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Araştırma Makalesi
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Etiology, clinical findings, and mortality in pediatric trauma: a retrospective analysis from Çanakkale

Yıl 2025, Cilt: 10 Sayı: 2, 73 - 82, 27.06.2025

Fatih Battal , Cahide Danaci

https://doi.org/10.22391/fppc.1667367

Öz

Introduction: Trauma remains one of the leading causes of death in childhood and adolescence, even in developed countries. Reducing trauma-related mortality in children continues to be a major public health concern. Physiological, anatomical, and developmental differences between children and adults influence both trauma mechanisms and treatment processes. Notably, head trauma is a primary cause of pediatric intensive care unit (PICU) admissions. This study aimed to evaluate the clinical characteristics and survival outcomes of children requiring intensive care following trauma.
Methods: In this retrospective study, 90 pediatric patients admitted to a PICU due to trauma between January 2019 and December 2023 were evaluated. Data were collected from electronic medical records, including demographic characteristics, mode of admission, trauma etiology, vital signs, laboratory values, imaging results, types of respiratory support, treatments administered, scoring systems (GCS, PEWS, PRISM III, PELOD, ISS, PTS, AIS), and mortality outcomes. The association between biomarkers—such as lactate, pH, standard base excess (SBE), and INR—and mortality was analyzed using ROC curve analysis.
Results: Of the patients, 7,.8% were male, with a mean age of 104,96±68,08 months. The most common trauma mechanism was falling from height (28,9%), followed by motorcycle accidents (16,7%) and drowning (16,7%). Head and neck injuries were present in 65,6% of cases, while extremity and skin involvement was observed in 75,6%. Invasive mechanical ventilation was required in 31,1% of the patients. The mean GCS was 11,7±0,44, and the mean ISS was 25,41±2,14. Seven patients (7,8%) died. The highest mortality rates were observed in cases of firearm injuries (100%), hanging/asphyxia (25%), and drowning (13,3%). Significant differences were found in pH, SBE, lactate, INR, and creatinine levels between survivors and non-survivors (all p<0.05). According to ROC analysis, lactate was the strongest single predictor of mortality (AUC: 0.848); however, when all four biomarkers were combined, the AUC reached 1.000. GCS, PRISM III, PELOD, and ISS scores were significantly correlated with mortality (p<0.001).
Conclusion: This study demonstrates that early risk assessment based on trauma mechanisms, clinical scores, and laboratory parameters can effectively predict mortality in pediatric trauma patients. The combined use of biomarkers such as lactate, pH, SBE, and INR provides a stronger predictive value than individual parameters alone. The high rates of head and neck injuries and the need for mechanical ventilation highlight the importance of early intervention. The frequent occurrence of trauma mechanisms such as motorcycle accidents and drowning among adolescent males underscores the need to develop targeted public health prevention strategies for this population.

