Jordan Evans
Mortality in adolescent trauma: A comparison of children's, mixed and adult major trauma centres
Evans, Jordan; Murch, Hannah; Begley, Roisin; Roland, Damian; Lyttle, Mark D; Bouamra, Omar; Mullen, Stephen
Authors
Hannah Murch
Roisin Begley
Damian Roland
Mark Lyttle mark.lyttle@uwe.ac.uk
Omar Bouamra
Stephen Mullen
Abstract
Objective: We aimed to compare adolescent mortality rates between different types of major trauma centre (MTC or level 1; adult, children's and mixed). Methods: Data were obtained from TARN (Trauma Audit Research Network) from English sites over a 6-year period (2012-2018), with adolescence defined as 10-24.99 years. Results are presented using descriptive statistics. Patient characteristics were compared using the Kruskal-Wallis test with Dunn's post-hoc analysis for pairwise comparison and χ2 test for categorical variables. Results: 21 033 cases met inclusion criteria. Trauma-related 30-day crude mortality rates by MTC type were 2.5% (children's), 4.4% (mixed) and 4.9% (adult). Logistic regression accounting for injury severity, mechanism of injury, physiological parameters and 'hospital ID', resulted in adjusted odds of mortality of 2.41 (95% CI 1.31 to 4.43; p=0.005) and 1.85 (95% CI 1.03 to 3.35; p=0.041) in adult and mixed MTCs, respectively when compared with children's MTCs. In three subgroup analyses the same trend was noted. In adolescents aged 14-17.99 years old, those managed in a children's MTC had the lowest mortality rate at 2.5%, compared with 4.9% in adult MTCs and 4.4% in mixed MTCs (no statistical difference between children's and mixed). In cases of major trauma (Injury Severity Score >15) the adjusted odds of mortality were also greater in the mixed and adult MTC groups when compared with the children's MTC. Median length of stay (LoS) and intensive care unit LoS were comparable for all MTC types. Patients managed in children's MTCs were less likely to have a CT scan (46.2% vs 62.8% mixed vs 64% adult). Conclusions: Children's MTC have lower crude and adjusted 30-day mortality rates for adolescent trauma. Further research is required in this field to identify the factors that may have influenced these findings.
Journal Article Type | Article |
---|---|
Acceptance Date | Feb 22, 2021 |
Online Publication Date | Mar 30, 2021 |
Publication Date | 2021 |
Deposit Date | Apr 13, 2021 |
Publicly Available Date | Apr 13, 2021 |
Journal | Emergency Medicine Journal |
Print ISSN | 1472-0205 |
Electronic ISSN | 1472-0213 |
Publisher | BMJ Publishing Group |
Peer Reviewed | Peer Reviewed |
Volume | 38 |
Issue | 7 |
Pages | 488-494 |
DOI | https://doi.org/10.1136/emermed-2020-210384 |
Keywords | Critical Care and Intensive Care Medicine; Emergency Medicine; General Medicine |
Public URL | https://uwe-repository.worktribe.com/output/7244253 |
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Mortality in Adolescent Trauma – A Comparison of Children’s, Mixed and Adult Major Trauma Centres
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This article has been accepted for publication in Emergency Medicine Journal (2021) following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/emermed-2020-211105.
© BMJ Publishing Group Ltd. Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) http://creativecommons.org
Mortality in adolescent trauma: A comparison of children’s, mixed and adult major trauma centres
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Document
Licence
http://creativecommons.org/licenses/by-nc/4.0/
Publisher Licence URL
http://www.rioxx.net/licenses/all-rights-reserved
Copyright Statement
This article has been accepted for publication in Emergency Medicine Journal (2021) following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/emermed-2020-211105.
© BMJ Publishing Group Ltd. Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) http://creativecommons.org
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