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  • Title: Increased mortality rates of young children with traumatic injuries at a US army combat support hospital in Baghdad, Iraq, 2004.
    Author: Matos RI, Holcomb JB, Callahan C, Spinella PC.
    Journal: Pediatrics; 2008 Nov; 122(5):e959-66. PubMed ID: 18977963.
    Abstract:
    OBJECTIVE: The objective of this study was to determine whether age <or=8 y is an independent predictor of mortality in noncoalition trauma patients at a US combat support hospital. METHODS: A retrospective chart review was conducted of 1132 noncoalition trauma patients who were admitted to a combat support hospital between December 2003 and December 2004. Data on age, severity of injury indices, and in-hospital mortality rates were analyzed. All variables that were associated with death on univariate analysis were analyzed by multivariate logistic regression to determine independent associations with mortality. RESULTS: There were 38 young pediatric patients (aged <or=8 years) and 1094 older pediatric and adult patients (aged >8 years). Penetrating trauma accounted for 83% of all injuries. Young pediatric patients compared with older pediatric and adult patients had increased severity of injury indicated by decreased Glasgow Coma Scale score; increased incidence of hypotension, base deficit, and serum pH on admission; red blood cell transfusion amount; and increased injury severity scores on admission. Young pediatric patients compared with older pediatric and adult patients also had increased ICU lengths of stay (median 2 [interquartile range 0-5] vs median 0 [interquartile range 0-2] days) and in-hospital mortality rate (18% vs 4%), respectively. Multivariate logistic regression indicated that base deficit, injury severity score of >or=15, Glasgow Coma Scale score of <or=8, and age of <or=8 years were independently associated with mortality. CONCLUSIONS: Young children who present to a combat support hospital have increased severity of injury compared with older children and adults. In a population with primarily penetrating injuries, after adjustment for severity of injury, young children may also have an independent increased risk for death compared with older children and adults. Providing forward-deployed medical staff with pediatric-specific equipment and training in the acute care of young children with severe traumatic injuries may improve outcomes in this population.
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