Skip to main content
Erschienen in: European Journal of Pediatrics 8/2006

01.08.2006 | Original Paper

Severe outcome of children following trauma resulting from road accidents

verfasst von: Etienne Javouhey, Anne-Céline Guérin, Emmanuèle Amoros, Mouloud Haddak, Amina Ndiaye, Daniel Floret, Mireille Chiron

Erschienen in: European Journal of Pediatrics | Ausgabe 8/2006

Einloggen, um Zugang zu erhalten

Abstract

Objective

The aim of the study was to determine the risk factors of a severe outcome for children severely injured [killed or with an Injury Severity Score (ISS) ≥16] in a road accident.

Materials and methods

Casualties that occurred between 1996 and 2001 which involved children under 14 years of age were assessed in a population-based study based on data included in a French road trauma Registry. A severe traumatic brain injury (TBI) was defined as a head injury with an Abbreviated Injury Scale (AIS) severity score ≥3. A multivariate logistic regression was performed to quantify the risk of a “severe outcome” defined as death or an expected serious impairment 1 year later.

Results

The annual incidence of an ISS of 16+ was 7.7 per 100,000 children. Among the 126 severely injured children included in this study, 40 died (including 16 immediate deaths), and a severe outcome was expected for 54 of the 86 survivors. Children with an “isolated severe TBI” and those with “multiple injuries including TBI” were more likely to have a severe outcome than those who had an “isolated severe injury without TBI” (OR: 7.91; 95%CI: 1.43–43.77 and OR: 8.37; 95%CI: 1.52–46.13, respectively). Age was inversely linked to a severe outcome. The unprotected motor vehicle occupants (MVO) had an odds ratio of 7.56 (95%CI: 1.07–53.56) compared to the protected MVO. Only 30% of children who survived a severe TBI were admitted to rehabilitation.