Anahtar Kelimeler

Child Critical Care Accidents Injury Severity Score Motorcycles

Kaynakça

  • 1. Türkiye İstatistik Kurumu. Istatistiklerle Cocuk 2022 [Internet]. [cited 2025 May 11]. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Cocuk-2022-49674
  • 2. Bambini DA, Almond PS. Abdominal trauma. In: Arensman RM, Bambini DA, Almond PS, et al., editors. Pediatric surgery. 2nd ed. Austin (TX): Landes Bioscience; 2009. p. 128–83.
  • 3. Cetin Aslan E. [Evaluation of emergency department utilization: a cross-sectional study] (in Turkish). Mersin Univ Saglik Bilim Derg. 2023;16(1):1–13.
  • 4. Osterman MJ, Kochanek KD, MacDorman MF, et al. Annual summary of vital statistics: 2012–2013. Pediatrics. 2015;135(6):1115–25.
  • 5. Simon TD, Bublitz C, Hambidge SJ. Emergency department visits among pediatric patients for sports-related injury: basic epidemiology and impact of race/ethnicity and insurance status. Pediatr Emerg Care. 2006;22(5):309–15.
  • 6. Cunningham RM, Walton MA, Carter PM. The major causes of death in children and adolescents in the United States. N Engl J Med. 2018;379(25):2468–75.
  • 7. World Health Organization. Paediatric emergency triage, assessment and treatment: care of critically ill children [Internet]. [cited 2025 May 11]. Available from: https://iris.who.int/bitstream/handle/10665/204463/9789241510219_eng.pdf
  • 8. Runde D, Beiner J. Calculated decisions: PECARN pediatric head injury/trauma algorithm. Pediatr Emerg Med Pract. 2018;15:CD3–4.
  • 9. Akay MA, Gurbuz N, Yayla D, et al. [Evaluation of pediatric trauma cases applied to emergency department] (in Turkish). Kocaeli Med J. 2013;2(3):1–5.
  • 10. Densmore JC, Lim HJ, Oldham KT, Guice KS. Outcomes and delivery of care in pediatric injury. J Pediatr Surg. 2000;41:92–8.
  • 11. MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354:366–78.
  • 12. Buschmann C, Kuhne CA, Losch C, Nast-Kolb D, Ruchholtz S. Major trauma with multiple injuries in German children: a retrospective review. J Pediatr Orthop. 2008;28:1–5. https://doi.org/10.1097/BPO.0b013e31815b4d90
  • 13. Brook U, Boaz M. Children hospitalized for accidental injuries: Israeli experiences. Patient Educ Couns. 2003;51:177–82.
  • 14. Koltka K, Ilhan M, Gok AFK, Gunay K, Ertekin C. Can ionized calcium levels and platelet counts be used for estimating the prognosis of pediatric trauma patients admitted to the emergency surgery intensive care? Ulus Travma Acil Cerrahi Derg. 2022;28:579–84.
  • 15. Voth M, Lustenberger T, Auner B, Frank J, Marzi I. What injuries should we expect in the emergency room? Injury. 2017;48:2119–24.
  • 16. Herbert HK, van As AB, Bachani AM, et al. Patterns of pediatric injury in South Africa: an analysis of hospital data between 1997 and 2006. J Trauma Acute Care Surg. 2012;73:168–74.
  • 17. Ulusoy E, Duman M, Caglar A, et al. Acute traumatic coagulopathy: the value of histone in pediatric trauma patients. Turk J Haematol. 2018;35:122–8.
  • 18. Varol F, Can YY, Ozgunay B, Cengiz M, Altas U, Guven S, Cam H. [Retrospective evaluation of pediatric trauma patients: a single-center experience of a tertiary pediatric intensive care unit] (in Turkish). J Med Palliat Care. 2022;15(1):45–52.
  • 19. Franzen L, Ortenwall P, Backteman T. Children in Sweden admitted to intensive care after trauma. Injury. 2007;38:91–7.
  • 20. Frisch L, Coate Johnston S, Melhorn K, Phillips Hill C, Boyce M. In the hands of children: fatal car, van, and truck crashes involving drivers aged 7 through 14 years. Arch Pediatr Adolesc Med. 2003;157(10):1032. https://doi.org/10.1001/archpedi.157.10.1032-a
  • 21. Mayer T, Walker ML, Johnson DG, Matlak ME. Causes of morbidity and mortality in severe pediatric trauma. JAMA. 1981;245:719–21.
  • 22. Hassan NE, DeCou JM, Reischman D, et al. RBC transfusions in children requiring intensive care admission after traumatic injury. Pediatr Crit Care Med. 2014;15:306–13.
  • 23. Pollack MM, Ruttimann UE, Getson PR. Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988;16(11):1110–6. https://doi.org/10.1097/00003246-198811000-00009
  • 24. Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review and meta-analysis. Crit Care Med. 2014;42(9):2118–25. https://doi.org/10.1097/CCM.0000000000000405
  • 25. Gatta A, Verardo A, Bolognesi M. Hypoalbuminemia. Intern Emerg Med. 2012;7(Suppl 3):S193–9. https://doi.org/10.1007/s11739-012-0802-0
  • 26. Cakir E, Turan IO. Lactate/albumin ratio is more effective than lactate or albumin alone in predicting clinical outcomes in intensive care patients with sepsis. Scand J Clin Lab Invest. 2021;81(3):225–9. https://doi.org/10.1080/00365513.2021.1901306

Pediatrik travmada etyoloji, klinik bulgular ve mortalite: Çanakkale'den retrospektif bir analiz

