Epidemiology of major paediatric trauma in a European Country – trends of a decade

OBJECTIVES: This study investigates causes, characteristics and temporal trends of paediatric major trauma over a 10-year period and assesses potential preventive areas. METHODS: Single-centre retrospective study of paediatric trauma patients admitted to a Paediatric Intensive Care Unit (PICU) in a tertiary university hospital in Europe with a level 1 paediatric trauma centre, from 2009 to 2019. Paediatric major trauma patients were defined as patients aged < 18 years with Injury Severity Score > 12, admitted for intensive care for more than 24 h following trauma. Demographic, social and clinical information, including place and mechanism of trauma, injury pattern, pre-hospital and in-hospital procedures, and length of stay in PICU was extracted from PICU medical records. RESULTS: Total 358 patients included (age 11 ± 4,9 years; 67% male); 75% were involved in road traffic accidents: 30% motor vehicle collision, 25% pedestrian, 10% motorcycle and bicycle each. Falls from height injured 19% of children, 4% during sports activities. Main injuries were to head/neck (73%) and extremities (42%). The incidence of major trauma was highest in teenagers and did not show a decreasing trend during the study years. All fatalities (1,7%; n = 6) were related to head/neck injuries. Motor vehicle collisions resulted in higher need for blood transfusion (9 vs. 2 mL/kg, p = 0,006) and the highest ICU-mortality (83%; n = 5). Children in motorcycle accidents had longer ICU length-of-stay (6,4 vs. 4,2 days, p = 0,036). Pedestrians had 25% higher risk of head/neck injuries (RR 1,25; 1,07 − 1,46; p = 0,004), and higher incidence of severe brain injury (46% vs. 34%, p = 0,042). Most children in motor-vehicle/bicycle accidents were not using restraints/protective devices (45%) or were using them inappropriately (13%). CONCLUSIONS: Over the last decade, the absolute numbers of paediatric major trauma did not decrease. Road traffic accidents remain the leading cause of injury and death. Teenagers are at highest risk for severe trauma. Appropriate use of child restraints and protective equipment remain key for prevention.