Conclusion

The mechanism of the injury, an injury pattern involving the head and a young age were associated with a severe outcome following a road accident. A majority of children severely injured were not referred to inpatient rehabilitation.
Literatur
1.
Zurück zum Zitat AAAM (1990) The abbreviated injury scale, 1990 revision, Des Plaines, Ill AAAM (1990) The abbreviated injury scale, 1990 revision, Des Plaines, Ill
2.
Zurück zum Zitat AAAM (1994) Injury Impairment Scale, Des Plaines, IlI AAAM (1994) Injury Impairment Scale, Des Plaines, IlI
3.
Zurück zum Zitat Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 15. Surgical treatment of pediatric intracranial hypertension. Pediatr Crit Care Med 4:S56–S59PubMedCrossRef Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW (2003) Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 15. Surgical treatment of pediatric intracranial hypertension. Pediatr Crit Care Med 4:S56–S59PubMedCrossRef
4.
Zurück zum Zitat Anderson VA, Morse SA, Klug G, Catroppa C, Haritou F, Rosenfeld J, Pentland L (1997) Predicting recovery from head injury in young children: a prospective analysis. J Int Neuropsychol Soc 3:568–580PubMed Anderson VA, Morse SA, Klug G, Catroppa C, Haritou F, Rosenfeld J, Pentland L (1997) Predicting recovery from head injury in young children: a prospective analysis. J Int Neuropsychol Soc 3:568–580PubMed
5.
Zurück zum Zitat Baker SP, O’Neill B, Haddon W Jr., Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196PubMed Baker SP, O’Neill B, Haddon W Jr., Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196PubMed
6.
Zurück zum Zitat Bayir H, Clark RS, Kochanek PM (2003) Promising strategies to minimize secondary brain injury after head trauma. Crit Care Med 31:S112–S117PubMedCrossRef Bayir H, Clark RS, Kochanek PM (2003) Promising strategies to minimize secondary brain injury after head trauma. Crit Care Med 31:S112–S117PubMedCrossRef
7.
Zurück zum Zitat Boyer MG, Edwards P (1991) Outcome 1 to 3 years after severe traumatic brain injury in children and adolescents. Injury 22:315–320PubMedCrossRef Boyer MG, Edwards P (1991) Outcome 1 to 3 years after severe traumatic brain injury in children and adolescents. Injury 22:315–320PubMedCrossRef
8.
Zurück zum Zitat Calkins CM, Bensard DD, Moore EE, McIntyre RC, Silliman CC, Biffl W, Harken AH, Partrick DA, Offner PJ (2002) The injured child is resistant to multiple organ failure: a different inflammatory response? J Trauma 53:1058–1063PubMed Calkins CM, Bensard DD, Moore EE, McIntyre RC, Silliman CC, Biffl W, Harken AH, Partrick DA, Offner PJ (2002) The injured child is resistant to multiple organ failure: a different inflammatory response? J Trauma 53:1058–1063PubMed
9.
Zurück zum Zitat Cantais E, Paut O, Giorgi R, Viard L, Camboulives J (2001) Evaluating the prognosis of multiple, severely traumatized children in the intensive care unit. Intens Care Med 27:1511–1517CrossRef Cantais E, Paut O, Giorgi R, Viard L, Camboulives J (2001) Evaluating the prognosis of multiple, severely traumatized children in the intensive care unit. Intens Care Med 27:1511–1517CrossRef
10.
Zurück zum Zitat Emanuelson I, Wendt L van (1997) Epidemiology of traumatic brain injury in children and adolescents in south-western Sweden. Acta Paediatr 86:730–735PubMedCrossRef Emanuelson I, Wendt L van (1997) Epidemiology of traumatic brain injury in children and adolescents in south-western Sweden. Acta Paediatr 86:730–735PubMedCrossRef
11.
Zurück zum Zitat Ewing-Cobbs L, Fletcher JM, Levin HS, Francis DJ, Davidson K, Miner ME (1997) Longitudinal neuropsychological outcome in infants and preschoolers with traumatic brain injury. J Int Neuropsychol Soc 3:581–591PubMed Ewing-Cobbs L, Fletcher JM, Levin HS, Francis DJ, Davidson K, Miner ME (1997) Longitudinal neuropsychological outcome in infants and preschoolers with traumatic brain injury. J Int Neuropsychol Soc 3:581–591PubMed
