Relationship between weather and seasonal factors and trauma admission volume at a Level I trauma center

BACKGROUND: We sought to determine whether trauma patient admission volume to our Level I trauma center was correlated with observable weather or seasonal phenomena. METHODS: Trauma registry data and national weather service data for the period between September 1, 1992, and August 31, 1998, were combined into a common data set containing trauma admission data and weather data for each day. Sequential linear regression models were constructed to determine relationships between variables in the data set. RESULTS: There is a highly significant relationship (p < 0.00001) between maximum daily temperature and trauma admissions (R = 0.22). Rain is associated with a decrease in overall trauma volume. Rain had no effect on the number of admissions because of motor vehicle crash, however. Neither humidity nor snowfall affects trauma admission volume. Trauma admissions are significantly more frequent in July and August, and on Saturdays and Sundays (p < 0.05). Linear regression analysis identified maximum temperature, precipitation, day of week, and month as independent predictors of trauma admission volume (p < 0.001, R = 0.328). CONCLUSION: There is a significant relationship between weather and trauma center activity; temperature and precipitation are independently associated with trauma admission volume at our institution. Statistical models of trauma incidence should consider these phenomena. Evaluation of a larger, population-based data set is needed to confirm these relationships.     

Correlating weather and trauma admissions at a level I trauma center

BACKGROUND: Popular emergency room wisdom touts higher temperatures, snowfall, weekends, and evenings as variables that increase trauma admissions. This study analyzed the possible correlation between trauma admissions and specific weather variables, and between trauma admissions and time of day or season. METHODS: Trauma admission data from a Level I trauma center database from July 1, 1996 to January 31, 2002 was downloaded and linked with local weather data from the Archives of the National Oceanic and Atmospheric Administration website, and then analyzed. RESULTS: There were 8,269 trauma admissions over a total of 48,984 hours for an average of one admission every 6 hours. Daily high temperature and precipitation were valid predictors of trauma admission volume, with a 5.25% increase in hourly incidents for each 10-degree difference in temperature, and a 60% to 78% increase in the incident rate for each inch of precipitation in the previous 3 hours. CONCLUSIONS: Weather and seasonal variations affect admissions at a Level I trauma center. Data from this study could be useful for determining staffing requirements and resource allocation.     

Children's injuries in a Scottish district general hospital

BACKGROUND: Injury is a common cause of emergency department (ED) attendance but there are few data published on the spectrum of paediatric injury in a typical district general hospital (DGH). This study aimed to provide a complete picture of injury presentations to such a centre. METHODS: Prospective questionnaire study of consecutive paediatric attendances at a DGH ED in Scotland (annual attendance 53,500 patients) due to injury or poisoning. Paediatric in this context was defined as less than 14 years on the day of presentation. Admission rates were identified from the hospital information system and information on deaths was sought from the local Procurator Fiscal (the Scottish equivalent of the Coroner). RESULTS: One thousand three hundred and seventy-eight questionnaires were completed from a potential 10,697 eligible patients. Safety devices (helmets, belts, etc.) were in use in only 99 cases. Cycle helmets were used in 26% of cycle incidents and seat belts were used in 71% of car incidents. Cycling and pedestrian incidents were more common during the summer months and outside school hours. Adult supervision was present in 49% of incidents. Seventy-three percent of incidents at school were unsupervised. There were 5.6 admissions to hospital per day in the 0-13 years age group for all causes, with little seasonal variation in admission rates. There were three deaths during the year, two from SIDS and one due to choking, all in infants. CONCLUSION: Trauma is a common cause of ED attendance in children. Preventative measures are still underutilised and could make a significant impact on the incidence of children's injuries and possibly ED attendances. Cycle helmets could play a major role in injury prevention in school age children in this area.     

