The effect of patient age upon survival in pediatric trauma.

Developmental changes in the anatomy and physiology of growing children are thought to improve the survivability of older children to significant injury. The effect of age upon survival, however, is poorly defined. Data for 4,615 patients less than 15 years old from a statewide trauma center registry were analyzed. Injury and survival were characterized by Abbreviated Injury Scale (AIS, 1985 revision), Injury Severity Score (ISS), Revised Trauma Score (RTS), and probability of survival [P(s)] and Z by TRISS. Patients were separated into age groups of 0 through 4, 5 through 9, and 10 through 14 years. The survival rate for patients with a maximum AIS 3 for any region was significantly higher in the 10-14-year age group. There were no significant differences in survival rates from head, thoracic, and abdominal injuries stratified by AIS among the three age groups. Survival rates for ISS cohorts were consistently lowest in the 0-4-year age group, but differences failed to reach significance. Survival for RTS and P(s) intervals were similar for all ages. The Z statistic reached significance for all children (Z = 4.717, W = 1.049), and for each group (Z = 2.203-3.029). Corresponding values of the W statistic suggest approximately one additional unexpected survivor per 100 admitted children when compared with the Major Trauma Outcome Study. Logistic regression for patients with all data required for TRISS showed no significant effect for any of the three age groups. We conclude that for this patient set, survival after childhood injury is independent of the age groups used in this study, after controlling for injury severity.