Yıl 2025, Cilt: 10 Sayı: 2, 73 - 82, 27.06.2025

Fatih Battal , Cahide Danaci

https://doi.org/10.22391/fppc.1667367

Öz

Giriş: Travma, gelişmiş ülkelerde bile çocukluk ve ergenlikte önde gelen ölüm nedenlerinden biri olmaya devam etmektedir. Çocuklarda travmayla ilişkili ölüm oranını azaltmak önemli bir halk sağlığı endişesi olmaya devam etmektedir. Çocuklar ve yetişkinler arasındaki fizyolojik, anatomik ve gelişimsel farklılıklar hem travma mekanizmalarını hem de tedavi süreçlerini etkiler. Özellikle, kafa travması çocuk yoğun bakım ünitesi(ÇYBÜ) yatışlarının birincil nedenidir. Bu çalışma, travmadan sonra yoğun bakım gerektiren çocukların klinik özelliklerini ve sağkalım sonuçlarını değerlendirmeyi amaçlamaktadır.
Yöntem: Bu retrospektif çalışmada, Ocak 2019 ile Aralık 2023 arasında travma nedeniyle ÇYBÜ’yeyatırılan 90 pediatrik hasta değerlendirildi. Veriler, demografik özellikler, yatış şekli, travma etiyolojisi, hayati bulgular, laboratuvar değerleri, görüntüleme sonuçları, solunum desteği türleri, uygulanan tedaviler, puanlama sistemleri (GKS, PEWS, PRISM III, PELOD, ISS, PTS, AIS) ve ölüm sonuçları dahil olmak üzere elektronik tıbbi kayıtlardan toplandı. Biyobelirteçler (laktat, pH, SBE ve INR gibi) ile mortalite arasındaki ilişki ROC eğrisi analizi kullanılarak analiz edildi.
Sonuçlar: Hastaların %7,8'i erkekti ve ortalama yaşları 104,96±68,08 ay idi. En sık görülen travma mekanizması yüksekten düşme (%28,9) idi, bunu motosiklet kazaları (%16,7) ve boğulma (%16,7) takip etti. Baş ve boyun yaralanmaları vakaların %65,6'sında mevcutken, ekstremite ve cilt tutulumu %75,6'sında gözlendi. Hastaların %31,1'inde invaziv mekanik ventilasyon gerekli oldu. Ortalama GKS 11,7±0,44 ve ortalama ISS 25,41±2,14 idi. Yedi hasta (%7,8) ex oldu. En yüksek mortalite oranları ateşli silah yaralanmaları (%100), asılma/asfiksi (%25) ve boğulma (%13,3) vakalarında gözlendi. pH, SBE, laktat, INR ve kreatinin düzeylerinde sağ kalanlar ve sağ kalmayanlar arasında önemli farklılıklar bulundu p<0,05). ROC analizine göre, laktat mortalitenin en güçlü tek öngörücüsüydü (AUC: 0,848); ancak, dört biyobelirteç birleştirildiğinde, AUC 1,000'e ulaştı. GKS, PRISM III, PELOD ve ISS skorları mortalite ile önemli ölçüde ilişkiliydi (p<0,001).
Sonuç: Bu çalışma, travma mekanizmalarına, klinik skorlara ve laboratuvar parametrelerine dayalı erken risk değerlendirmesinin pediatrik travma hastalarında mortaliteyi etkili bir şekilde öngörebileceğini göstermektedir. Laktat, pH, SBE ve INR gibi biyobelirteçlerin birlikte kullanımı, tek başına bireysel parametrelerden daha güçlü bir öngörü değeri sağlar. Baş-boyun yaralanmalarının ve mekanik ventilasyon gereksiniminin yüksekliği, erken müdahalenin önemini vurgulamaktadır. Özellikle motosiklet kazaları ve suda boğulma gibi mekanizmaların adölesan erkeklerde sık görülmesi, bu gruba yönelik koruyucu halk sağlığı stratejilerinin geliştirilmesi gerekliliğini ortaya koymaktadır.

