Comparison of injury patterns and interventions between adolescent, adult and paediatric trauma cases: A cross-sectional review of TARN data

Mullen, Stephen; Tolson, Amy; Bouamra, Omar; Watson, Ben; Lyttle, Mark David; Roland, Damian; James, David

Abstract

Objectives The aim is to compare adolescent (10-24.99 years) trauma patterns and interventions to adult (≥25) and paediatric cases (<10) and to identify any transition points. Design and setting Data were collected from the Trauma and Audit Research Network (TARN) over a 10-year period. We conducted a retrospective cross-sectional analysis. Participants After exclusions there were 505 162 TARN eligible cases. Primary and secondary outcome measures To compare adolescent trauma patterns and interventions to those in paediatric and adult cohorts. Identify transition points for mechanism of injury (MOI) and interventions by individual year over the adolescent age range (10-24.99). Results Road traffic accidents are the most common MOI in the adolescent group, in contrast to both the paediatric and adult group where falls <2 m are most common. Violence-related injury (shootings and stabbings) are more common in the adolescent group, 9.4% compared with 0.3% and 1.5% in the paediatric and adult groups, respectively. The adolescent grouping had the highest median Injury Severity Score (ISS) and the highest proportion of interventions. The proportion of cases due to stabbing peaked at age 17 (11.8%) becoming the second most common MOI. The median ISS peaked at 13 at age 18. The percentage of cases that fulfil the definition of polytrauma enters double figures (11.8%) at age 15 reaching a peak of 17.6% at age 18. The use of blood products within the first 6 hours remains around 2% (1.6%-2.8%) until age 15 (3.4%), increasing to 4.7% at age 16. Conclusions Trauma patterns are more closely aligned between adult and paediatric cohorts than adolescence. The highest proportion of trauma interventions occur in the adolescent population. Analysing the adolescent cohort by year of age identified some common points for when descriptors or outcomes altered in frequency, predominantly between the ages of 15-17 years.

• Journal Article Type: Article
• Acceptance Date: Mar 30, 2023
• Online Publication Date: May 9, 2023
• Publication Date: May 9, 2023
• Deposit Date: May 26, 2023
• Publicly Available Date: May 30, 2023
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Issue: 5
• Article Number: e064101
• DOI: https://doi.org/10.1136/bmjopen-2022-064101
• Keywords: Paediatrics, trauma management, Child psychiatry, adolescent psychiatry, A&E, care, ambulatory care, emergency medicine, TARN, injury patterns, interventions, paediatric trauma, trauma
• Public URL: https://uwe-repository.worktribe.com/output/10800895
• Publisher URL: https://bmjopen.bmj.com/content/13/5/e064101