Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children

Öz:

BACKGROUND: Motor vehicle collisions (MVCs) are the number one cause of death in the pediatric age group. The aim of this study was to determine the differences between MVCs and other trauma mechanisms (OTMs) in patients who were followed up at a pediatric intensive care unit (PICU). METHODS: Data were retrospectively collected for pediatric trauma patients hospitalized at a third level PICU between 2014 and 2018. Patients have been divided into two groups as MVC and OTM. Demographic data, pre-PICU interventions (cardiopulmonary resuscitation, intubation, injury severity scores, time period before intensive care), intensive care interventions (invasive mechanical ventilation, non-invasive mechanical ventilation, need for surgery, type of surgery, need for transfusion, and inotrope therapy) were compared between two groups. Outcomes were evaluated by survival, discharge from hospital, Pediatric Cerebral Performance Category (PCPC) at discharge, tracheotomy presence, and amputation performed. RESULTS: During the 5-year study period, 135 patients were hospitalized for trauma. The injured body regions were the head and neck (61.5%), abdomen and lumbar spine (39.4%), and extremities and pelvis (36.3%). Multiple trauma was mostly seen in the MVC trauma group (p=0.001). The need for invasive mechanical ventilation and inotrope therapy was greater in the MVC group (p=0.002, 0.001 respectively). One hundred and twenty-three patients (91.1%) survived. The mortality rate was higher in the MVC group (p=0.026). The PCPC results were better in the OTM group (p=0.017). CONCLUSION: MVCs lead to more multiple trauma cases than OTMs. Invasive mechanical ventilation, inotropes, and other intensive care interventions were necessary much more often in MVC victims than in OTM patients.

Anahtar Kelime:

Çocuklarda motorlu araç çarpışma travması ve diğer travma mekanizmalarının çocuk yoğun bakım öncesi ve çocuk yoğun bakım kabulünde uygulanan müdahaleler, klinik özellikler ve nörolojik sonuçların karşılaştırılması

Öz:

