Paediatric major trauma: demographics, management and outcomes at Cork University Hospital

Objectives To establish the demographics, injury patterns, management and outcomes of paediatric major trauma patients at Cork University Hospital (CUH). Methods This was a retrospective, descriptive study. Data from all CUH paediatric major trauma cases that were recorded in the Trauma Audit and Research Network (TARN) database from January 2014 to July 2018 were examined. All patients were under the age of sixteen and fulfilled NOCA's Major Trauma Audit inclusion criteria (Appendix). Results A total of 163 patients were included, with a mean age of 9 years (standard deviation 4.8 years); 33% (n = 54) had an Injury Severity Score (ISS) > 15. The majority (62%) was male. Paediatric trauma accounts for 6% of TARN eligible cases at CUH. The most common mechanism of injury was falls < 2 m (35%) followed by road trauma (26%). Fifty-one percent were brought by ambulance; 45% self presented. Six percent were transferred out of CUH for definitive care. Limb injuries occurred in 45% of patients (n = 74) and head injury in 29% (n = 47). Head injuries were isolated in 62% (n = 29). Injuries to chest or face were rarely isolated. The mean ISS was 12 (SD 7). The majority of patients (62%) presented out of hours. The median length of stay was 5 days (Interquartile range 3-8 days). Four patients died (mortality rate 2%), all male, two due to head injury and two due to asphyxia by hanging. Conclusions Paediatric trauma is of low volume, creating challenges in terms of preparedness. The annual number of paediatric major trauma presentations to CUH, including road trauma cases, remains roughly constant.