Defining predictors of mortality in pediatric trauma patients

Abstract

Background: The aim of this study was to describe our cohort of pediatric trauma patients and to analyze their physiological data. The intention was to highlight the difficulty in using systolic blood pressure (SBP) readings in this population and to investigate the role of base excess (BE) in predicting clinical outcomes in pediatric trauma patients.
Methodology: The Pietermaritzburg Metropolitan Trauma Service (PMTS) maintains a prospective digital trauma registry, and all pediatric trauma patients admitted to the service for the period January 2012 – July 2016 were included.
Results: Out of an original dataset of 1239 pediatric trauma patients admitted to the emergency departments of the PMTS, 26 elective patients and 216 patients with missing SBP were excluded to leave a sample size of 997 patients. The majority of the sample was male accounting for 669 patients (67.2 %) with 327 females (32.8%) and 1 (0.1%) missing data. The mean age (SD) was 7.7 years (3.9) and the median age (IQR) was 8 years (5 – 11). There were 58 children < 2 years of age, 177 between the age of 2 to < 5 years of age, 402 between 5 to < 10 years of age and 360 between 10 and < 15 years of age. The predominant mechanism of injury was blunt trauma (78.4% or 782/997). Penetrating trauma accounted for 11.0% of cases (110/997). The mean systolic BP (SD) across the whole cohort was 110.1 mm Hg (16.9) and the median systolic BP (IQR) was 110 mm Hg (100–119). Mortality rate remains low and then precipitously increases below a SBP of 93 mm Hg in children older than 2 and below 89 mm Hg in children younger than 2. This suggests that a SBP of 93 mm Hg or less in children older than 2 and 89 mm Hg or less in children under 2 years is clinically significant. Similarly, as BE decreased, the mortality risk also increased prominently.
Conclusion: This study has used a previously described methodology based on large developed world trauma databases and confirms the current thinking that SBP is a late marker and thus not useful in the pediatric population and a better system/ approach is needed. The use of BE in conjunction with SBP may be a more useful means of identifying shock.

Keywords: pediatric trauma; trauma registry; mortality; shock