Glasgow Coma Scale and outcomes after structural traumatic head injury in early childhood.

OBJECTIVE: To assess the association of the Glasgow Coma Scale (GCS) with radiological evidence of head injury (the Abbreviated Injury Scale for the head region, AIS-HR) in young children hospitalized with traumatic head injury (THI), and the predictive value of GCS and AIS-HR scores for long-term impairment. METHODS: Our study involved a 10-year retrospective review of a database encompassing all patients admitted to Starship Children's Hospital (Auckland, New Zealand, 2000-2010) with THI. RESULTS: We studied 619 children aged <5 years at the time of THI, with long-term outcome data available for 161 subjects. Both GCS and AIS-HR scores were predictive of length of intensive care unit and hospital stay (all p<0.001). GCS was correlated with AIS-HR (ρ=-0.46; p<0.001), although mild GCS scores (13-15) commonly under-estimated the severity of radiological injury: 42% of children with mild GCS scores had serious-critical THI (AIS-HR 3-5). Increasingly severe GCS or AIS-HR scores were both associated with a greater likelihood of long-term impairment (neurological disability, residual problems, and educational support). However, long-term impairment was also relatively common in children with mild GCS scores paired with structural THI more severe than a simple linear skull fracture. CONCLUSION: Severe GCS scores will identify most cases of severe radiological injury in early childhood, and are good predictors of poor long-term outcome. However, young children admitted to hospital with structural THI and mild GCS scores have an appreciable risk of long-term disability, and also warrant long-term follow-up.

Dangerous toys.

BACKGROUND: Motorcycles are sources of significant injury for children. There is limited data describing New Zealand's experience. The study's aim was to quantify the burden of motorcycle trauma presenting to Starship Children's Hospital by assessing the annual admission rates, severity and pattern of injuries, and patient mortality, and to compare injury patterns of those riding all-terrain vehicles (ATV) and two-wheeled motorbikes (MB). METHODS: Retrospective chart review of all motorcycle trauma admissions to Starship Children's Hospital between November 1999 and December 2008. Patients were identified using the Starship Trauma Registry. RESULTS: One hundred forty-six admissions (123 MBs, 23 ATVs). Admissions have increased threefold in 9 years. Mean age was 10.5 years (range 2-14 years). ATV riders were significantly younger than MB riders (median 9 and 12 years, P = 0.001). Eighty-five per cent of patients were male and New Zealand European. There were two deaths in the study. Median length of stay was 2 days (1-80 days); 7.4% required intensive care admission. The median injury severity score (ISS) was 4 (1-35). Twenty-six per cent of ATV riders had an ISS >12, and 8.9% of MB riders had and ISS >12, P = 0.03. Eighty-five per cent of patients with an ISS >12 were under 12 years. Sixty per cent of patients required an operative procedure. No difference in pattern of injuries between in ATVs and motorbikes. CONCLUSIONS: Motorcycle trauma admissions are increasing. ATV riders are more severely injured and younger than MB riders. Children <12 years are more likely to be severely injured in comparison to those >12 years.

Television tip-overs: the Starship Children's Hospital experience and literature review.

BACKGROUND: Injuries sustained from television (TV) sets tipping over onto children are uncommon when compared to other forms of trauma, but because of the weight of some TVs relative to the size of small children, severe and sometimes fatal injuries can result. The international literature is limited in describing this form of trauma and none is available for the Australasian region. AIM: The aims of the present paper are to describe the characteristics and immediate outcomes of children admitted to Starship Children's Hospital following TV tip-overs and review the international literature on this topic. METHODS: Patients admitted to Starship Hospital were identified retrospectively from the Paediatric Trauma database, and the case notes reviewed. Structured telephone interviews were then conducted with each of the families involved. RESULTS: Over the 28-month period (June 2006-October 2008) reviewed, 13 children under 15 years of age were identified, with an almost even sex distribution. 5 required admission to the Paediatric Intensive Care Unit (PICU). 9/13 sustained head injuries and 1 patient died from their injuries. Mechanism of injury was in keeping with behaviour to be expected of toddlers. Parents and caregivers were unaware of the dangers posed by TV sets and no precautions had been taken to prevent injury. CONCLUSIONS: The injuries sustained by children from TV tip-overs are often serious and most commonly involve the head and upper body. This is a common finding in all papers reviewed, but numbers of patients studied are still limited. There is a need for both education of families and improvement in the design of TV sets, to prevent this form of trauma in the paediatric population.

Contemporary New Zealand coefficients for the Trauma Injury Severity Score: TRISS(NZ).

