| Affiliation: | 1. Division of Pediatric Surgery, Children''s Hospital Los Angeles, Los Angeles, CA 90027;2. Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033;3. Southern California Clinical and Translational Science Institute (SC-CTSI), Los Angeles, CA 90033;4. Department of Preventative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033;5. Division of Trauma and Burn Surgery, Children''s National Medical Center, Washington, DC 20310 |
| Abstract: | Background/purposeThe classic “trimodal” distribution of death has been described in adult patients, but the timing of mortality in injured children is not well understood. The purpose of this study was to define the temporal distribution of mortality in pediatric trauma patients.MethodsA retrospective cohort of patients with mortality from the National Trauma Data Bank (2007–2014) was analyzed. Categorical comparison of ‘dead on arrival’, ‘death in the emergency department’, and early (≤ 24 h) or late (> 24 h) inpatient death was performed. Secondary analyses included mortality by pediatric age, predictors of early mortality, and late complication rates.ResultsChildren (N = 5463 deaths) had earlier temporal distribution of death compared to adults (n = 104,225 deaths), with 51% of children dead on arrival or in ED compared to 44% of adults (p < 0.001). For patients surviving ED resuscitation, children and adolescents had a shorter median time to death than adults (1.2 d and 0.8 days versus 1.6 days, p < 0.001). Older age, penetrating mechanism, bradycardia, hypotension, tube thoracostomy, and thoracotomy were associated with early mortality in children.ConclusionsInjured children have higher incidence of early mortality compared to adults. This suggests that injury prevention efforts and strategies for improving early resuscitation have potential to improve mortality after pediatric injury.Level of evidenceLevel III: Retrospective cohort study. |