A review of major trauma admissions to a tertiary adult referral hospital over a ten year period: Fewer patients,similar survival

BackgroundTrauma is an important cause for presentation to the emergency department, representing a significant number of emergency surgical admissions. Societal changes result in alterations in the epidemiology of trauma.ObjectivesThis study aimed to review patients admitted to a tertiary referral hospital as a result of traumatic injuries, assessing for changes in admission epidemiology.MethodsTrauma admissions over two year-long periods a decade apart were reviewed. The Trauma Audit and Research Network (TARN) audit system identified admissions and transfers between June 2006 and May 2007. The Hospital In-Patient Enquiry (HIPE) system identified those fulfilling TARN criteria a decade earlier. Comparative analysis was performed on the dataset.ResultsThere were 367 trauma admissions between June 2006 and May 2007: 88 road traffic accidents (RTAs), 201 falls and 77 other injuries, with 627 admissions a decade earlier: 286 RTAs, 247 falls and 94 others. Males comprised 72% and 69% of RTA admissions in both periods respectively. Firearm-related injuries increased significantly (p = 0.015). Neurosurgical transfers decreased from 256 to 150 with a slight increase in unadjusted overall mortality from 8.5% to 10.9%. Admissions of patients aged less than 19 reduced from 150 to 59 (p = 0.0031) with a similar trend in those aged between 20 and 29 years from 149 to 78.ConclusionAdmissions resulting from RTAs and of patients aged under 30 reduced significantly, however, young males remain the most affected sub-group. Firearm injuries increased significantly, a worrying trend in view of the severity of injury sustained by these victims.     

Training in paediatric trauma: the problem of safer societies

BACKGROUND: Trauma remains the most common cause of child death worldwide but the incidence of major trauma is declining in many developed countries: this has implications for training. METHODS: A survey of paediatric surgeons and paediatric surgical trainees was undertaken to evaluate perceptions of the relative importance of various forms of trauma training. A questionnaire was e-mailed to Australasian paediatric surgeons and trainees to determine trauma courses they had undertaken, operative and non-operative paediatric trauma experience and attitudes towards trauma training. RESULTS: The overall response rate was 49% (40 of 83 consultants and 11 of 22 trainees). The Early Management of Severe Trauma course had been undertaken by 82% of consultants and all trainees. The Definitive Surgical Trauma Care course had been undertaken by 22% of consultants and one trainee. The number of trauma laparotomies carried out in the previous year was in the one to five range for 71% of responders. Greater emphasis was placed on the value of adult trauma experience by consultants who had a general surgical fellowship. CONCLUSION: In societies where major trauma in children is relatively rare (fortunately) and the opportunities for training are limited, it is important to ensure that advanced trainees in paediatric surgery gain sufficient skills from a variety of sources to enable them to treat competently the severely injured child with multiple injuries.     

Investigating the relationship between weather and violence in Baltimore,Maryland, USA

BackgroundIt is a common refrain at major urban trauma centers that caseloads increase in the heat of the summer. Several previous studies supported this assertion, finding trauma admissions and crime to correlate positively with temperature. We examined links between weather and violence in Baltimore, MD, through trauma presentation to Johns Hopkins Hospital and crime reports filed with the Baltimore Police Department.MethodsCrime data were obtained from the Baltimore City Police Department from January 1, 2008 to March 31, 2013. Trauma data were obtained from a prospectively collected registry of all trauma patients presenting to Johns Hopkins Hospital from January 1, 2007 to March 31, 2013. Weather data were obtained from the National Climatic Data Center. Correlation coefficients were calculated and negative binomial regression was used to elucidate the independent associations of weather and temporal variables with the trauma and crime data.ResultsWhen adjusting for temporal and meteorological factors, maximum daily temperature was positively associated with total trauma, intentional injury, and gunshot wounds presenting to Johns Hopkins Hospital along with total crime, violent crime, and homicides in Baltimore City. Associations of average wind speed, daily precipitation, and daily snowfall with trauma and crime were far weaker and, when significant, nearly universally negative.ConclusionMaximum daily temperature is the most important weather factor associated with violence and trauma in our study period and location. Our findings suggest potential implications for hospital staffing to be explored in future studies.     

