Skip to main content

Prehospital and Early Clinical Care of Infants, Children, and Teenagers Compared to an Adult Cohort

Analysis of 2,961 Children in Comparison to 21,435 Adult Patients from the Trauma Registry of DGU in a 15-Year Period

European Journal of Trauma and Emergency Surgery volume 36, pages 300–307 (2010)Cite this article

Abstract

Background:

Although the incidence of pediatric patients in emergency services is as low as 5–10%, trauma remains one of the leading causes of death during childhood. Only a few reports exist about the quality of the initial treatment of pediatric trauma patients. Therefore, we tested the hypothesis of whether prehospital treatment and emergency management in pediatric trauma patients is similar to the treatment that is provided for adult patients.

Materials and Methods:

We performed a retrospective data analysis of the German Trauma Registry of the DGU from January 1993 to December 2007. Exclusion criteria were missing information about injury severity and/or age and patients older than 50 years. All pediatric patients were subdivided into five groups (infants 0–1 year, toddlers 2–5 years, children 6–9 years, pupils 10–13 years, teenagers 14–17 years) with regard to their age and were compared with the adult cohort (18–50 years). From 24,396 patients, 2,961 were below 18 years of age, thus, about 12% of the whole population of injured patients below the age of 50 years.

Results:

66.4% of infants sustained relevant head injuries (Abbreviated Injury Scale [AIS] ≥3), and this rate declined with increasing age. The mean Injury Severity Score (ISS) increased from 21.0 (±11.6) in the group of infants to 26.7 (±13.9) in the adult cohort. In all groups, the majority of patients were male. The injury pattern differed according to age, with predominant traumatic brain injury (TBI) in infants. During the preclinical treatment, infants were less often intubated and this was contrasted by a higher rate of cardiopulmonary resuscitation in this group (infants 16.2%, toddlers 6.8%, adults 3.1%). Diagnostic multislice computed tomography (CT) examination was less often performed in infants as compared to the other groups (infants 57.1%, toddlers 77.2%, adults 77.8%). Mortality and quality indicators such as timelines show no significant differences between children and adults.

Conclusion:

We observed typical age-dependent differences regarding the injury pattern and severity and differences referring to the preclinical and initial treatment. With respect to the high rate of serious TBI in the infants and toddlers age groups, a more focused education and training of emergency physicians and paramedics should be considered.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Schlechtriemen T, Masson R, Burghofer K, Lackner CK, Altemeyer KH. Pediatric cases in preclinical emergency medicine: critical aspects in the range of missions covered by ground ambulance and air rescue services. Anaesthesist 2006;55:255–62.

    CAS  Article  PubMed  Google Scholar 

  2. Schelhase T, Rübenach SP. Die Todesursachenstatistik—Methodik und Ergebnisse 2004. Wirtschaft und Statistik 2006;6:614–29.

    Google Scholar 

  3. Gatzka C, Begemann PG, Wolff A, Zörb J, Rueger JM, Windolf J. Injury pattern and clinical course of children with multiple injuries in comparison to adults, Ab 11-year analysis at a clinic of maximum utilization. Unfallchirurg 2005;108:470–80.

    CAS  Article  PubMed  Google Scholar 

  4. Schmidt U, Geerling J, Fühler M, Hubrich V, Richter M, Krettek C. Pediatric prehospital trauma care. A retrospective comparison of air and ground transportation. Unfallchirurg 2002;105:1000–6.

    CAS  Article  PubMed  Google Scholar 

  5. Suominen P, Baillie C, Kivioja A, Korpela R, Rintala R, Silfvast T, Olkkola KT. Prehospital care and survival of pediatric patients with blunt trauma. J Pediatr Surg 1998;33:1388–92.

    CAS  Article  PubMed  Google Scholar 

  6. Laurer H, Wutzler S, Wyen H, Westhoff J, Lehnert M, Lefering R, Marzi I; Sektion NIS der DGU. Quality of prehospital and early clinical care of pediatric trauma patients of school age compared to an adult cohort. A matched-pair analysis of 624 patients from the DGU trauma registry. Unfallchirurg 2009;112:771–7.

    CAS  Article  PubMed  Google Scholar 

  7. Jakob H, Brand J, Marzi I. Multiple trauma in pediatric patients. Unfallchirurg 2009;112:951–8.

    CAS  Article  PubMed  Google Scholar 

  8. Sharples PM, Storey A, Aynsley-Green A, Eyre JA. Avoidable factors contributing to death of children with head injury. BMJ 1990;300:87–91.

    CAS  Article  PubMed  Google Scholar 

  9. Huber-Wagner S, Lefering R, Qvick LM, Körner M, Kay MV, Pfeifer KJ, Reiser M, Mutschler W, Kanz KG; Working Group on Polytrauma of the German Trauma Society. Effect of wholebody CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 2009;373:1455–61.

    Article  PubMed  Google Scholar 

  10. Kanz KG, Huber-Wagner S, Lefering R, Kay M, Qvick M, Biberthaler P, Mutschler W. Estimation of surgical treatment capacity for managing mass casualty incidents based on time needed for life-saving emergency operations. Unfallchirurg 2006;109:278–84.

    Article  PubMed  Google Scholar 

  11. Maegele M, Lefering R, Yucel N, Tjardes T, Rixen D, Paffrath T, Simanski C, Neugebauer E, Bouillon B; AG Polytrauma of the German Trauma Society (DGU). Early coagulopathy in multiple injury: an analysis from the German Trauma Registry on 8724 patients. Injury 2007;38:298–304.

