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Outcomes in Pediatric Trauma Care in the Stockholm Region

  • Focus on Pediatric Polytrauma
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background:

Although trauma is a leading cause of pediatric mortality and morbidity in Sweden, few studies have examined the outcome of pediatric trauma.

Objective:

Here, we describe the age and gender distribution, injury mechanisms, injury severity, and outcome of pediatric trauma in the Stockholm region.

Methods:

This retrospective study comprises all trauma patients (age ≤ 15 years) admitted to a regional pediatric trauma center and all pediatric deaths due to trauma in Stockholm in 2002. Data from the trauma registry database were verified by comparison with medical records and autopsy reports. Outcome was measured by mortality and length of stay in a pediatric intensive care unit (PICU) and acute care hospital.

Results:

In all, 432 injured children were included. The median age was 10 years and 59% were males. The median injury severity score was 4 (interquartile range [IQR] 1–9) and 50% sustained head injuries. Mortality was low (1%) and the median length of hospital stay was 2 days (IQR 1–3); 19% stayed in a PICU and, of those, 89% stayed for one day. Comparison with medical records showed that much information in the trauma registry database was either incorrect or missing.

Conclusions:

Many injuries were minor and half of the children were discharged home from the emergency department.Head injurieswere themost common injury in all age groups. The most severe head injuries were seen in the youngest group and were caused by falls. Trauma team activation criteria should be improved to avoid overutilization. The quality and completeness of data in the trauma registry must be enhanced.

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References

  1. World Health Organization Europe. European report on child injury prevention. 2008. Available online at: http://www.euro.who.int/Document/E92049.pdf.

  2. Petridou ET, Kyllekidis S, Jeffrey S, Chishti P, Dessypris N, Stone DH. Unintentional injury mortality in the European Union: how many more lives could be saved? Scand J Public Health 2007;35:278–87.

    Article  PubMed  Google Scholar 

  3. Centre for Epidemiology (EpC) Statistics: causes of death 1998–2003. National Swedish Board of Health and Welfare, 2005.

  4. Swedish Rescue Services Agency. Nationellt Centrum för lärande om olyckor. Olycksfall bland barn och ungdomar. 2007:6 [Available in Swedish].

  5. Swedish Government. Regeringskansliet: Socialdepartementet (SOU 2002:99). Rapport från Barnsäkerhetsdelegationen [Available in Swedish].

  6. Potoka DA, Schall LC, Gardner MJ, Stafford PW, Peitzman AB, Ford HR. Impact of pediatric trauma centers on mortality in a statewide system. J Trauma 2000;49:237–45.

    Article  CAS  PubMed  Google Scholar 

  7. Densmore JC, Lim HJ, Oldham KT, Guice KS. Outcomes and delivery of care in pediatric injury. J Pediatr Surg 2006;41:92–8.

    Article  PubMed  Google Scholar 

  8. van der Sluis CK, Kingma J, Eisma WH, ten Duis HJ. Pediatric polytrauma: short-term and long-term outcomes. J Trauma 1997;43:501–6.

    Article  PubMed  Google Scholar 

  9. Augutis M, Levi R. Pediatric spinal cord injury in Sweden: incidence, etiology and outcome. Spinal Cord 2003;41:328–36.

    Article  CAS  PubMed  Google Scholar 

  10. Wahlström MR, Olivecrona M, Koskinen LOD, Rydenhag B, Naredi S. Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy — the Lund concept. Intensive Care Med 2005;31:832–9.

    Article  PubMed  Google Scholar 

  11. Falk AC, Klang B, Paavonen EJ, von Wendt L. Current incidence and management of children with traumatic head injuries: the Stockholm experience. Dev Neurorehabil 2007;10:49–55.

    Article  PubMed  Google Scholar 

  12. Styrke J, Stålnacke B-M, Sojka P, Björnstig U. Traumatic brain injuries in a well-defined population: epidemiological aspects and severity. J Neurotrauma 2007;24:1425–36.

    Article  PubMed  Google Scholar 

  13. Franzén L, Örtenwall P, Backteman T. Children in Sweden admitted to intensive care after trauma. Injury 2007;38:91–7.

    Article  PubMed  Google Scholar 

  14. Dowd MD. Effect of emergency department care on outcomes in pediatric trauma: what approaches make a difference in quality of care? J Trauma 2007;63:S136–9.

    Article  PubMed  Google Scholar 

  15. Statistics Sweden (SCB). 2003. Home page at: http://www.ssd.scb.se/databaser/makro/start.asp.

  16. Association for the Advancement of Automotive Medicine, Committee on Injury Scaling. The Abbreviated Injury Scale, 1990 Revision (AIS-90). Des Plaines, IL: Association of the Advancement of Automotive Medicine, 1990.

    Google Scholar 

  17. Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187–96.

    Article  CAS  PubMed  Google Scholar 

  18. Statistics Sweden (SCB) 3003. Localities 2000. Available online at: http://www.scb.se/statistick/MI/MI10810/2000A01/MI0810/2000A01sMMI38sM0101.pdf.

  19. Hlaing T, Hollister L, Aaland M. Trauma registry data validation: essential for quality trauma care. J Trauma 2006;61:1400–7.