The Outreach Trauma Program: a model for survival of the academic trauma center

BACKGROUND: In the current health care climate, trauma centers face particular economic challenges. Statewide trauma systems provide a network for referral of critically injured patients to academic Level I trauma centers, but favorable reimbursement in states such as Colorado results in intense competition for patients. We hypothesized that a comprehensive Outreach Trauma Program would facilitate our mission as a key resource facility in our trauma system, and would increase referrals of critically injured patients to our center from outside our metropolitan area. METHODS: The Colorado statewide trauma system was formalized in 1995; our Outreach program-including providing visiting trauma call, continuing medical education lectures, 24-hour/7-day immediate consultation and transfers, and public relations/marketing-was fully implemented in 1997. We audited our trauma registry from January 1994 to July 2001 to determine the impact on patient volume and acuity as well as academic productivity. RESULTS: Annual overall trauma admissions have remained stable. Since 1997, high-acuity patients (i.e., Injury Severity Score > 15, intensive care unit admissions, those requiring surgery) have increased 27% to 51%, attributable largely to an approximately 300% increase in high-acuity Outreach patients. In 2000, Outreach patients constituted 8% of our total trauma admissions, but 21% of intensive care unit trauma admissions; notably, they accounted for 25% of our center's trauma charges. Meanwhile, our group's academic productivity has not suffered; in fact, we had 57 publications in 2000, compared with an average of 35 per year from 1993 through 1997. CONCLUSION: The Outreach Trauma Program has proven clinically, academically, and financially rewarding. Our program may serve as a model whereby academic trauma centers, through a demonstrated commitment to serving the clinical and educational needs of their referral base, can satisfy their mission while ensuring their survival.     

Mathematical modeling to define optimum operating room staffing needs for trauma centers

BACKGROUND: Level II trauma centers may be verified (1999, American College of Surgeons Committee on Trauma) with an on-call operating room team if the performance-improvement program shows no adverse outcomes. Using queuing and simulation methodology, this study attempted to add a volume guideline. STUDY DESIGN: Data from 72 previously verified trauma centers identified multiple demographic factors, including specific information about the first trauma-related operation that was done between 11:00 PM and 7:00 AM each month for 12 consecutive months. RESULTS: The annual admissions averaged 1,477 for 37 Level I trauma centers, 802 for 28 Level II trauma centers, 481 for 4 Level III trauma centers, and 731 for 3 pediatric trauma centers. The annual admissions correlated with the number of operations done between 11:00 PM and 7:00 AM (p < 0.001). These 946 operations were performed by general surgery (39%), neurosurgery (8%), orthopaedic surgery (33%), another specialty (9%), or multiple services (10%). Admission to operation time was within 30 minutes for 12.1% of patients (2.6% for blunt and 24.1% for penetrating injuries). The probability of operation within 30 minutes of arrival varied with the number of admissions and with the percentage of penetrating versus blunt injuries. The likely number of operations from 11:00 PM to 7:00 AM would be 19 for 500 annual admissions, 26 for 750 annual admissions, and 34 for 1,000 annual admissions, with 5.83, 7.98, and 10.13 patients, respectively, going to operation within 30 min. The probability that two rooms would be occupied simultaneously was 0.14 and 0.24 for centers admitting 500 and 1,000 patients, respectively. CONCLUSIONS: Trauma centers performing fewer than six operations between 11:00 PM and 7:00 AM per year could conserve resources by using an immediately available on-call team, with responses monitored by the performance-improvement program.     

Population-based prediction of trauma volumes at a Level 1 trauma centre

Objective: With an ageing US population, the demographics of traumatic injuries are being significantly altered. Census projections predict that the number of Americans over age 65 will double in the next 20 years. We used stochastic methods to forecast trauma admissions in order to predict the effects of such demographic changes at our trauma centre.

Methods: Age- and sex-related rates of traumatic admission were determined using population statistics and trauma registry data from 1994 to 1999. These rates were then projected from 2000 to 2025 based on both the Lee–Carter and random walk with drift methods. Stochastic population projections were made and paired with the projected trauma rates, allowing estimation of total trauma volume.