Anahtar Kelimeler

Çocuk yoğun bakım Kazalar Yaralanma Şiddet Skoru Motosikletler

Teşekkür

We would like to express our sincere gratitude to the nurses and ancillary healthcare personnel of the Pediatric Intensive Care Unit at Çanakkale Onsekiz Mart University Hospital for their dedicated efforts and valuable contributions to patient care throughout the conduct of this study.

Kaynakça

  • 1. Türkiye İstatistik Kurumu. Istatistiklerle Cocuk 2022 [Internet]. [cited 2025 May 11]. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Cocuk-2022-49674
  • 2. Bambini DA, Almond PS. Abdominal trauma. In: Arensman RM, Bambini DA, Almond PS, et al., editors. Pediatric surgery. 2nd ed. Austin (TX): Landes Bioscience; 2009. p. 128–83.
  • 3. Cetin Aslan E. [Evaluation of emergency department utilization: a cross-sectional study] (in Turkish). Mersin Univ Saglik Bilim Derg. 2023;16(1):1–13.
  • 4. Osterman MJ, Kochanek KD, MacDorman MF, et al. Annual summary of vital statistics: 2012–2013. Pediatrics. 2015;135(6):1115–25.
  • 5. Simon TD, Bublitz C, Hambidge SJ. Emergency department visits among pediatric patients for sports-related injury: basic epidemiology and impact of race/ethnicity and insurance status. Pediatr Emerg Care. 2006;22(5):309–15.
  • 6. Cunningham RM, Walton MA, Carter PM. The major causes of death in children and adolescents in the United States. N Engl J Med. 2018;379(25):2468–75.
  • 7. World Health Organization. Paediatric emergency triage, assessment and treatment: care of critically ill children [Internet]. [cited 2025 May 11]. Available from: https://iris.who.int/bitstream/handle/10665/204463/9789241510219_eng.pdf
  • 8. Runde D, Beiner J. Calculated decisions: PECARN pediatric head injury/trauma algorithm. Pediatr Emerg Med Pract. 2018;15:CD3–4.
  • 9. Akay MA, Gurbuz N, Yayla D, et al. [Evaluation of pediatric trauma cases applied to emergency department] (in Turkish). Kocaeli Med J. 2013;2(3):1–5.
  • 10. Densmore JC, Lim HJ, Oldham KT, Guice KS. Outcomes and delivery of care in pediatric injury. J Pediatr Surg. 2000;41:92–8.
  • 11. MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354:366–78.
  • 12. Buschmann C, Kuhne CA, Losch C, Nast-Kolb D, Ruchholtz S. Major trauma with multiple injuries in German children: a retrospective review. J Pediatr Orthop. 2008;28:1–5. https://doi.org/10.1097/BPO.0b013e31815b4d90
  • 13. Brook U, Boaz M. Children hospitalized for accidental injuries: Israeli experiences. Patient Educ Couns. 2003;51:177–82.
  • 14. Koltka K, Ilhan M, Gok AFK, Gunay K, Ertekin C. Can ionized calcium levels and platelet counts be used for estimating the prognosis of pediatric trauma patients admitted to the emergency surgery intensive care? Ulus Travma Acil Cerrahi Derg. 2022;28:579–84.
  • 15. Voth M, Lustenberger T, Auner B, Frank J, Marzi I. What injuries should we expect in the emergency room? Injury. 2017;48:2119–24.
  • 16. Herbert HK, van As AB, Bachani AM, et al. Patterns of pediatric injury in South Africa: an analysis of hospital data between 1997 and 2006. J Trauma Acute Care Surg. 2012;73:168–74.
  • 17. Ulusoy E, Duman M, Caglar A, et al. Acute traumatic coagulopathy: the value of histone in pediatric trauma patients. Turk J Haematol. 2018;35:122–8.
  • 18. Varol F, Can YY, Ozgunay B, Cengiz M, Altas U, Guven S, Cam H. [Retrospective evaluation of pediatric trauma patients: a single-center experience of a tertiary pediatric intensive care unit] (in Turkish). J Med Palliat Care. 2022;15(1):45–52.
  • 19. Franzen L, Ortenwall P, Backteman T. Children in Sweden admitted to intensive care after trauma. Injury. 2007;38:91–7.
  • 20. Frisch L, Coate Johnston S, Melhorn K, Phillips Hill C, Boyce M. In the hands of children: fatal car, van, and truck crashes involving drivers aged 7 through 14 years. Arch Pediatr Adolesc Med. 2003;157(10):1032. https://doi.org/10.1001/archpedi.157.10.1032-a
  • 21. Mayer T, Walker ML, Johnson DG, Matlak ME. Causes of morbidity and mortality in severe pediatric trauma. JAMA. 1981;245:719–21.
  • 22. Hassan NE, DeCou JM, Reischman D, et al. RBC transfusions in children requiring intensive care admission after traumatic injury. Pediatr Crit Care Med. 2014;15:306–13.
  • 23. Pollack MM, Ruttimann UE, Getson PR. Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988;16(11):1110–6. https://doi.org/10.1097/00003246-198811000-00009
  • 24. Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review and meta-analysis. Crit Care Med. 2014;42(9):2118–25. https://doi.org/10.1097/CCM.0000000000000405
  • 25. Gatta A, Verardo A, Bolognesi M. Hypoalbuminemia. Intern Emerg Med. 2012;7(Suppl 3):S193–9. https://doi.org/10.1007/s11739-012-0802-0
  • 26. Cakir E, Turan IO. Lactate/albumin ratio is more effective than lactate or albumin alone in predicting clinical outcomes in intensive care patients with sepsis. Scand J Clin Lab Invest. 2021;81(3):225–9. https://doi.org/10.1080/00365513.2021.1901306
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Çocuk Yoğun Bakımı
Bölüm Araştırma Makalesi (Original Article)
Yazarlar

