Abstract

Objective:

Vital signs and trauma scores of pediatric trauma patients affect morbidity and length of stay in the intensive care unit; treatment and follow-up of appropriate trauma patients in experienced centers is of great importance. This study aimed to determine the demographic data, clinical findings and scoring systems, and respiratory and circulatory support requirements of trauma patients during their follow-up in the pediatric intensive care unit(PICU) and investigate the effects of these factors on the length of PICU and hospital stay and mortality.

Materials and Methods:

Demographic and clinical findings of 49 pediatric patients who were hospitalized in the PICU because of trauma were prospectively recorded for 16 months. Data on the length of PICU and hospital stay, trauma mechanisms, and affected organ systems were collected.

Results:

The most frequent etiology of trauma was falling from heights in 36.7% of the patients. Mechanical ventilation (MV) was necessary in 18.4% of the cases, and the mean duration for MV was 48 (12-306) hours. When MV need was evaluated concerning vital findings, the findings showed that patients with bradypnea needed MV more (p=0.004). MV was needed in 66.7% of hypotensive patients, and there was a statistically significant difference between blood pressure and MV requirement (p=0.005). GCS and length of PICU stay were correlated (p=0.02). PICU (p=0.005, p=0.005, p=0.001) and hospital stay (p=0.02, p=0.01, p=0.04) were statistically significantly longer in patients who had blood products, inotropic agents and MV

Conclusion:

The effects of initial vital signs and trauma scores on morbidity and length of PICU stay of pediatric trauma patients, as well as the importance of treatment and follow-up of appropriate patients in experienced centers, have been shown in our study.