Results: Trauma rates were predicted to increase for most age groups. Trauma admissions are predicted to increase 57% by 2024. By 2019, 50% of trauma admissions will be 60 or older.

Conclusions: Our trauma volume is expected to increase 57% by 2024, an increase of 2% per year. More of this volume will consist of elderly patients, potentially requiring increased health-care resources.     

Mechanism of injury does not predict acuity or level of service need: field triage criteria revisited

BACKGROUND: Trauma systems use specific criteria based on physiologic, anatomic, and mechanistic factors for field triage. The purpose of this study was to evaluate the emergency department disposition of patients not meeting mandatory criteria (ie, physiologic or anatomic factors) for triage to a trauma center and the potential for over- or undertriage. METHODS: This was a retrospective review of trauma admissions from July 1999 to June 2001, to a level I trauma center. Triage criteria were classified as physiologic factors (n=300), anatomic factors (n=115), or mechanistic factors (n=414), according to the criteria of the American College of Surgeons Committee on Trauma. Physiologic and anatomic factors were combined and compared with mechanistic factors. RESULTS: There were 1253 admissions during the study period. Sixty-six percent (n=830) met study inclusion criteria. Fifty percent (n=413) were admitted to the intensive care unit or operating room. Approximately 50% of each group (physiologic/anatomic, 52%; mechanistic, 47%; P=.08) were admitted directly to the operating room or to the intensive care unit. CONCLUSIONS: Patients not meeting mandatory criteria for transfer to a trauma center often have serious injuries that require a higher level of care. The inclusion of all or select mechanistic criteria for evaluation at a trauma center is appropriate to achieve an acceptable rate of clinical undertriage, as well as resource undertriage and its subsequent complications.     

Paediatric trauma teams in Australia

BACKGROUND: Trauma teams have been associated with improved survival probability of paediatric trauma patients. The present study seeks to estimate the use of trauma teams in Australian paediatric tertiary referral centres and describe their medical composition, leadership and criteria for activation. METHODS: Australian paediatric tertiary referral centres were identified. A structured questionnaire assessing the presence, composition and means of activation of a trauma team was mailed to the 'Director, Emergency Department' of all identified hospitals. Three months later, all hospitals were contacted by telephone to complete and verify data collection. RESULTS: Questionnaires were distributed to eight hospitals. Seventy-five per cent had an established trauma team. Hospitals without a trauma team claimed to have insufficient doctors to form a team and insufficient trauma caseload to justify a team. All trauma teams were potentially activated by prehospital paramedic data (field triage) and required a combination of anatomical, physiological and mechanistic criteria for activation. The two methods of mobilizing a trauma team were by dispatching a common call onto individual pagers (66%) or a specific trauma pager (33%) carried by trauma team members. Fifty per cent of hospitals had a two-tier, stratified trauma team response. All teams consisted of emergency, surgical and intensive care unit registrars. Trauma team leaders were emergency medicine specialists/registrars (33%), surgical registrars (33%) and non-defined (33%). Consultant surgeons were not members of any trauma team. Eighty-three per cent of trauma teams consisted of more junior members after hours. Fifty per cent of hospitals did not have a surgical registrar on site outside of business hours. Eighty-eight per cent of hospitals engaged in some form of trauma audit. CONCLUSIONS: Trauma teams are utilized by most Australian paediatric tertiary referral centres, with fairly uniform medical composition and criteria for activation. Paediatric surgeons presently have limited leadership roles and membership of Australian paediatric trauma teams.     