AMAÇ: Motorlu araç kazaları (MAK), pediatrik yaş grubunda bir numaralı ölüm nedenidir. Bu çalışmanın amacı, çocuk yoğun bakım ünitesinde (ÇYBÜ) takip edilen hastalarda MAK ile diğer travma mekanizmaları (DTM) arasındaki farklılıkları belirlemektir. GEREÇ VE YÖNTEM: 2014–2018 yılları arasında üçüncü düzey ÇYBÜ’de yatan pediatrik travma hastalarının veriler geriye dönük olarak kayıt edildi. Hastalar MAK ve DTM olarak iki gruba ayrıldı. Demografik veriler, yoğun bakım öncesi yapılan müdahaleler (kardiyopulmoner resüsitasyon, entübasyon, yaralanma şiddeti skorları, yoğun bakıma ulaşana kadar geçen süre), yoğun bakım müdahaleleri (invaziv mekanik ventilasyon, non-invaziv mekanik ventilasyon, ameliyat ihtiyacı, ameliyat türü, transfüzyon ihtiyacı ve inotrop tedavisi) iki grup arasında karşılaştırıldı. Sonuçlar sağkalım, hastaneden taburcu olma, taburculukta Pediatrik Serebral Performans Kategorisi (PSPK) ile değerlendirildi. BULGULAR: Beş yıllık çalışma süresi boyunca, 135 hasta travma nedeniyle hastaneye kaldırıldı. Yaralanan vücut bölgeleri baş ve boyun (%61.5), karın ve bel omurgası (%39.4) ve ekstremiteler ve pelvis (%36.3) idi. Çoklu travma en çok MAK travma grubunda görüldü (p=0.001). Motorlu araç kazaları grubunda invaziv mekanik ventilasyon ve inotrop tedavi ihtiyacı daha fazlaydı (sırasıyla, p=0,002, 0,001). Yüz yirmi üç hasta (%91.1) hayatta kaldı. Mortalite oranı MAK grubunda daha yüksekti (p=0.026). Pediatrik Serebral Performans Kategorisi sonuçları DTM grubunda daha iyiydi (p=0.017). TARTIŞMA: Motorlu araç kazaları, DTM’lerden daha fazla çoklu travma olgusuna yol açar. İnvaziv mekanik ventilasyon, inotroplar ve diğer yoğun bakım müdahaleleri, MAK hastalarında DTM hastalarına göre çok daha sık gerekliydi.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Committee on Pediatric Emergency Medicine, Council on Injury and Violence, and Poison Prevention, Section on Critical Care, Section on Orthopedics, Section on Surgery, Section on Transport Medicine, Pediatric Trauma Society, and Society of Trauma Nurses Pediatric Committee: Management of Pediatric Trauma. Pediatrics 2016;138:e20161569.
2. Svantner J, Dolci M, Heim C, Schoettker P. Pediatric trauma six years of experience in a Swiss trauma center. Pediatr Emerg Care 2021;37:e1133– 8.
3. Averello CT, Cantor RM. Pediatric major trauma: An approach to evaluation and management. Emerg Med Clin North Am 2007;25:803–36.
4. Roskind CR, Dayan PS, Klein BL. Acute care of victim of multiple trauma. In: Kliegman RM, editor. Nelson Textbook of Pediatrics. 20th ed. Philadelphia PA: Elsevier; 2016. p. 545–52.
5. NSW Institute of Trauma and Injury Management. Injury Scoring. Available from: http://www.aci.health.nsw.gov.au/get-involved/institue- of-trauma-and-injury-management/Data/injury-scoring. Accessed Dec 10, 2020.
6. Schoeneberg C, Schilling M, Keitel J, Burggraf M, Hussmann B, Lendemans S. Mortality in severely injured children: Experiences of a German level 1 trauma center (2002-2011). BMC Pediatr 2014;14:194.
7. Nance ML, Kallan MJ, Arbogast KB, Park MS, Durbin DR, Winston FK. Factors associated with clinically significant head injury in children involved in motor vehicle crashes. Traffic Inj Prev 2010;11:600–5.
8. Ludvigsson JF, Stiris T, Del Torso S, Mercier JC, Valiulis A, Hadjipanayis A. European Academy of Paediatrics Statement: Vision zero for child deaths in traffic accidents. Eur J Pediatr 2017;176:291–2.
9. Peden M, Oyegbite K, Ozanne-Smith J, Ashby K, Stathakis V. World Report on Child Injury Prevention. Available from: http://who.int. Accessed Nov 01, 2020.
10. Coulthard MG, Varghese V, Harvey LP, Gillen TC, Kimble RM, Ware RS. A review of children with severe trauma admitted to pediatric intensive care in Queensland, Australia. PLoS One 2019;14:e0211530.
11. Rhodes M, Smith S, Boorse D. Pediatric trauma patients in an “adult” trauma center. J Trauma 1993;35:384–92.
12. Franzen L, Ortenwall P, Backteman T. Children in Sweden admitted to intensive care after trauma. İnjury 2007;38:91–7.
13. Wetzel RC, Burns RC. Multiple trauma in children: Critical care overview. Crit Care Med 2002;30 Suppl:468–77.
14. White JR, Dalton HJ. Pediatric trauma: Postinjury care in the pediatric intensive care unit. Crit Care Med 2002;30 Suppl:478–88.
15. Mclaughlin C, Zagory JA, Fenlon M, Park C, Lane CJ, Meeker D, et al. Timing of mortality in pediatric trauma patients: A National Trauma Data Bank analysis. J Pediatr Surg 2018;53:344–51.
16. Huang YT, Huang YH, Hsieh CH, Li CJ, Chiu IM. Comparison of injury severity score, Glasgow coma scale, and revised trauma score in predicting the mortality and prolonged ICU stay of traumatic young children: A cross-sectional retrospective study. Emerg Med Int 2019;2019:5453624.
17. Champion HR, Sacco WJ, Hanna DS, Lepper RL, Atzinger ES, Copes WS, et al. Assessment of injury severity: The triage index. Crit Care Med 1980;8:201–8.

