Paediatric trauma: urban epidemiology and an analysis of methods for assessing the severity of trauma in 598 injured children.

This study is based on a 12 month prospective analysis of 598 paediatric trauma admissions, drawn principally from an urban environment. The spectrum of trauma is described, highlighting the minor nature of most injuries and the rarity of penetrating trauma. A subgroup of seriously injured children was identified and further analysed. All deaths were examined. The predictive value of the Trauma Score (TS) and Method of Injury (MOI) were assessed in terms of eventual injury severity using the Injury Severity Score (ISS), and morbid outcome. Most of the patients were not seriously injured, and sustained single system injury only. The injuries were related principally to falls (62%). Seventy-nine children (13%) were identified as seriously injured (ISS greater than or equal to 16). In this group pedestrian injuries were the major cause of injury (29%). Amongst seriously injured children, cranial injury was identified in 91%, followed by abdominal injury in 33%. There were nine deaths in the series, representing 1.5% of all paediatric trauma admissions, and 11% of seriously injured patients. All deaths were associated with a significant head injury. Although the TS had a specificity of 99% in predicting serious injury and a positive predictive value of 94%, its sensitivity was only 26%. The MOI was associated with an overtriage rate of 200%. Of children admitted following pedal cycle accidents, 86% of the total and 91% of seriously injured children were not wearing a helmet. Of passengers in a motor car, 37% of the total number were unrestrained. The results suggest triage in children requires more than a physiological measure (TS) or MOI.(ABSTRACT TRUNCATED AT 250 WORDS)