Paediatric major trauma in the setting of the Irish trauma network

BackgroundThe construction of a new tertiary children's hospital and reconfiguration of its two satellite centres will become the Irish epicentre for all paediatric care including paediatric trauma. Ireland is also currently establishing a national trauma network although further planning of how to manage paediatric trauma in the context of this system is required. This research defines the unknown epidemiology of paediatric major trauma in Ireland to assist strategic planning of a future paediatric major trauma network.MethodsData from 1068 paediatric trauma cases was extracted from a longitudinal series of annual cross-sectional studies collected by the Trauma Audit and Research Network (TARN). All paediatric patients between the ages of 0-16 suffering AIS ≥2 injuries in Ireland between 2014-2018 were included. Demographics, injury patterns, hospital care processes and outcomes were analysed.ResultsChildren were most commonly injured at home (45.1%) or in public places/roads (40.1%). The most frequent mechanisms of trauma were falls <2 m (36.8%) followed by RTAs (24.3%). Limb injuries followed by head injuries were the most often injured body parts. The proportion of head injuries in those aged <1 year is double that of any other age group. Only 21% of patients present directly to a children's hospital and 46% require transfer. Consultant-led emergency care is currently delivered to 41.5% of paediatric major trauma patients, there were 555 (48.2%) patients who required operative intervention and 22.8% who required critical care admission. A significant number of children in Ireland aged 1-5 years die from asphyxia/drowning. The overall mortality rate was 3.8% and was significantly associated with the presence of head injuries (p < 0.001).ConclusionPaediatric Trauma represents a significant childhood burden of mortality and morbidity in Ireland. There are currently several sub-optimal elements of paediatric trauma service delivery that will benefit from the establishment of a trauma network. This research will help guide prevention strategy, policy-making and workforce planning during the establishment of an Irish paediatric trauma network and will act as a benchmark for future comparison studies after the network is implemented.     

Paediatric supracondylar humeral fractures: epidemiology,mechanisms and incidence during school holidays

Purpose

The purpose of this study was to investigate the epidemiology of paediatric patients sustaining supracondylar humeral fractures, to identify common mechanisms of injury and to corroborate the anecdotal evidence that fractures occur more frequently during school holidays.

Methods

All paediatric patients who presented to the accident and emergency department with a supracondylar distal humerus fracture over the 3-year period from 1 July 2008 to 30 June 2011 were included in the study. Data were collected from the electronic medical records and radiology picture archiving and communication system (PACS) regarding age at injury, sex, Gartland type, date of injury, mechanism and management. The dates of all school holidays during the study period were obtained from the local education authority website.

Results

A total of 159 patients were identified, with a median age of 6 years 1 month (range 1 year to 14 years 4 months); 53 % of patients were male. The 155 extension-type injuries comprised 46, 28 and 26 % Gartland I, II and III fractures, respectively. Sixty-five patients (41 %) were treated operatively. Six patients had either neurological and/or vascular complications; however, none had any long-term neurological compromise and none required vascular surgical intervention. The mechanism of injury was recorded in 118 cases, the majority (37 %) of which were sustained during falls from play equipment. Among the patients, 115 were of school age. The weekly incidence during school holidays was significantly higher than that during term-time (1.16 vs. 0.60, p = 0.0005).

Conclusions

This study demonstrates the epidemiology of paediatric supracondylar fractures managed at a district general hospital over a 3-year-period. This work supports the long-standing anecdotal evidence that play equipment carries a high risk of injury and that the incidence of supracondylar fractures is significantly higher during school holidays.     

Is outcome worse in a small volume Canadian trauma centre?

The minimum number of seriously injured patients required to maintain clinical competence and achieve acceptable clinical competence in a single trauma centre is unknown. It has been suggested that the probability of survival is improved in hospitals treating greater than 200 trauma patients annually. We sought to determine if probability of survival was lower in our small volume centre. Between 1986 and 1989, 752 (522 male, 230 female; average age, 36 years) trauma patients were admitted to our institution. The major mechanism of injury was blunt (89%). All patients underwent trauma severity scoring. Trauma Score, Injury Severity Score, and a Revised Trauma Score were used to derived the probability of survival by the TRISS method. The mean Injury Severity Score was 23.3 and the mean Trauma Score was 13.2. The overall mortality rate was 15.8%. The Z statistic demonstrated no significant difference between actual and predicted deaths for the 4-year period or for any individual year (range, -1.05 to 1.26, p greater than 0.05). The M statistic was 0.753. We conclude that, despite fewer trauma patient admissions (less than 200 per year), comparable clinical results can be achieved by surgeons dedicated to trauma management.     

