Traumatic injuries are a major cause of morbidity and mortality in children. The purpose of the present study was to determine the incidence of nonaccidental trauma (NAT) and to compare the outcomes of accidental trauma (AT) patients with NAT patients at a large pediatric trauma center.
A retrospective chart review of 6186 trauma patients younger than 18 years evaluated during the period of 1996 to 2004.
During the period of study, NAT accounted for 7.3% (n = 453) of trauma evaluations (n = 6186). Compared to AT, the NAT patient was younger, 12 vs 76 months (P < .05); were more severely injured, injury severity score 18 vs 9 (P < .05); and required both longer intensive care unit stay, 2 vs 1 day (P < .05), and overall hospital stay, 6 vs 3 days (P < .05). Craniotomy was required in 4.4% of NAT patients compared with 2.7 % of AT patients (P < .05). Abdominal exploration was necessary in 3.5% of NAT patients compared to 1.6% of AT patients. The mortality rate for NAT was 9.7% compared to 2.2% for AT (P < .05).
The surgeon caring for children must appreciate the high incidence of NAT with its increased morbidity and mortality relative to AT patients. A surgical evaluation should be performed promptly in NAT patients because of their frequent need for emergent intervention.
"These data are extremely alarming when considering the growing violence in our society and the social and economic repercussions that this may cause. The same pattern of intent was described in a study conducted in Recife, in the state of Pernambuco, and in another U.S. study conducted in Denver
[6,27]. Other studies in Canada, Nepal, South Africa and China show accidents as the leading cause of death in children and adolescents
[Show abstract][Hide abstract] ABSTRACT: Injury is the first cause of death worldwide in the population aged 1 to 44. In developed countries, the most common trauma-related injuries resulting in death during childhood are traffic accidents, followed by drowning.
This retrospective study based on autopsy examinations describes the epidemiology profile of deaths by trauma-related causes in individuals younger than 18 years from 2001 to 2008 in the city of Campinas. The aim is to identify epidemiology changes throughout the years in order to develop strategies of prevention.
There were 2,170 deaths from all causes in children < 18 years old, 530 of which were due to trauma-related causes, with a male predominance of 3.4:1. The age distribution revealed that 76% of deaths occurred in the 10-17 age group. The most predominant trauma cause was firearm injury (47%). Other frequent causes were transport-related injuries (138 cases-26%; pedestrians were struck in 57.2% of these cases) and drowning (55 cases-10.4%). Asphyxia/suffocation was the cause of death in 72% of cases in children < 1 year old; drowning (30.8%) was predominant in the 1-4 age group; transport-related deaths were frequent in the 5-9 age group (56%) and the 10-14 age group (40.4%). Gun-related deaths were predominant (68%) in the 14-17 age group. 51% of deaths occurred at the scene.
There was a predominance of deaths in children and adolescents males, between 15-17 years old, mainly from gun-related homicides, and the frequency has decreased since 2004 after the disarmament statute and the combating of violence.
World Journal of Emergency Surgery 12/2013; 8(1):52. DOI:10.1186/1749-7922-8-52 · 1.47 Impact Factor
"In children b 24 months of age, it has been suggested that more than 50% of traumatic brain injuries requiring hospitalization are secondary to AHT . These children tend to be younger, have distinctive patterns of injury, worse functional outcomes, and higher mortality compared with patients suffering from non-AHT     . The reason for the differences in mortality and functional outcome in children with AHT compared to non-AHT remains elusive and cannot be explained solely by differences in injury severity score (ISS), intracranial pressure (ICP), or Glasgow Coma Scale (GCS)  . "
[Show abstract][Hide abstract] ABSTRACT: Children suffering from abusive head trauma (AHT) have worse outcomes compared to non-AHT, but the reasons for this are unclear. We hypothesized that delayed medical care associated with AHT causes prolonged pre-hospital hypotension and hypoxia as measured by admission base deficit (BD), and that this would correlate with outcome.
We performed a 10-year retrospective chart review of children admitted for AHT at two academic level-I trauma centers. Statistics were performed using Student's t test, chi-square analysis, and multivariate logistic regression, and considered significant at p<0.05.
Four-hundred twelve children with AHT were identified, and admission BD was drawn for 148/412 (36%) children, including 104 survivors and 44 non-survivors. Non-survivors had significantly higher BD compared to survivors (12.6±1.6 versus 5.3±0.6, p<0.001). Non-survivors were more likely to be intubated pre-hospital and get cardiopulmonary resuscitation (CPR) (p<0.001). Mortality increased with rising BD, according to CPR status. There was no difference in patterns of brain injury between survivors and non-survivors (p>0.05).
BD correlates with mortality in children suffering severe AHT. Non-survivors are also more likely to be intubated pre-hospital and require CPR, with no difference in pattern of brain injury, suggesting that secondary injury is a major determinant of outcome in severe AHT.
Journal of Pediatric Surgery 10/2013; 48(10):2106-2111. DOI:10.1016/j.jpedsurg.2013.05.009 · 1.39 Impact Factor
"The same distribution was noted in Sweden and in others less developed countries such as Nepal, South Africa and Brazil [8, 17–19]. One study conduced in Denver between 1996 and 2004 at a regional level 1 pediatric trauma center showed that unintentional trauma was a major cause of morbidity and mortality among children . In Recife, a particularly violent city in northeast Brazil, the most frequent cause of death in adolescents by intent was homicide . "
[Show abstract][Hide abstract] ABSTRACT: External causes of death are important in the pediatric population worldwide. We performed an analysis of all injury-fatalities in children between ages zero and 17 years, between January 2000 and December 2006, in San Diego County, California, United States of America. Information was obtained from the County of San Diego Medical Examiner's database. External causes were selected and grouped by intent and mechanism. Demographics, location of death and relation between the injury mechanism and time of death were described. There were 884 medico-legal examinations, of which 480 deaths were due to external causes. There majority were males (328, 68.3%) and whites (190, 39.6%). The most prevalent mechanism of injury leading to death was road traffic accidents (40.2%), followed by asphyxia (22.7%) and penetrating trauma (17.7%). Unintentional injuries occurred in 65.8% and intentional injuries, including homicide and suicide, occurred in 24.2 and 9.4%, respectively. Death occurred at the scene in 196 cases (40.9%). Most deaths occurred in highways (35.3%) and at home (28%). One hundred forty-six patients (30.4%) died in the first 24 h. Seven percent died 1 week after the initial injury. Among the cases that died at the scene, 48.3% were motor vehicle accidents, 20.9% were victims of firearms, 6.5% died from poisoning, 5% from hanging, and 4% from drowning. External causes remain an important cause of death in children in San Diego County. Specific strategies to decrease road-traffic accidents and homicides must be developed and implemented to reduce the burden of injury-related deaths in children.
European Journal of Epidemiology 03/2010; 25(3):211-7. DOI:10.1007/s10654-009-9420-1 · 5.34 Impact Factor
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