Fatih Battal 0000-0001-9040-7880

Cahide Danaci 0009-0008-0038-1049

Yayımlanma Tarihi 27 Haziran 2025
Gönderilme Tarihi 28 Mart 2025
Kabul Tarihi 13 Mayıs 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 10 Sayı: 2

Kaynak Göster

APA Battal, F., & Danaci, C. (2025). Etiology, clinical findings, and mortality in pediatric trauma: a retrospective analysis from Çanakkale. Family Practice and Palliative Care, 10(2), 73-82. https://doi.org/10.22391/fppc.1667367
AMA Battal F, Danaci C. Etiology, clinical findings, and mortality in pediatric trauma: a retrospective analysis from Çanakkale. Fam Pract Palliat Care. Haziran 2025;10(2):73-82. doi:10.22391/fppc.1667367
Chicago Battal, Fatih, ve Cahide Danaci. “Etiology, clinical findings, and mortality in pediatric trauma: a retrospective analysis from Çanakkale”. Family Practice and Palliative Care 10, sy. 2 (Haziran 2025): 73-82. https://doi.org/10.22391/fppc.1667367.
EndNote Battal F, Danaci C (01 Haziran 2025) Etiology, clinical findings, and mortality in pediatric trauma: a retrospective analysis from Çanakkale. Family Practice and Palliative Care 10 2 73–82.
IEEE F. Battal ve C. Danaci, “Etiology, clinical findings, and mortality in pediatric trauma: a retrospective analysis from Çanakkale”, Fam Pract Palliat Care, c. 10, sy. 2, ss. 73–82, 2025, doi: 10.22391/fppc.1667367.
ISNAD Battal, Fatih - Danaci, Cahide. “Etiology, clinical findings, and mortality in pediatric trauma: a retrospective analysis from Çanakkale”. Family Practice and Palliative Care 10/2 (Haziran2025), 73-82. https://doi.org/10.22391/fppc.1667367.
JAMA Battal F, Danaci C. Etiology, clinical findings, and mortality in pediatric trauma: a retrospective analysis from Çanakkale. Fam Pract Palliat Care. 2025;10:73–82.
MLA Battal, Fatih ve Cahide Danaci. “Etiology, clinical findings, and mortality in pediatric trauma: a retrospective analysis from Çanakkale”. Family Practice and Palliative Care, c. 10, sy. 2, 2025, ss. 73-82, doi:10.22391/fppc.1667367.
Vancouver Battal F, Danaci C. Etiology, clinical findings, and mortality in pediatric trauma: a retrospective analysis from Çanakkale. Fam Pract Palliat Care. 2025;10(2):73-82.
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Family Practice and Palliative Care      ISSN 2458-8865       E-ISSN 2459-1505