AIMS: To develop local contemporary coefficients for the Trauma Injury Severity Score in New Zealand, TRISS(NZ), and to evaluate their performance at predicting survival against the original TRISS coefficients. METHODS: Retrospective cohort study of adults who sustained a serious traumatic injury, and who survived until presentation at Auckland City, Middlemore, Waikato, or North Shore Hospitals between 2002 and 2006. Coefficients were estimated using ordinary and multilevel mixed-effects logistic regression models. RESULTS: 1735 eligible patients were identified, 1672 (96%) injured from a blunt mechanism and 63 (4%) from a penetrating mechanism. For blunt mechanism trauma, 1250 (75%) were male and average age was 38 years (range: 15-94 years). TRISS information was available for 1565 patients of whom 204 (13%) died. Area under the Receiver Operating Characteristic (ROC) curves was 0.901 (95%CI: 0.879-0.923) for the TRISS(NZ) model and 0.890 (95% CI: 0.866-0.913) for TRISS (P<0.001). Insufficient data were available to determine coefficients for penetrating mechanism TRISS(NZ) models. CONCLUSIONS: Both TRISS models accurately predicted survival for blunt mechanism trauma. However, TRISS(NZ) coefficients were statistically superior to TRISS coefficients. A strong case exists for replacing TRISS coefficients in the New Zealand benchmarking software with these updated TRISS(NZ) estimates.

Using Trauma Injury Severity Score (TRISS) variables to predict length of hospital stay following trauma in New Zealand.

AIM: To develop and assess the predictive capabilities of a statistical model that relates routinely collected Trauma Injury Severity Score (TRISS) variables to length of hospital stay (LOS) in survivors of traumatic injury. METHOD: Retrospective cohort study of adults who sustained a serious traumatic injury, and who survived until discharge from Auckland City, Middlemore, Waikato, or North Shore Hospitals between 2002 and 2006. Cubic-root transformed LOS was analysed using two-level mixed-effects regression models. RESULTS: 1498 eligible patients were identified, 1446 (97%) injured from a blunt mechanism and 52 (3%) from a penetrating mechanism. For blunt mechanism trauma, 1096 (76%) were male, average age was 37 years (range: 15-94 years), and LOS and TRISS score information was available for 1362 patients. Spearman's correlation and the median absolute prediction error between LOS and the original TRISS model was p=0.31 and 10.8 days, respectively, and between LOS and the final multivariable two-level mixed-effects regression model was p=0.38 and 6.0 days, respectively. Insufficient data were available for the analysis of penetrating mechanism models. CONCLUSIONS: Neither the original TRISS model nor the refined model has sufficient ability to accurately or reliably predict LOS. Additional predictor variables for LOS and other indicators for morbidity need to be considered.

Paediatric driveway run-over injuries: time to redesign?

AIMS: To investigate the demographic, accident, and environmental characteristics associated with driveway run-over injuries in order to identify potentially modifiable factors and prevention strategies METHODS: Retrospective review of all children less than 15 years old who were hospitalised or killed due to a driveway run-over injury in the Auckland region of New Zealand over the 50-month period, November 2001 to December 2005. Data was collected on the demographics, accident and environmental characteristics, and parental awareness. Data was obtained from clinical records and telephone interviews with parents. RESULTS: A total of 93 cases were identified, including 9 fatalities. The median age was 2 years with 73% under 5 years old. Children of Pacific Island and Maori ethnicity comprised 43% and 25% of cases respectively. Injuries occurred predominately on the child's home driveway (80% of cases). In 64% the driveway was the usual play area for the child. Only 13% of driveways were fenced. 51% were long driveways extending through the section, and 51% were shared with other properties. 51% of properties were rented and of these 57% were government houses. CONCLUSION: The absence of physical separation between driveways and children's play and living areas may predispose to driveway injuries. Further research is needed to investigate the ideal way to implement such separation in current properties and future property developments.

Paediatric pedestrian trauma: the danger after school.

AIM: To examine the demographics of road pedestrian trauma in children in the Auckland region and to provide data that can help target prevention strategies. METHODS: A retrospective analysis was conducted of all children (0-14 years) in the Auckland region admitted to the hospital or killed following a pedestrian versus vehicle injury for the 6-year period 2000-2005. Excluded were pedestrians injured in a driveway. RESULTS: Over the 6-year period, 364 children were involved in pedestrian crashes resulting in 25 deaths. The median age was 7 years. Males comprised 63%. Pacific Islanders and Maori were over-represented. Three hundred seventeen patients had injury times recorded. Of these, 49% occurred between 3 and 7 pm. Injury peaks for school days showed a tri-modal pattern with injury peaks at 8-9 am, 3-4 pm and 5-6 pm with the 3-4 pm after-school peak predominating. CONCLUSION: Prevention strategies should concentrate on the hours after school finishes and should be tailored for Maori and Pacific Island communities.