    Article  PubMed  Google Scholar 

  20. American College of Surgeons Committee on Trauma: Subcommittee on Trauma Registry Programs. National Trauma Data Bank Annual Report, 2002. Chicago: American College of Surgeons, 2003.

    Google Scholar 

  21. Falk AC, Cederfjäll C, von Wendt L, Klang Söderkvist B. Management and classification of children with head injury. Child Nerv Syst 2005;21:430–6.

    Article  Google Scholar 

  22. Police report on traffic accidents in Stockholm 2000–2003. Polisrapporterade trafikolyckor med personskada i Stockholm 2000–2002. Gatu- och fastighetskontoret. 2003 [Available in Swedish].

  23. Jansson B, De Leon AP, Ahmed N, Jansson V. Why does Sweden have the lowest childhood injury mortality in the world? The roles of architecture and public pre-school services. J Public Health Policy 2006;27:146–65.

    Article  PubMed  Google Scholar 

  24. Brudvik C. Child injuries in Bergen, Norway. Injury 2000;31:761–7.

    Article  CAS  PubMed  Google Scholar 

  25. Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye OC. The impact of traumatic brain injuries: a global perspective. Neurorehabilitation 2007;22:341–53.

    PubMed  Google Scholar 

  26. Emanuelson I. How safe are childcare products, toys and playground equipment? A Swedish analysis of mild brain injuries at home and during leisure time 1998–1999. Inj Control Saf Promot 2003;10:139–44.

    Article  CAS  PubMed  Google Scholar 

  27. Greenberg RA, Bolte RG, Schunk JE. Infant carrier-related falls: an unrecognized danger. Pediatr Emerg Care 2009;25:66–8.

    Article  PubMed  Google Scholar 

  28. Swedish Government. Regeringskansliet: Socialdepartementet (SOU) 2002:68. Rapport från Barnsäkerhetsdelegationen [Available in Swedish].

  29. MacKay M, Vincenten J. Child safety summary report card for 18 countries. Amsterdam, European Child Safety Alliance, Eurosafe, 2007.

    Google Scholar 

  30. Farrell LS, Hannan EL, Cooper A. Severity of injury and mortality associated with pediatric blunt injuries: hospitals with pediatric intensive care units versus other hospitals. Pediatr Crit Care Med 2004;5:5–9.

    Article  PubMed  Google Scholar 

  31. Pracht EE, Tepas JJ 3rd, Langland-Orban B, Simpson L, Pieper P, Flint LM. Do pediatric patients with trauma in Florida have reduced mortality rates when treated in designated trauma centers? J Pediatr Surg 2008;43:212–21.

    Article  PubMed  Google Scholar 

  32. Lagerberg D. A descriptive survey of Swedish child health nurses’ awareness of abuse and neglect. II. Characteristics of the children. Acta Pediatr 2004;93:692–701.

    Article  CAS  Google Scholar 

  33. Theodore AD, Chang JJ, Runyan DK, Hunter WM, Bangdiwala SI, Agans R. Epidemiologic features of the physical and sexual maltreatment of children in the Carolinas. Pediatrics 2005;115:e331–7.

    Article  PubMed  Google Scholar 

  34. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. MMWR 2009;58(No. RR-1):1–35.

    Google Scholar 

  35. Engum SA, Mitchell MK, Scherer LR, Gomez G, Jacobson L, Solotkin K, Grosfeld JL. Prehospital triage in the injured pediatric patient. J Pediatr Surg 2000;35:82–7.

    Article  CAS  PubMed  Google Scholar 

  36. Tepas JJ 3rd, Mollitt DL, Talbert JL, Bryant M. The pediatric trauma score as a predictor of injury severity in the injured child. J Pediatr Surg 1987;22:14–8.

    Article  PubMed  Google Scholar 

  37. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29:623–9.

    Article  CAS  PubMed  Google Scholar 

  38. Dowd MD, McAneney C, Lacher M, Ruddy RM. Maximizing the sensitivity and specificity of pediatric trauma team activation criteria. Acad Emerg Med 2000;7:1119–25.

    Article  CAS  PubMed  Google Scholar 

  39. Kann SH, Hougaard K, Christensen EF. Evaluation of pre-hospital trauma triage criteria: a prospective study at a Danish level I trauma centre. Acta Anaesthesiol Scand 2007;51:1172–7.

    CAS  PubMed  Google Scholar 

  40. American College of Surgeons. Resources for optimal care of the injured patient: 2006. Chicago: American College of Surgeons, 2006.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Kerstin Sluys & Lennart Iselius

  2. Department of Pediatric Emergency, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden

    Margaretha Lannge

  3. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden

    Kerstin Sluys & Lars E. Eriksson

  4. Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Kerstin Sluys

Authors
  1. Kerstin Sluys
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  2. Margaretha Lannge
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  4. Lars E. Eriksson
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Correspondence to Kerstin Sluys.

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Sluys, K., Lannge, M., Iselius, L. et al. Outcomes in Pediatric Trauma Care in the Stockholm Region. Eur J Trauma 36, 308–317 (2010). https://doi.org/10.1007/s00068-009-9080-6

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  • DOI: https://doi.org/10.1007/s00068-009-9080-6

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