title: Mechanism of injury predicts case fatality and functional outcomes in pediatric trauma patients: the case for its use in trauma outcomes studies.
abstract: OBJECTIVE
  The mechanism of injury (MOI) may serve as a useful adjunct to injury scoring systems in pediatric trauma outcomes research. The objective is to determine the independent effect of MOI on case fatality and functional outcomes in pediatric trauma patients.
  
  
  METHODS
  Retrospective review of pediatric patients ages 2 to 18 years in the National Trauma Data Bank from 2002 through 2006 was done. Mechanism of injury was classified by the International Classification of Diseases, Ninth Revision, E codes. The main outcome measures were mortality, discharge disposition (home vs rehabilitation setting), and functional impairment at hospital discharge. Multiple logistic regression was used to adjust for injury severity (using the Injury Severity Score and the presence of shock upon admission in the emergency department), age, sex, and severe head or extremity injury.
  
  
  RESULTS
  Thirty-five thousand ninety-seven pediatric patients in the National Trauma Data Bank met inclusion criteria. Each MOI had differences in the adjusted odds of death or functional disabilities as compared with the reference group (fall). The MOI with the greatest risk of death was gunshot wounds (odds ratio [OR], 3.52; 95% confidence interval [CI], 2.23-5.54 95). Pediatric pedestrians struck by a motor vehicle have the highest risk of locomotion (OR, 3.30; 95% CI, 2.89-3.77) and expression (OR, 1.65; 95% CI, 1.22-2.23) disabilities.
  
  
  CONCLUSIONS
  Mechanism of injury is a significant predictor of clinical and functional outcomes at discharge for equivalently injured patients. These findings have implications for injury prevention, staging, and prognosis of traumatic injury and posttreatment planning.
authors.affiliation: Center for Trials and Outcomes Research, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. ahaider1@jhmi.edu
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Crompton
authors.forename: Tolulope
authors.initials: T
authors.lastname: Oyetunji
authors.forename: Donald
authors.initials: D
authors.lastname: Risucci
authors.forename: Stephen
authors.initials: S
authors.lastname: DiRusso
authors.forename: Hatice
authors.initials: H
authors.lastname: Basdag
authors.forename: Cassandra V
authors.initials: CV
authors.lastname: Villegas
authors.forename: Zain U
authors.initials: ZU
authors.lastname: Syed
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: David T
authors.initials: DT
authors.lastname: Efron
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010351:Patient Discharge; D011379:Prognosis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D014948:Wounds, Gunshot / Q000453:epidemiology / Q000401:mortality