    Article  PubMed  Google Scholar 

  12. Weiss M, Bernoulli L, Zollinger A. The NACA scale. Construct and predictive validity of the NACA scale for prehospital severity rating in trauma patients. Anaesthesist 2001;50:150–4.

    CAS  Article  PubMed  Google Scholar 

  13. Wutzler S, Lefering R, Laurer HL, Walcher F, Wyen H, Marzi I; NIS (Notfall-, Intensivmedizin und Schwerverletztenversorgung) der DGU. Changes in geriatric traumatology. An analysis of 14,869 patients from the German Trauma Registry. Unfallchirurg 2008;111:592–8.

    CAS  Article  PubMed  Google Scholar 

  14. Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187–96.

    CAS  Article  PubMed  Google Scholar 

  15. Association for the Advancement of Automotive Medicine. Abbreviated Injury Scale (AIS) 1990 Revision — update 1998. Barlington: Association for the Advancement of Automotive Medicine, 1998.

    Google Scholar 

  16. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81–4.

    CAS  Article  PubMed  Google Scholar 

  17. Nagele P, Hüpfl M, Kroesen G. Epidemiology and outcome of pediatric trauma treated by an emergency-physician-staffed advanced life-support unit. Wien Klin Wochenschr 2004;116:398–403.

    Article  PubMed  Google Scholar 

  18. Agran PF, Anderson C, Winn D, Trent R, Walton-Haynes L, Thayer S. (2003) Rates of pediatric injuries by 3-month intervals for children 0 to 3 years of age. Pediatrics 111:e683–92.

    Article  PubMed  Google Scholar 

  19. Soreide K, Krüger AJ, Ellingsen CL, Tjosevik KE. Pediatric trauma deaths are predominated by severe head injuries during spring and summer. Scand J Trauma Resusc Emerg Med 2009;17:3.

    Article  PubMed  Google Scholar 

  20. Dykes EH. Paediatric trauma. Br J Anaesth 1999;83:130–8.

    CAS  PubMed  Google Scholar 

  21. Ruchholtz S. The trauma network of the German Society of Accident Surgery. Chirurg 2007(Suppl):266–7.

  22. Cowley RA. The resuscitation and stabilization of major multiple trauma patients in a trauma center environment. Clin Med 1976;83:16–22.

    Google Scholar 

  23. Paul TR, Marias M, Pons PT, Pons KA, Moore EE. Adult versus pediatric prehospital trauma care: is there a difference? J Trauma 1999;47:455–9.

    CAS  Article  PubMed  Google Scholar 

  24. Schmitz B, Albrecht S. Pediatric trauma anesthesia. Curr Opin Anaesthesiol 2002;15:187–91.

    Article  PubMed  Google Scholar 

  25. Meyer PG, Orliaguet G, Blanot S, Jarreau MM, Charron B, Sauverzac R, Carli P. Complications of emergency tracheal intubation in severely head-injured children. Paediatr Anaesth 2000;10:253–60.

    CAS  Article  PubMed  Google Scholar 

  26. Capizzani AR, Drongowski R, Ehrlich PF. Assessment of termination of trauma resuscitation guidelines: are children small adults? J Pediatr Surg 2010;45:903–7.

    Article  PubMed  Google Scholar 

  27. Chwals WJ, Robinson AV, Sivit CJ, Alaedeen D, Fitzenrider E, Cizmar L. Computed tomography before transfer to a level I pediatric trauma center risks duplication with associated increased radiation exposure. J Pediatr Surg 2008;43:2268–72.

    Article  PubMed  Google Scholar 

  28. Wyen H, Wutzler S, Rüsseler M, Mack M, Walcher F, Marzi I. Five years experience of trauma care in a German urban level I university trauma center. Eur J Trauma Emerg Surg 2009;35:448–54.

    Article  Google Scholar 

  29. Hammad A-MM, Regal MA. Is routine spiral CT-chest justified in evaluation of the major blunt trauma patients? Eur J Trauma Emerg Surg 2009;35:31–4.

    Article  Google Scholar 

  30. Wilson JRF, Green A. Acute traumatic brain injury: a review of recent advances in imaging and management. Eur J Trauma Emerg Surg 2009;35:176–85.

    Article  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany

    Hendrik Wyen MD, Heike Jakob, Sebastian Wutzler, Helmut L. Laurer, Ingo Marzi & Mark Lehnert

  2. IFOM, Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany

    Rolf Lefering

  3. Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe University, Theodor Stern Kai 7, D-60590, Frankfurt, Germany

    Hendrik Wyen MD

Authors
  1. Hendrik Wyen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heike Jakob
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sebastian Wutzler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rolf Lefering
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Helmut L. Laurer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ingo Marzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mark Lehnert
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The Trauma Registry of DGU

Corresponding author

Correspondence to Hendrik Wyen MD.

Additional information

The Trauma Registry of DGU: Committee on Emergency Medicine, Intensive and Trauma Care (Sektion NIS) of the German Society for Trauma Surgery (DGU).

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wyen, H., Jakob, H., Wutzler, S. et al. Prehospital and Early Clinical Care of Infants, Children, and Teenagers Compared to an Adult Cohort. Eur J Trauma 36, 300–307 (2010). https://doi.org/10.1007/s00068-010-1124-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-010-1124-4

Key Words

  • Polytrauma management including prehospital and shockroom
  • Pediatric
  • Prehospital care
  • Multiple trauma
  • Pediatric trauma