12.
Zurück zum Zitat Fay GC, Jaffe KM, Polissar NL, Liao S, Rivara JB, Martin KM (1994) Outcome of pediatric traumatic brain injury at three years: a cohort study. Arch Phys Med Rehabil 75:733–741PubMed Fay GC, Jaffe KM, Polissar NL, Liao S, Rivara JB, Martin KM (1994) Outcome of pediatric traumatic brain injury at three years: a cohort study. Arch Phys Med Rehabil 75:733–741PubMed
13.
Zurück zum Zitat Fletcher JM, Levin HS, Lachar D, Kusnerik L, Harward H, Mendelsohn D, Lilly MA (1996) Behavioral outcomes after pediatric closed head injury: relationships with age, severity, and lesion size. J Child Neurol 11:283–290PubMed Fletcher JM, Levin HS, Lachar D, Kusnerik L, Harward H, Mendelsohn D, Lilly MA (1996) Behavioral outcomes after pediatric closed head injury: relationships with age, severity, and lesion size. J Child Neurol 11:283–290PubMed
14.
Zurück zum Zitat Greenspan AI, MacKenzie EJ (1994) Functional outcome after pediatric head injury. Pediatrics 94:425–432PubMed Greenspan AI, MacKenzie EJ (1994) Functional outcome after pediatric head injury. Pediatrics 94:425–432PubMed
15.
Zurück zum Zitat Hackbarth RM, Rzeszutko KM, Sturm G, Donders J, Kuldanek AS, Sanfilippo DJ (2002) Survival and functional outcome in pediatric traumatic brain injury: a retrospective review and analysis of predictive factors. Crit Care Med 30:1630–1635PubMedCrossRef Hackbarth RM, Rzeszutko KM, Sturm G, Donders J, Kuldanek AS, Sanfilippo DJ (2002) Survival and functional outcome in pediatric traumatic brain injury: a retrospective review and analysis of predictive factors. Crit Care Med 30:1630–1635PubMedCrossRef
16.
Zurück zum Zitat Hu X, Wesson DE, Logsetty S, Spence LJ (1994) Functional limitations and recovery in children with severe trauma: a one-year follow-up. J Trauma 37:209–213PubMed Hu X, Wesson DE, Logsetty S, Spence LJ (1994) Functional limitations and recovery in children with severe trauma: a one-year follow-up. J Trauma 37:209–213PubMed
17.
Zurück zum Zitat Hussain LM, Redmond AD (1994) Are pre-hospital deaths from accidental injury preventable? Brit Med J 308:1077–1080PubMed Hussain LM, Redmond AD (1994) Are pre-hospital deaths from accidental injury preventable? Brit Med J 308:1077–1080PubMed
18.
Zurück zum Zitat Javouhey E, Guerin AC, Chiron M (2006) Incidence and risk factors of severe traumatic brain injury resulting from road accidents: a population-based study. Accident Anal Prev 38:225–233CrossRef Javouhey E, Guerin AC, Chiron M (2006) Incidence and risk factors of severe traumatic brain injury resulting from road accidents: a population-based study. Accident Anal Prev 38:225–233CrossRef
19.
Zurück zum Zitat Laumon B, Martin JL (2002) Analysis of biases in epidemiological knowledge of road accidents in France. Rev Epidemiol Sante 50:277–285 Laumon B, Martin JL (2002) Analysis of biases in epidemiological knowledge of road accidents in France. Rev Epidemiol Sante 50:277–285
20.
Zurück zum Zitat Laumon B, Martin JL, Collet P, Chiron M, Verney MP, Ndiaye A, Vergnes I (1997) A french road accident trauma registry: first results. In: AAAM (ed) 41st AAAM conference. AAAM, Orlando, Fla., pp 127–137 Laumon B, Martin JL, Collet P, Chiron M, Verney MP, Ndiaye A, Vergnes I (1997) A french road accident trauma registry: first results. In: AAAM (ed) 41st AAAM conference. AAAM, Orlando, Fla., pp 127–137
21.
Zurück zum Zitat Levin HS (1998) Cognitive function outcomes after traumatic brain injury. Curr Opin Neurol 11:643–646PubMedCrossRef Levin HS (1998) Cognitive function outcomes after traumatic brain injury. Curr Opin Neurol 11:643–646PubMedCrossRef
22.
