Pediatric Mortality andPreventable Death at a Mature Trauma Center

Abstract

Objectives: It is critical to review pediatric mortality and identify preventable/potentially preventable death (PD). We sought to characterize mortality in pediatric trauma patients at our center and identify causes of PD. Methods:A retrospective review of pediatric (<14) trauma deaths (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) at our American College of Surgeons verified level 1 adult/ level 2 pediatric trauma center was conducted. Patients that died from burns, drowning or hanging were excluded. Demographics, clinical characteristics, and autopsy data were collected. Injury severity (ISS) and trauma & injury severity (TRISS) scores were calculated for each patient. Injuries were classified as non-survivable if they involved an ISS of 75. Death after non-survivable injury was considered nonpreventable. A multi-disciplinary panel reviewed all mortalities and rendered decisions regarding preventability and causes of PD.Results: 49 of 3,065 patients died over the study period (MR=1.6%). Patients that died were primarily male (73%) with severe injuries (ISS 32 (19)) caused by a blunt (85%) mechanism. Fifteen deaths (31%) were the result of non-accidental trauma (NAT). Seven patients had an ISS of 75 indicating non-survivable injuries. After calculating TRISS on the remaining 42 patients, 12 patients had a >50% probability of survival. 25% of patients with a TRISS >50% were determined to be PD's for an overall preventable death rate (PDR) of 6%. Failure to control hemorrhage (67%) and failure to secure an airway (33%) were the causes of PD. Conclusion:We identified a PDR of 6% at our institution and found that a TRISS >50% correlates significantly with PD.