Keywords: Pediatric trauma, trauma scores, vital signs

References

  1. Tambay G, Satar S, Kozacı N, Açıkalın A, Ay MO, Gülen M, et al. Retrospective analysis of pediatric trauma cases admitted to the emergency medicine department. JAEM 2013;12:8-12.
  2. Grinkeviciūte DE, Kevalas R, Saferis V, Matukevicius A, Ragaisis V, Tamasauskas A. Predictive value of scoring system in severe pediatric head injury. Medicina (Kaunas) 2007;43:861-9.
  3. Melek M, Çobanoğlu U, Bilici S, Ceylan A, Beğer B, Epçaçan S. General approach to the childhood trauma. Van Med J 2013;20:266-73.
  4. Turan Y, Uysal C, Korkmaz M, Yılmaz T, Göçmez C, Özevren H, et al. Evaluation of patients who admitted to hospital due to accidentally falling objects on them. Dicle Med J 2015;42:51-4.
  5. Cause of Death Statistics, 2018. Turkish Statistical Institute. https://data.tuik.gov.tr
  6. Yılmaz G. Approach to multi-trauma in children and scoring systems. TOTBİD Dergisi 2019;18:313-9.
  7. Osler TM, Vane DW, Tepas JJ, Rogers FB, Shackford SR, Badger GJ. Do pediatric trauma centers have better survival rates than adult trauma centers? An examination of the National Pediatric Trauma Registry. J Trauma 2001;50:96-101.
  8. Marcin JP, Pollack MM. Triage scoring systems, severity of illness measures, and mortality prediction models in pediatric trauma. Crit Care Med 2002;30(11 Suppl):457-67.
  9. Hannan EL, Farrell LS, Meaker PS, Cooper A. Predicting inpatient mortality for pediatric trauma patients with blunt injuries: a better alternative. J Pediatr Surg 2000;35:155-9.
  10. Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol 2014;13:844-54.
  11. Ramenofsky ML, Ramenofsky MB, Jurkovich GJ, Threadgill D, Dierking BH, Powell RW. The predictive validity of the Pediatric Trauma Score. J Trauma 1988;28:1038-42.
  12. Lecuyer M. Calculated Decisions: Pediatric Trauma Score (PTS). Pediatr Emerg Med Pract 2019;16:3-4.
  13. Pollack MM, Ruttimann UE, Getson PR. Pediatric risk of mortality (PRISM) score. Crit Care Med 1988;16:1110-6.
  14. Leteurtre S, Martinot A, Duhamel A, Gauvin F, Grandbastien B, Nam TV, et al. Development of a pediatric multiple organ dysfunction score: use of two strategies. Med Decis Making 1999;19: 399-410.
  15. Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med 2013;39:1190-206.
  16. Rasulo FA, Bertuetti R. Transcranial Doppler and optic nerve sonography. J Cardiothorac Vasc Anesth 2019;33(Suppl 1):38-52.
  17. Drayna PC, Abramo TJ, Estrada C. Near-infrared spectroscopy in the critical setting. Pediatr Emerg Care 2011;27:440-2.
  18. Wohlgemut JM, Morrison JJ, Apodaca AN, Egan G, Sponseller PD, Driver CP, et al. Demographic and geographical characteristics of pediatric trauma in Scotland. J Pediatr Surg 2013;48:1593-7.
  19. Öztan MO, Anıl M, Anıl AB, Yaldız D, Uz İ, Turgut A, et al. First step toward a better trauma management: Initial results of the Northern Izmir Trauma Registry System for children. Ulus Travma Acil Cerrahi Derg 2019;25:20-8.
  20. Yousefzadeh Chabok S, Ranjbar Taklimie F, Malekpouri R, Razzaghi A. Predicting mortality, hospital length of stay and need for surgery in pediatric trauma patients. Chin J Traumatol 2017;20:339-42.
  21. Alonge O, Hyder AA. Reducing the global burden of childhood unintentional injuries. Arch Dis Child 2014;99:62-9.
  22. Korkmaz T, Erkol Z, Kahramansoy N. Evaluation of Pediatric Forensic Cases in Emergency Department: A Retrospective Study. Med Bull Haseki 2014;52:271-7.
  23. Simon R, Gilyoma JM, Dass RM, Mchembe MD, Chalya PL. Paediatric injuries at Bugando Medical Centre in Northwestern Tanzania: a prospective review of 150 cases. J Trauma Manag Outcomes 2013;7:10.
  24. Atike Ongun E, Dursun O. Prediction of mortality in pediatric traumatic brain injury: Implementations from a tertiary pediatric intensive care facility. Ulus Travma Acil Cerrahi Derg 2018;24:199-206.
  25. Mayer T, Walker ML, Johnson DG, Matlak ME. Causes of morbidity and mortality in severe pediatric trauma. JAMA 1981;245:719-21.
  26. Serinken M, Ozen M. Pediyatrik yaş grubunda trafik kazası sonucu oluşan yaralanmalar ve özellikleri [Characteristics of injuries due to traffic accidents in the pediatric age group]. Ulus Travma Acil Cerrahi Derg 2011;17:243-7.
  27. Anıl M, Saritas S, Bicilioglu Y, Gokalp G, Kamit Can F, Anıl AB. The Performance of the Pediatric Trauma Score in a Pediatric Emergency Department: A Prospective Study. J Pediatr Emerg Intensive Care Med 2017;4:1-7.
  28. Melo JR, Di Rocco F, Lemos-Júnior LP, Roujeau T, Thélot B, Sainte-Rose C, et al. Defenestration in children younger than 6 years old: mortality predictors in severe head trauma. Childs Nerv Syst 2009;25:1077-83.
  29. Doğan Z, Kukul Guven FM, Cankorkmaz L, Korkmaz I, Coşkun A, Döleş KA. Evaluation of pediatric cases presenting to the emergency department of our hospital because of trauma. Turk Arch Pediatr 2011;46:156-60.
  30. Narci A, Solak O, Turhan-Haktanir N, Ayçiçek A, Demir Y, Ela Y, et al. The prognostic importance of trauma scoring systems in pediatric patients. Pediatr Surg Int 2009;25:25-30.

How to cite?

1.
Sapmaz Tohumcuoğlu M, Mısırlıoğlu M, Yöntem A, Ekinci F, Yıldızdaş D, Horoz ÖÖ. Initial Vital Signs in Traumatized Children Determine the Length of Stay in Intensive Care Unit. Turk J Intensive Care. 2023;22(2):101-109. https://doi.org/10.4274/tybd.galenos.2023.05902