Zurück zum Zitat Mackay LE, Bernstein BA, Chapman PE, Morgan AS, Milazzo LS (1992) Early intervention in severe head injury: long-term benefits of a formalized program. Arch Phys Med Rehabil 73:635–641PubMed Mackay LE, Bernstein BA, Chapman PE, Morgan AS, Milazzo LS (1992) Early intervention in severe head injury: long-term benefits of a formalized program. Arch Phys Med Rehabil 73:635–641PubMed
23.
Zurück zum Zitat Macpherson AK, Rothman L, McKeag AM, Howard A (2003) Mechanism of injury affects 6-month functional outcome in children hospitalized because of severe injuries. J Trauma 55:454–458PubMed Macpherson AK, Rothman L, McKeag AM, Howard A (2003) Mechanism of injury affects 6-month functional outcome in children hospitalized because of severe injuries. J Trauma 55:454–458PubMed
24.
Zurück zum Zitat Masson F, Salmi LR, Maurette P, Dartigues JF, Vecsey J, Garros B, Erny P (1996) Characteristics of head trauma in children: epidemiology and a 5-year follow-up. Arch Pediatr 3:651–660PubMedCrossRef Masson F, Salmi LR, Maurette P, Dartigues JF, Vecsey J, Garros B, Erny P (1996) Characteristics of head trauma in children: epidemiology and a 5-year follow-up. Arch Pediatr 3:651–660PubMedCrossRef
25.
Zurück zum Zitat Mazurek AJ (1994) Epidemiology of paediatric injury. J Accid Emerg Med 11:9–16PubMed Mazurek AJ (1994) Epidemiology of paediatric injury. J Accid Emerg Med 11:9–16PubMed
26.
Zurück zum Zitat Michaud LJ, Rivara FP, Grady MS, Reay DT (1992) Predictors of survival and severity of disability after severe brain injury in children. Neurosurgery 31:254–264PubMedCrossRef Michaud LJ, Rivara FP, Grady MS, Reay DT (1992) Predictors of survival and severity of disability after severe brain injury in children. Neurosurgery 31:254–264PubMedCrossRef
27.
Zurück zum Zitat Nybo T, Koskiniemi M (1999) Cognitive indicators of vocational outcome after severe traumatic brain injury (TBI) in childhood. Brain Injury 13:759–766PubMedCrossRef Nybo T, Koskiniemi M (1999) Cognitive indicators of vocational outcome after severe traumatic brain injury (TBI) in childhood. Brain Injury 13:759–766PubMedCrossRef
28.
Zurück zum Zitat Osberg JS, DiScala C, Gans BM (1990) Utilization of inpatient rehabilitation services among traumatically injured children discharged from pediatric trauma centers. Am J Phys Med Rehabil 69:67–72PubMedCrossRef Osberg JS, DiScala C, Gans BM (1990) Utilization of inpatient rehabilitation services among traumatically injured children discharged from pediatric trauma centers. Am J Phys Med Rehabil 69:67–72PubMedCrossRef
29.
Zurück zum Zitat Ponsford J, Willmott C, Rothwell A, Cameron P, Ayton G, Nelms R, Curran C, Ng K (2001) Impact of early intervention on outcome after mild traumatic brain injury in children. Pediatrics 108:1297–1303PubMedCrossRef Ponsford J, Willmott C, Rothwell A, Cameron P, Ayton G, Nelms R, Curran C, Ng K (2001) Impact of early intervention on outcome after mild traumatic brain injury in children. Pediatrics 108:1297–1303PubMedCrossRef
30.
Zurück zum Zitat Robertson CM, Joffe AR, Moore AJ, Watt JM (2002) Neurodevelopmental outcome of young pediatric intensive care survivors of serious brain injury. Pediatr Crit Care Med 3:345–350PubMedCrossRef Robertson CM, Joffe AR, Moore AJ, Watt JM (2002) Neurodevelopmental outcome of young pediatric intensive care survivors of serious brain injury. Pediatr Crit Care Med 3:345–350PubMedCrossRef
31.
Zurück zum Zitat Stancin T, Drotar D, Taylor HG, Yeates KO, Wade SL, Minich NM (2002) Health-related quality of life of children and adolescents after traumatic brain injury. Pediatrics 109:E34PubMedCrossRef Stancin T, Drotar D, Taylor HG, Yeates KO, Wade SL, Minich NM (2002) Health-related quality of life of children and adolescents after traumatic brain injury. Pediatrics 109:E34PubMedCrossRef
