title: Mortality in severely injured children: experiences of a German level 1 trauma center (2002 - 2011).
abstract: BACKGROUND
  Trauma in pediatric patients is a major cause of death. This study investigated differences between decedents and survivors. Furthermore, an analysis of preventable and potential preventable trauma deaths was conducted and errors in the acute trauma care were investigated.
  
  
  METHODS
  All patients aged less than 16 years with an Injury Severity Score (ISS) ≥ 16 upon primary admission to the hospital between July 2002 and December 2011 were included in this study. Decedents were compared with survivors and an analysis of deceased children for preventable and potential preventable deaths was conducted. The acute trauma care was investigated regarding errors in treatment.
  
  
  RESULTS
  Significant differences were found in Glasgow Coma Scale, Injury Severity Score, Revised Trauma Score, New ISS, Revised Injury Severity Classification, and Trauma and Injury Severity Score. Decedents had a worse head trauma with associated coagulopathy. The overall mortality rate was 13.4%. The majority of death occurred soon after arrival. No long term intensive care unit stay was found.No preventable but one potential preventable death was analyzed. Most errors occurred in fluid volume management and in a delay of starting the therapy for hemorrhage and coagulopathy.Prolonged preclinical rescue time and surgery time within the first 24 hours was found.
  
  
  CONCLUSIONS
  Head trauma is the determinant factor for mortality in severely injured pediatric patients. Death occurred shortly after arrival and long term intensive care stays might be an exception. In treatment of severely injured children volume management, hemorrhage and coagulopathy management, rescue time, and total surgery time should receive more attention.
authors: Department of Trauma Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, Essen, Germany. carsten.schoeneberg@uk-essen.de.
authors: Carsten
authors: C
authors: Schoeneberg
authors: Marc
authors: M
authors: Schilling
authors: Judith
authors: J
authors: Keitel
authors: Manuel
authors: M
authors: Burggraf
authors: Bjoern
authors: B
authors: Hussmann
authors: Sven
authors: S
authors: Lendemans
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D005260:Female; D005440:Fluid Therapy; D005858:Germany / Q000453:epidemiology; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D011379:Prognosis; D012042:Registries; D012151:Resuscitation; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy