Characteristics of injured children attending the emergency department: patients potentially in need of rehabilitation

Sturms, Leontien M.; van der Sluis, Corry K.; Groothoff, Johan W.; ten Duis, H. J.; Eisma, Willem H. · 2002 · OpenAlex-citations

DOI: 10.1191/0269215502cr466oa

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Summary

This study addresses the need for a comprehensive epidemiological overview of pediatric injuries to identify predictors of hospitalization and potential disablement. While injuries are a leading cause of death and disability in children, previous research often focused exclusively on fatal cases or specific subpopulations, such as severely injured or hospitalized patients. This gap limits the understanding of the broader injury burden, particularly regarding survivors who may require rehabilitation. The authors aimed to characterize the entire spectrum of injured children attending an emergency department and compare hospitalized versus nonhospitalized groups to determine factors associated with admission. The researchers conducted a retrospective analysis of data from the University Hospital Groningen’s computerized trauma registration system (RLOG) and medical records. The study population comprised 5,057 children aged 0–19 years treated at the Department of Traumatology between January 1996 and December 1997. Injury severity was assessed using the Injury Severity Score (ISS) and the Abbreviated Injury Scale (AIS), with diagnoses coded according to ICD-9CM. Causes of injury were categorized into traffic accidents, home and leisure injuries, sports injuries, intentional injuries, and others. Multivariate logistic regression was employed to identify predictors of hospitalization, adjusting for ISS, the body region of the most severe injury (MAIS), and injury cause. The results indicated that home and leisure accidents were the most common cause of injury (53%), followed by sports (23%) and traffic accidents (19%). The majority of injuries were minor, with only 1% of patients having an ISS ≥ 16. Overall, 10% of patients required hospitalization, 24 died, and 19 were referred to rehabilitation centers. Hospitalized patients were more likely to be male, involved in traffic accidents, and sustain injuries to the head/neck, spine, thorax, or abdomen. In contrast, nonhospitalized patients had proportionally more extremity injuries. Logistic regression identified ISS, MAIS, and traffic-related injury causes as significant predictors of hospitalization. Specifically, patients with MAIS thorax/abdomen had the highest risk of admission (adjusted odds ratio 48.4), followed by those with MAIS head/neck/face (OR 10.1). Traffic victims were 1.4 times more likely to be hospitalized than those with other injury causes. The study concludes that young traffic victims, children with high ISS scores, and those with head/neck or thorax/abdomen injuries carry the highest risk of hospitalization. The authors argue that rehabilitation needs should not be limited to hospitalized patients, as nonhospitalized children with extremity or minor head injuries may also suffer residual disabilities. They highlight that single-bicycle accidents are a significant, often overlooked cause of injury. The findings suggest that ISS and hospitalization status are imperfect predictors of disability, urging future research to include outcome assessments for nonhospitalized patients to better identify those requiring rehabilitation services.

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• demographic disparities