Preventing the disaster: severe abdominal injury in child passengers of motor vehicle accidents often indicate even more serious trauma.

Abstract

Purpose: The purpose of this study was to assess severe abdominal injury in child passengers of different ages of motor vehicle accidents and analyze the concomitant pattern of injury regarding injury severity, trauma management and outcome.

Method: Data acquisition from Trauma Register DGU^® (TR-DGU) in a 10-years period (2010-2020) of seriously injured children (max. AIS 2+ / intensive care) 0-15 years of age, as motor vehicle passengers (cMVP) (n = 1,035). Primarily treated in or transferred to a German Trauma Center. Matched pairs analysis with adult severely injured motor vehicle passengers (aMVP) (age 20-50 years, n = 26,218), matching 1:4 (child: adult), was performed to identify causes of mortality.

Results: The study group (cMVP) included 1,035 children. The mean age was 9.5 years, 50.5% were male and the mean Injury Severity Score (ISS) was 18.7 points. 93.0% were transported from scene directly to the final trauma center. Transferred patients showed a higher ISS (26 vs. 18 points), higher rate of severe traumatic brain injury (TBI), a higher rate of serious abdominal injury and a higher mortality rate (12.5% vs. 7.4%). Most of the severe abdominal injuries occurred after the third year of age (first peak between 8 and 9 years; second peak 14-15 years). Serious injuries to the pelvis show a similar distribution but less often, the same applies to thoracical injuries. Severe brain and head injuries show an antiproportional distribution to the age groups with the highest rate in the 0-1 year old (78%) and the lowest in the 14-15 year old (40%). The highest mortality rate was shown in the youngest age groups, related to TBI (AIS_TBI ≥ 3; 62% in 0-1 years). The matched pairs analysis shows a higher mortality rate of cMVP compared to aMVP within the first 24 h after hospital admission and a significantly higher rate of shock and unconsciousness, while the intubation rate is significantly lower.

Conclusion: Child passengers of motor vehicle accidents are in need of a specific and age-related attention towards security systems. Severe injuries in children are rare, yet life threatening. The highest mortality rate is related to severe TBI, especially in the youngest children. But also severe abdominal as well as thoracic injuries their concomitant trauma need to be prevented and are indicators for even more severe injuries. It seems to be favorable for cMVP to be directly transported to designated special centers with sufficient capacity and competency to treat and manage severely injured children.