Scand J Trauma Resusc Emerg Med. 2025 Nov 15;33(1):183. doi: 10.1186/s13049-025-01510-3.
ABSTRACT
BACKGROUND: Severe thoracic trauma in children is rare and often underestimated. While standardized protocols exist, the rarity of polytrauma in children may lead to uncertainties in their application. Thus, we aim to characterize severely injured children with significant thoracic trauma and identify age-dependent differences in prehospital and early clinical management.
METHODS: Patients documented by German hospitals between 2008 and 2023 in the TraumaRegister DGU®, aged ≤ 20 years and sustaining at least serious chest injury (AISThorax ≥ 3) were analyzed. Patients were grouped by age: 0-5 years, 6-12 years and 13-16 years and statistically compared; additional data from patients aged 17-20 years is provided. Demographic, clinical characteristics and treatment comparing the aforementioned groups were evaluated using descriptive statistics. In the group of 0-16 years old independent risk factors for mortality were scrutinized applying multiple logistic regression analysis.
RESULTS: A total of 5,040 severely injured patients were analyzed (310 patients aged 0-5 years, 475 aged 6-12 years, 984 aged 13-16 years and 3,271 in group 17-20 years). With increasing age, significantly more males were injured and mechanism of injury was significantly different between the age groups. During prehospital management significant age dependent differences were seen regarding helicopter emergency medical service treatment, intubation, chest tube placement, application of catecholamines or tranexamic acid. Significant differences were found in terms of injured body regions, where the youngest suffered most from leading thoracic injury and injury to the head while abdominal injury and injury to extremities happened significantly more often in the 13-16 years old. During treatment the 13-16 years old received more blood products, were more likely to undergo thoracic surgery and stayed longer on the respective wards. Multivariate logistic regression showed an independent association with a significant mortality risk for MAIS ≥ 4 (OR = 2.87; p = 0.03), polytrauma (OR = 3.09; p < 0.001) and the need for blood transfusion before admission to the intensive care unit (OR = 2.46; p < 0.001).
CONCLUSIONS: Treating severely injured children is always challenging, even more so when they have suffered critical trauma to the chest. With our results we offer starting points for age-dependent injury prevention and provide information to analyze and question current (pre-) hospital management protocols.
PMID:41241732 | DOI:10.1186/s13049-025-01510-3