A comparison of severely injured trauma patients admitted to level 1 trauma centres in Queensland and Germany

Background: The allocation of a trauma network in Queensland is still in the developmental phase. In a search for indicators to improve trauma care both locally as state‐wide, a study was carried out comparing trauma patients in Queensland to trauma patients in Germany, a country with 82.4 million inhabitants and a well‐established trauma system. Methods: Trauma patients ≥15 years of age, with an Injury Severity Score (ISS) ≥ 16 admitted to the Princess Alexandra Hospital (PAH) and to the 59 German hospitals participating in the Trauma Registry of the German Society for Trauma Surgery (DGU‐G) during the year 2005 were retrospectively identified and analysed. Results: Both cohorts are comparable when it comes to demographics and injury mechanism, but differ significantly in other important aspects. Striking is the low number of primary admitted patients in the PAH cohort: 58% versus 83% in the DGU‐G cohort. PAH patients were less physiologically deranged and less severely injured: ISS 25.2 ± 9.9 versus 29.9 ± 13.1 (P < 0.001). Subsequently, they less often needed surgery (61% versus 79%), ICU admission (49% versus 92%) and had a lower mortality: 9.8% versus 17.9% of the DGU‐G cohort. Conclusions: Relevant differences were the low number of primary admissions, the lesser severity of injuries, and the low mortality of the patients treated at the PAH. These differences are likely to be interrelated and Queensland's size and suboptimal organization of trauma care may have played an important role.     

The influence of prehospital trauma care on motor vehicle crash mortality

BACKGROUND: This study evaluated the impact of the prehospital trauma care system on the mortality from motor vehicle crashes and on the temporal distribution between the crash and related death. METHODS: Autopsies performed by the Forensic Medical Institute on all deaths caused by motor vehicle crashes 1 year before and 1 year after the beginning of the prehospital trauma care system were evaluated. RESULTS: In the first period, 128 deaths occurred, 53.9% of them in the first hour after the crash, 36.7% between the first hour and the seventh day, and 9.4% after 1 week. In the second period, 115 deaths occurred, 40.8% of them in the first hour, 52.2% between the first hour and the seventh day, and 7% after 1 week. Central nervous system injury was the most frequent cause of death in both periods. Mortality was greatest among young people as well as male victims in both periods. CONCLUSION: After starting the prehospital trauma care system in our city, there was a decrease in the deaths occurring before hospital admission, a change in temporal distribution of deaths, and a reduction in the motor vehicle crash mortality rate.     

From the pursuit of excellence to the quest for significance: promotion of a Childsafe South Africa

Trauma represents a major burden of disease in South Africa. Children are disproportionately affected by trauma; rightly, childhood trauma can be referred to as 'the neglected childhood killer disease'. Unlike the field of infectious diseases, where vaccinations and prevention are the norm, paediatric trauma is usually ignored and prevention strategies are scarce. In this article, we review paediatric trauma and its effect on our society in light of the development of more effective child safety promotion strategies.     

Nocturnal violence: implications for resident trauma operative experiences

Trauma centers face novel challenges in resource allocation in an era of cost consciousness and work-hour restrictions. Studies have shown that time of day and day of week affect trauma admission volume; however, these studies were performed in cold climates. Data from 2000 to 2010 at a Level I trauma center were reviewed. Demographic, injury severity, and injury timing from 23,827 trauma patients were analyzed along with their emergency department disposition (operating room, intensive care unit, ward) and final outcome. Nighttime arrivals (NAs) accounted for 56.6 per cent and daytime arrivals accounted for 43.4 per cent of total admissions. The increase in NAs was most pronounced during the period from midnight to 6 am on weekends (P < 0.05). Also, the period from midnight to 6 am on weekends showed a significantly increased proportion of penetrating trauma (P < 0.01). Similarly, there was an increased rate of trauma arrivals needing emergent operative intervention in the period between midnight and 6 am on weekends when compared with any other time period (P < 0.01). In a southern Level I trauma center, patient volume varies nonrandomly with time. Emergent operative intervention is more likely between midnight and 6 am, the peak time for penetrating trauma. Because resident operative experience is maximized at night and on weekends, coverage during these periods should remain a priority for residency programs.     

