A review of children with severe trauma admitted to pediatric intensive care in Queensland, Australia

Background
The aim of this study is to review patient characteristics, injury patterns, and outcomes of trauma cases admitted to pediatric intensive care in Children’s Health Queensland, Brisbane, Queensland, Australia.
Methods
Routinely recorded data collected prospectively from the Children’s Health Queensland Trauma Service registry from November 2008 to October 2015 were reviewed. Demographic and clinical characteristics of trauma cases in children under 16 years of age are described, and their association with age and mortality analyzed.
Results
There were 542 cases of pediatric trauma identified and 66.4% were male. The overall mortality since January 2012 was 11.1%. The median injury severity score (ISS) was 11 (IQR = 9–22), 48.2% (n = 261) had an ISS > 12 and 41.7% (n = 226) patients had an ISS > 15. The most common injury patterns were isolated head injury (29.7%; n = 161) and multiple trauma (31.2%; n = 169). In 28.4% of cases (n = 154) surgery was required. The home was reported to be the most common place of injury (37.6%; n = 204). Children aged 0–4 years were least likely to survive their injury (15.3% mortality) compared with the 5–9 (5.6% mortality) and 10–15 (9.0% mortality) age groups. Higher mortality was associated with more severe injuries, abdomen/spine/thorax injuries, inflicted injuries, drowning and hanging.
Conclusion
This description of major pediatric trauma cases admitted to pediatric intensive care in Children’s Health Queensland, Australia, will inform future pediatric major trauma service requirements as it identifies injury patterns and profiles, injury severity, management and mortality across different age groups.

背景
本研究旨在回顾澳大利亚昆士兰州布里斯班昆士兰儿童健康中心（Children’s Health Queensland）收治于儿科重症监护室的创伤病例的患者特征、损伤类型及转归情况。

方法
本研究回顾分析了2008年11月至2015年10月期间，从昆士兰儿童健康中心创伤服务登记系统中前瞻性收集的常规记录数据。研究描述了16岁以下创伤儿童的人口学与临床特征，并分析其与年龄及死亡率的相关性。

结果
本研究共纳入542例儿科创伤病例，其中男性占比66.4%。自2012年1月起的总死亡率为11.1%。创伤严重程度评分（Injury Severity Score, ISS）的中位数为11（四分位距=9~22），48.2%（n=261）的患者ISS＞12，41.7%（n=226）的患者ISS＞15。最常见的损伤类型为孤立性颅脑损伤（29.7%；n=161）与多发创伤（31.2%；n=169）。28.4%的病例（n=154）需接受手术治疗。损伤最常发生于家中（37.6%；n=204）。与5~9岁年龄组（死亡率5.6%）及10~15岁年龄组（死亡率9.0%）相比，0~4岁儿童的创伤死亡率最高（15.3%）。更高的死亡率与更严重的创伤、腹部/脊柱/胸部损伤、故意伤害、溺水及缢吊密切相关。

结论
本研究对澳大利亚昆士兰儿童健康中心儿科重症监护室收治的重症儿科创伤病例进行了系统描述，明确了不同年龄组的损伤特征与类型、创伤严重程度、诊疗方案及死亡率，可为未来儿科重症创伤服务的需求规划提供科学参考依据。