APA	Özcan S, Akyuzluer Gunes M, Havan M, perk o, azapağası e, Gün E, botan e, ergun e, Ates U, Kahilogullari G, KENDIRLI T (2022). Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children. , 456 - 463. 10.14744/tjtes.2022.86617
Chicago	Özcan Serhan,Akyuzluer Gunes Merve Setenay,Havan Merve,perk oktay,azapağası ebru,Gün Emrah,botan edin,ergun ergun,Ates Ufuk,Kahilogullari Gokmen,KENDIRLI TANIL Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children. (2022): 456 - 463. 10.14744/tjtes.2022.86617
MLA	Özcan Serhan,Akyuzluer Gunes Merve Setenay,Havan Merve,perk oktay,azapağası ebru,Gün Emrah,botan edin,ergun ergun,Ates Ufuk,Kahilogullari Gokmen,KENDIRLI TANIL Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children. , 2022, ss.456 - 463. 10.14744/tjtes.2022.86617
AMA	Özcan S,Akyuzluer Gunes M,Havan M,perk o,azapağası e,Gün E,botan e,ergun e,Ates U,Kahilogullari G,KENDIRLI T Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children. . 2022; 456 - 463. 10.14744/tjtes.2022.86617
Vancouver	Özcan S,Akyuzluer Gunes M,Havan M,perk o,azapağası e,Gün E,botan e,ergun e,Ates U,Kahilogullari G,KENDIRLI T Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children. . 2022; 456 - 463. 10.14744/tjtes.2022.86617
IEEE	Özcan S,Akyuzluer Gunes M,Havan M,perk o,azapağası e,Gün E,botan e,ergun e,Ates U,Kahilogullari G,KENDIRLI T "Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children." , ss.456 - 463, 2022. 10.14744/tjtes.2022.86617
ISNAD	Özcan, Serhan vd. "Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children". (2022), 456-463. https://doi.org/10.14744/tjtes.2022.86617

APA	Özcan S, Akyuzluer Gunes M, Havan M, perk o, azapağası e, Gün E, botan e, ergun e, Ates U, Kahilogullari G, KENDIRLI T (2022). Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children. Ulusal Travma ve Acil Cerrahi Dergisi, 28(4), 456 - 463. 10.14744/tjtes.2022.86617
Chicago	Özcan Serhan,Akyuzluer Gunes Merve Setenay,Havan Merve,perk oktay,azapağası ebru,Gün Emrah,botan edin,ergun ergun,Ates Ufuk,Kahilogullari Gokmen,KENDIRLI TANIL Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children. Ulusal Travma ve Acil Cerrahi Dergisi 28, no.4 (2022): 456 - 463. 10.14744/tjtes.2022.86617
MLA	Özcan Serhan,Akyuzluer Gunes Merve Setenay,Havan Merve,perk oktay,azapağası ebru,Gün Emrah,botan edin,ergun ergun,Ates Ufuk,Kahilogullari Gokmen,KENDIRLI TANIL Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children. Ulusal Travma ve Acil Cerrahi Dergisi, vol.28, no.4, 2022, ss.456 - 463. 10.14744/tjtes.2022.86617
AMA	Özcan S,Akyuzluer Gunes M,Havan M,perk o,azapağası e,Gün E,botan e,ergun e,Ates U,Kahilogullari G,KENDIRLI T Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children. Ulusal Travma ve Acil Cerrahi Dergisi. 2022; 28(4): 456 - 463. 10.14744/tjtes.2022.86617
Vancouver	Özcan S,Akyuzluer Gunes M,Havan M,perk o,azapağası e,Gün E,botan e,ergun e,Ates U,Kahilogullari G,KENDIRLI T Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children. Ulusal Travma ve Acil Cerrahi Dergisi. 2022; 28(4): 456 - 463. 10.14744/tjtes.2022.86617
IEEE	Özcan S,Akyuzluer Gunes M,Havan M,perk o,azapağası e,Gün E,botan e,ergun e,Ates U,Kahilogullari G,KENDIRLI T "Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children." Ulusal Travma ve Acil Cerrahi Dergisi, 28, ss.456 - 463, 2022. 10.14744/tjtes.2022.86617
ISNAD	Özcan, Serhan vd. "Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children". Ulusal Travma ve Acil Cerrahi Dergisi 28/4 (2022), 456-463. https://doi.org/10.14744/tjtes.2022.86617