Dangerous toys

Background: Motorcycles are sources of significant injury for children. There is limited data describing New Zealand's experience. The study's aim was to quantify the burden of motorcycle trauma presenting to Starship Children's Hospital by assessing the annual admission rates, severity and pattern of injuries, and patient mortality, and to compare injury patterns of those riding all‐terrain vehicles (ATV) and two‐wheeled motorbikes (MB). Methods: Retrospective chart review of all motorcycle trauma admissions to Starship Children's Hospital between November 1999 and December 2008. Patients were identified using the Starship Trauma Registry. Results: One hundred forty‐six admissions (123 MBs, 23 ATVs). Admissions have increased threefold in 9 years. Mean age was 10.5 years (range 2–14 years). ATV riders were significantly younger than MB riders (median 9 and 12 years, P = 0.001). Eighty‐five per cent of patients were male and New Zealand European. There were two deaths in the study. Median length of stay was 2 days (1–80 days); 7.4% required intensive care admission. The median injury severity score (ISS) was 4 (1–35). Twenty‐six per cent of ATV riders had an ISS >12, and 8.9% of MB riders had and ISS >12, P = 0.03. Eighty‐five per cent of patients with an ISS >12 were under 12 years. Sixty per cent of patients required an operative procedure. No difference in pattern of injuries between in ATVs and motorbikes. Conclusions: Motorcycle trauma admissions are increasing. ATV riders are more severely injured and younger than MB riders. Children <12 years are more likely to be severely injured in comparison to those >12 years.     

Are falls more common than road traffic accidents in pediatric trauma? Experience from a Level 1 trauma centre in New Delhi, India

Purpose: The epidemiology of pediatric trauma is different in different parts of the world. Some researchers suggest falls as the most common mechanism, whereas others report road traffic accidents (RTAs) as the most common cause. The aim of this study is to find out the leading cause of pediatric admissions in Trauma Surgery in New Delhi, India. Methods: Inpatient data from January 2012 to September 2014 was searched retrospectively in Jai Prakash Narayan Apex Trauma Centre Trauma Registry. All patients aged 18 years or less on index presentation admitted to surgical ward/ICU or later taken transfer by the Department of Trauma Surgery were included. Data were retrieved in predesigned proformas. Information thus compiled was coded in unique alphanumeric codes for each variable and subjected to statistical analysis using SPSS version 21. Results: We had 300 patients over a 33 month period. Among them, 236 (78.6%) were males and 64 (21.3%) females. Overall the predominant cause was RTAs in 132 (43%) patients. On subgroup analysis of up to 12 years age group (n=147), the most common cause was found to be RTAs again. However, falls showed an incremental upward trend (36.05% in up to 12 age group versus 27% overall), catching up with RTAs (44.89%). Pediatric Trauma Score (PTS) ranged from 0 to 12 with a mean of 8.12 ± 2.022. 223 (74.33%) patients experienced trauma limited to one anatomic region only, whereas 77 (25.66%) patients suffered polytrauma. 288 patients were discharged to home care. Overall, 12 patients expired in the cohort. Median hospital stay was 6 days (range 1e182). Conclusion: Pediatric trauma is becoming a cause of increasing concern, especially in the developing countries. The leading cause of admissions in Trauma Surgery is RTAs (43%) as compared to falls from height (27%); however, falls from height are showing an increasing trend as we move to younger age groups. Enhancing road safety alone may not be a lasting solution for prevention of pediatric trauma and local injury patterns must be taken into account when formulating policies to address this unique challenge.