Evaluation of the relationship between mechanism of injury and outcome in pediatric trauma

Background: Most prehospital triage strategies are based on physiologic, anatomic, and mechanism-related variables. Although previous studies have suggested the value of physiologic and anatomic triage criteria, the predictive capacity of mechanism of injury has been questioned. The purpose of the current study was to evaluate the relationship between mechanism of injury and resource utilization and outcome among injured children treated at trauma centers. Methods: The relationship between mechanism of injury and mortality and resource utilization (need for operative care, total and ICU length of stay) was analyzed using the records of pediatric patients (age <15 years) included in the National Pediatric Trauma Registry between 1995 and 2001. Results: Significant variability in the outcome, resources requirements, and need for inpatient rehabilitation after discharge were observed among the mechanisms analyzed. Mechanisms such as firearm injuries were more likely to be severe and require significant trauma center resources, whereas other mechanisms such as falls related to stairs were more likely to result in injuries that were less severe and require relatively few resources. A proposed framework is presented into which mechanisms are stratified according to severity of injury (high vs. low severity) and need for trauma center resources (high vs. low requirement). Conclusions: Mechanism of injury is associated with the need for trauma center care but this association is highly dependent on the measure used to determine appropriateness of triage.