International Study of the Epidemiology of Paediatric Trauma: PAPSA Research Study
Tóm tắt
Trauma is a significant cause of morbidity and mortality worldwide. The literature on paediatric trauma epidemiology in low- and middle-income countries (LMICs) is limited. This study aims to gather epidemiological data on paediatric trauma. This is a multicentre prospective cohort study of paediatric trauma admissions, over 1 month, from 15 paediatric surgery centres in 11 countries. Epidemiology, mechanism of injury, injuries sustained, management, morbidity and mortality data were recorded. Statistical analysis compared LMICs and high-income countries (HICs). There were 1377 paediatric trauma admissions over 31 days; 1295 admissions across ten LMIC centres and 84 admissions across five HIC centres. Median number of admissions per centre was 15 in HICs and 43 in LMICs. Mean age was 7 years, and 62% were boys. Common mechanisms included road traffic accidents (41%), falls (41%) and interpersonal violence (11%). Frequent injuries were lacerations, fractures, head injuries and burns. Intra-abdominal and intra-thoracic injuries accounted for 3 and 2% of injuries. The mechanisms and injuries sustained differed significantly between HICs and LMICs. Median length of stay was 1 day and 19% required an operative intervention; this did not differ significantly between HICs and LMICs. No mortality and morbidity was reported from HICs. In LMICs, in-hospital morbidity was 4.0% and mortality was 0.8%. The spectrum of paediatric trauma varies significantly, with different injury mechanisms and patterns in LMICs. Healthcare structure, access to paediatric surgery and trauma prevention strategies may account for these differences. Trauma registries are needed in LMICs for future research and to inform local policy.
Tài liệu tham khảo
Bradshaw CJ, Lakhoo K, Ameh E et al (2016) A day in the life of a paediatric surgeon: a PAPSA research study. Ann Pediatr Surg. https://doi.org/10.1097/01.XPS.0000482657.19506.30
Peclet MH, Newman KD, Eichelberger MR et al (1990) Patterns of injury in children. J Pediatr Surg 25:85–91. https://doi.org/10.1016/S0022-3468(05)80169-1
Centers for Disease Control and Prevention (2010) 10 leading causes of death by age group, United States
Peden M, McGee K, Krug E (2000) Injury: a leading cause of the global burden of disease. World Health Organization, Geneva, pp 1–54
Mock C, Abantanga F, Goosen J et al (2009) Strengthening care of injured children globally. Bull World Health Organ 87:382–389. https://doi.org/10.2471/BLT.08.057059
Collaborative GlobalSurg (2016) Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries. BMJ Glob Health 1:e000091. https://doi.org/10.1136/bmjgh-2016-000091
Goodman LF, St-Louis E, Yousef Y et al (2017) The global initiative for children’s surgery: optimal resources for improving care. Eur J Pediatr Surg. https://doi.org/10.1055/s-0037-1604399
Abdur-Rahman LO, van As AB, Rode H (2012) Pediatric trauma care in Africa: the evolution and challenges. Semin Pediatr Surg 21:111–115. https://doi.org/10.1053/j.sempedsurg.2012.01.003
Bickler SW, Rode H (2002) Public health reviews surgical services for children in developing countries. Bull World Health Organ 80:829–835
Bayreuther J, Wagener S, Woodford M et al (2009) Paediatric trauma: injury pattern and mortality in the UK. Arch Dis Child Educ Pract Ed 94:37–41. https://doi.org/10.1136/adc.2007.132787
Naqvi G, Johansson G, Yip G et al (2017) Mechanisms, patterns and outcomes of paediatric polytrauma in a UK major trauma centre. Ann R Coll Surg 99:39–45. https://doi.org/10.1308/rcsann.2016.0222
Kristiansen T, Rehn M, Gravseth HM et al (2012) Paediatric trauma mortality in Norway: a population-based study of injury characteristics and urban–rural differences. Injury 43:1865–1872. https://doi.org/10.1016/j.injury.2011.08.011
