Family Practice and Palliative Care

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.