y-L, Chien D-S, Yiang G-T, Wu M-Y. Analysis of Clinical Outcome and Predictors of Mortality in Pediatric Trauma Population: Evidence from a 10 Year Analysis in a Single Center. Children. 2021; 8(8):688. https://doi.org/10.3390/children8080688
Chicago/Turabian StyleYang, Ya-Chih, Tsung-Han Hsieh, Chi-Yuan Liu, Chun-Yu Chang, Yueh-Tseng Hou, Po-Chen Lin, Yu-Long Chen, Da-Sen Chien, Giou-Teng Yiang, and Meng-Yu Wu. 2021. "Analysis of Clinical Outcome and Predictors of Mortality in Pediatric Trauma Population: Evidence from a 10 Year Analysis in a Single Center" Children 8, no. 8: 688. https://doi.org/10.3390/children8080688