Ademuyiwa A, Oluwadiya K, Glover-Addy H et al (2012) Pediatric trauma in sub-Saharan Africa: challenges in overcoming the scourge. J Emerg Trauma Shock 5:55–61. https://doi.org/10.4103/0974-2700.93114
Plummer V, Boyle M (2017) EMS systems in lower-middle income countries: a literature review. Prehosp Disaster Med 32:64–70. https://doi.org/10.1017/S1049023X1600114X
Jayaraman S, Mabweijano JR, Lipnick MS et al (2009) Current patterns of prehospital trauma care in Kampala, Uganda and the feasibility of a lay-first-responder training program. World J Surg 33:2512–2521. https://doi.org/10.1007/s00268-009-0180-6
Shah MI (2010) Prehospital management of pediatric trauma. Clin Pediatr Emerg Med 11:10–17. https://doi.org/10.1016/j.cpem.2009.12.003
Callese TE, Richards CT, Shaw P et al (2014) Layperson trauma training in low- and middle-income countries: a review. J Surg Res 190:104–110. https://doi.org/10.1016/j.jss.2014.03.029
Nantulya VM, Reich MR (2003) Equity dimensions of road traffic injuries in low- and middle-income countries. Inj Control Saf Promot 10:13–20. https://doi.org/10.1076/icsp.10.1.13.14116
Abu-Zidan FM, Abbas AK, Hefny AF et al (2012) Effects of seat belt usage on injury pattern and outcome of vehicle occupants after road traffic collisions: prospective study. World J Surg 36:255–259. https://doi.org/10.1007/s00268-011-1386-y
Phillips RO, Ulleberg P, Vaa T (2011) Meta-analysis of the effect of road safety campaigns on accidents. Accid Anal Prev 43:1204–1218. https://doi.org/10.1016/j.aap.2011.01.002
Toroyan T (2009) Global status report on road safety. Inj Prev 15:286. https://doi.org/10.1258/jrsm.2010.090426
Al-Mousawi AM, Mecott-Rivera GA, Jeschke MG, Herndon DN (2009) Burn teams and burn centers: the importance of a comprehensive team approach to burn care. Clin Plast Surg 36:547–554. https://doi.org/10.1016/j.cps.2009.05.015
Stevenson JH, Borgstein E, Hasselt EV, Falconer I (2017) The establishment of a burns unit in a developing country—a collaborative venture in Malawi. Br J Plast Surg 52:488–494. https://doi.org/10.1054/bjps.1999.3114
Atiyeh B, Masellis A, Conte F (2010) Optimizing burn treatment in developing low- and middle-income countries with limited health care resources (part 3). Ann Burns Fire Disasters 23:13–18
Othman N, Kendrick D, Downs S et al (2010) Epidemiology of burn injuries in the East Mediterranean Region: a systematic review. BMC Public Health 10:83. https://doi.org/10.1186/1471-2458-10-83
Metcalfe D, Bouamra O, Parsons NR et al (2014) Effect of regional trauma centralization on volume, injury severity and outcomes of injured patients admitted to trauma centres. Br J Surg 101:959–964. https://doi.org/10.1002/bjs.9498
Mooney DP, Gutierrez IM, Chen Q et al (2013) Impact of trauma system development on pediatric injury care. Pediatr Surg Int 29:263–268. https://doi.org/10.1007/s00383-012-3232-1
O’Reilly GM, Joshipura M, Cameron PA, Gruen R (2013) Trauma registries in developing countries: a review of the published experience. Injury 44:713–721. https://doi.org/10.1016/j.injury.2013.02.003
Nwomeh BC, Lowell W, Kable R et al (2006) History and development of trauma registry: lessons from developed to developing countries. World J Emerg Surg 1:32. https://doi.org/10.1186/1749-7922-1-32
Weeks SR, Juillard CJ, Monono ME et al (2014) Is the Kampala Trauma Score an effective predictor of mortality in low-resource settings? A comparison of multiple trauma severity scores. World J Surg 38:1905–1911. https://doi.org/10.1007/s00268-014-2496-0
St-Louis E, Séguin J, Roizblatt D et al (2016) Systematic review and need assessment of pediatric trauma outcome benchmarking tools for low-resource settings. Pediatr Surg Int. https://doi.org/10.1007/s00383-016-4024-9
Meara JG, Hagander L, Leather AJM (2014) Surgery and global health: a lancet commission. Lancet 383:12–13. https://doi.org/10.1016/S0140-6736(13)62345-4