Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries

BACKGROUND: Thoracoabdominal injuries (TAI) are an important cause of trauma-related morbidity in children. Early and correct intervention is essential to reduce mortality. We aimed to determine factors associated with mortality and the need for intensive care in TAI.
METHODS: The children admitted to the pediatric emergency department of a tertiary care hospital with TAI in a 6-year-period were enrolled. Demographic data; mechanism of injuries; clinical, laboratory and imaging findings; length of hospital and intensive care unit (ICU) stay; invasive procedures and medical treatments; surgical interventions; and survival outcomes were recorded.
RESULTS: The median age of the 136 children was 9 (IQR: 5–14) years and 72.8% were male. The vast majority of injuries were caused by blunt trauma (92.7%). Pulmonary contusion, pneumothorax, splenic, and liver injuries were the most common diagnoses. Motor vehicle accidents were seen in more than half of the cases (52.2%). The median length of hospital stay was 5 (IQR: 2–8) days; 21 patients were hospitalized in the ICU (15.4%). The need for intensive care was higher in patients with lower Glasgow Coma Scale (GCS) scores and lower Pediatric Trauma Scores (PTSs), in the presence of multiple injuries, pulmonary contusion, and pneumothorax (p<0.001). Mortality was seen in nine patients, eight of whom had multiple injuries. The mortality rate was higher in patients with pulmonary contusion and pneumothorax (p=0.002 and p=0.003, respectively). The PTS and GCS were found to be lower in patients who died in hospital (p<0.001). Prolongation of coagulation parameters and hyperglycemia was more common in the non-survivor group (p=0.005 and p=0.004, respectively).
CONCLUSION: Although thoracoabdominal trauma is not common in childhood, it is an important part of trauma-associated mortality. Multiple injuries, pulmonary contusion, pneumothorax, lower GCS, and PTSs can be a sign of serious injuries to which physicians must be alert.

Pediatrik torakoabdominal yaralanmalarda mortalite ve yoðun bakým gereksiniminin belirleyicileri

AMAÇ: Torakoabdominal travmalar çocuklarda kafa travmasýný takiben en sýk yaralanma nedenidir. Erken ve doðru müdahale mortalitenin azaltýl-masý için önemlidir. Bu çalýþmada, torakoabdominal yaralanmalarda mortalite ve yoðun bakým ihtiyacý ile iliþkili faktörlerin belirlenmesi amaçlandý. GEREÇ VE YÖNTEM: Altý yýllýk süre içinde üçüncü basamak bir hastanenin pediatrik acil servisine torakoabdominal yaralanma nedeniyle baþvuran hastalar çalýþmaya alýndý. Demografik veriler, yaralanma mekanizmalarý, klinik, laboratuvar ve görüntüleme bulgularý, hastanede ve yoðun bakýmda kalýþ süreleri, uygulanan invaziv giriþimler, týbbi tedaviler ve cerrahi müdahaleler, saðkalým sonuçlarý kaydedildi.
BULGULAR: Çalýþmaya alýnan 136 hastanýn ortanca yaþý dokuz yýl (ÇAA: 5–14) olup %72.8’i erkekti. Yaralanmalarýn büyük çoðunluðu künt travma sonucu gerçekleþmiþti (%92.7). Pulmoner kontüzyon, pnömotoraks, dalak ve karaciðer yaralanmalarý en sýk saptanan tanýlardý. Olgularýn yarýsýndan fazlasýnda motorlu araç kazasý sonucu yaralanma görüldü (%52.2). Hastanede ortanca yatýþ süresi beþ gündü (ÇAA: 2–8); 21 hasta yoðun bakým ünitesinde tedavi edilmiþti (%15.4). Çoklu yaralanma, pulmoner kontüzyon, pnömotoraks, düþük Glasgow Koma Skalasý (GKS) skoru ve Pediatrik Travma Skoru olan hastalarda yoðun bakým ihtiyacý daha yüksek bulundu. (p<0.001). Dokuz olguda ölüm görüldü, bu hastalarýn sekizinde çoklu yaralanma saptandý. Pulmoner kontüzyon ve pnömotoraksý olan hastalarýn daha sýk ölümle sonuçlandýðý gözlendi (p=0.002; p=0.003). Pediatrik travma skoru ve GKS ölümle sonuçlanan olgularda daha düþük saptandý (p<0.001). Mortalite grubunda koagülasyon parametrelerinde uzama ve hiperglisemi daha fazla bulundu (p=0.005; p=0.004).
TARTIÞMA: Torakoabdominal yaralanmalar çocukluk çaðýnda travmaya baðlý mortalitenin önemli bir nedenidir. Çoklu yaralanmalar, pulmoner kon-tüzyon, pnömotoraks, düþük GKS ve pediatrik travma skoru varlýðý ciddi yaralanmalar açýsýndan klinisyenler için uyarýcý olmalýdýr.