32.
Zurück zum Zitat Suominen P, Kivioja A, Ohman J, Korpela R, Rintala R, Olkkola KT (1998) Severe and fatal childhood trauma. Injury 29:425–430PubMedCrossRef Suominen P, Kivioja A, Ohman J, Korpela R, Rintala R, Olkkola KT (1998) Severe and fatal childhood trauma. Injury 29:425–430PubMedCrossRef
33.
Zurück zum Zitat Tepas JJ 3rd, DiScala C, Ramenofsky ML, Barlow B (1990) Mortality and head injury: the pediatric perspective. J Pediatr Surg 25:92–95, discussion 96PubMedCrossRef Tepas JJ 3rd, DiScala C, Ramenofsky ML, Barlow B (1990) Mortality and head injury: the pediatric perspective. J Pediatr Surg 25:92–95, discussion 96PubMedCrossRef
34.
Zurück zum Zitat Thakker JC, Splaingard M, Zhu J, Babel K, Bresnahan J, Havens PL (1997) Survival and functional outcome of children requiring endotracheal intubation during therapy for severe traumatic brain injury. Crit Care Med 25:1396–1401PubMedCrossRef Thakker JC, Splaingard M, Zhu J, Babel K, Bresnahan J, Havens PL (1997) Survival and functional outcome of children requiring endotracheal intubation during therapy for severe traumatic brain injury. Crit Care Med 25:1396–1401PubMedCrossRef
35.
Zurück zum Zitat Tilford JM, Simpson PM, Yeh TS, Lensing S, Aitken ME, Green JW, Harr J, Fiser DH (2001) Variation in therapy and outcome for pediatric head trauma patients. Crit Care Med 29:1056–1061PubMedCrossRef Tilford JM, Simpson PM, Yeh TS, Lensing S, Aitken ME, Green JW, Harr J, Fiser DH (2001) Variation in therapy and outcome for pediatric head trauma patients. Crit Care Med 29:1056–1061PubMedCrossRef
36.
Zurück zum Zitat Tomlin P, Clarke M, Robinson G, Roach J (2002) Rehabilitation in severe head injury in children: outcome and provision of care. Dev Med Child Neurol 44:828–837PubMedCrossRef Tomlin P, Clarke M, Robinson G, Roach J (2002) Rehabilitation in severe head injury in children: outcome and provision of care. Dev Med Child Neurol 44:828–837PubMedCrossRef
37.
Zurück zum Zitat Valadka S, Poenaru D, Dueck A (2000) Long-term disability after trauma in children. J Pediatr Surg 35:684–687PubMedCrossRef Valadka S, Poenaru D, Dueck A (2000) Long-term disability after trauma in children. J Pediatr Surg 35:684–687PubMedCrossRef
38.
Zurück zum Zitat van der Sluis CK, ten Duis HJ, Geertzen JH (1995) Multiple injuries: an overview of the outcome. J Trauma 38:681–686PubMed van der Sluis CK, ten Duis HJ, Geertzen JH (1995) Multiple injuries: an overview of the outcome. J Trauma 38:681–686PubMed
39.
Zurück zum Zitat Waller JA, Skelly JM, Davis JH (1995) The injury impairment scale as a measure of disability. J Trauma 39:949–954PubMed Waller JA, Skelly JM, Davis JH (1995) The injury impairment scale as a measure of disability. J Trauma 39:949–954PubMed
40.
Zurück zum Zitat Wesson DE, Scorpio RJ, Spence LJ, Kenney BD, Chipman ML, Netley CT, Hu X (1992) The physical, psychological, and socioeconomic costs of pediatric trauma. J Trauma 33:252–255, discussion 255–7PubMedCrossRef Wesson DE, Scorpio RJ, Spence LJ, Kenney BD, Chipman ML, Netley CT, Hu X (1992) The physical, psychological, and socioeconomic costs of pediatric trauma. J Trauma 33:252–255, discussion 255–7PubMedCrossRef
Metadaten
Titel
Severe outcome of children following trauma resulting from road accidents
verfasst von
Etienne Javouhey
Anne-Céline Guérin
Emmanuèle Amoros
Mouloud Haddak
Amina Ndiaye
Daniel Floret
Mireille Chiron
Publikationsdatum
01.08.2006
Verlag
Springer-Verlag
Erschienen in
European Journal of Pediatrics / Ausgabe 8/2006
Print ISSN: 0340-6199
Elektronische ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-006-0118-z

Weitere Artikel der Ausgabe 8/2006

European Journal of Pediatrics 8/2006 Zur Ausgabe

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.