Epidemiology and aetiology of paediatric traumatic cardiac arrest in England and Wales. Issue 5 (16th May 2019)

• Record Type: Journal Article
• Authors: Vassallo, James; Webster, Melanie; Barnard, Edward B G; Lyttle, Mark D; Smith, Jason E
• Is Part Of: Archives of disease in childhood. Volume 104:Issue 5(2019)
• Page Start: 437
• Publication Date: 2019-05-16
• Subjects: paediatric trauma -- epidemiology -- paediatric traumatic cardiac arrest -- cardiac arrest; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2018-314985
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Objective: To describe the epidemiology and aetiology of paediatric traumatic cardiac arrest (TCA) in England and Wales. Design: Population-based analysis of the UK Trauma Audit and Research Network (TARN) database. Patients and setting: All paediatric and adolescent patients with TCA recorded on the TARN database for a 10-year period (2006–2015). Measures: Patient demographics, Injury Severity Score (ISS), location of TCA ('prehospital only', 'in-hospital only' or 'both'), interventions performed and outcome. Results: 21 710 paediatric patients were included in the database; 129 (0.6%) sustained TCA meeting study inclusion criteria. The majority, 103 (79.8%), had a prehospital TCA. 62.8% were male, with a median age of 11.7 (3.4–16.6) years, and a median ISS of 34 (25–45). 110 (85.3%) had blunt injuries, with road-traffic collision the most common mechanism (n=73, 56.6%). 123 (95.3%) had severe haemorrhage and/or traumatic brain injury. Overall 30-day survival was 5.4% ((95% CI 2.6 to 10.8), n=7). 'Pre-hospital only' TCA was associated with significantly higher survival (n=6) than those with TCA in both 'pre-hospital and in-hospital' (n=1)—13.0% (95% CI 6.1% to 25.7%) and 1.2% (95% CI 0.1% to 6.4%), respectively, p<0.05. The greatest survival (n=6, 10.3% (95% CI 4.8% to 20.8%)) was observed in those transported to a paediatric major trauma centre (MTC) (defined as either a paediatric-only MTC or combined adult-paediatric MTC). Conclusions: Survival is possible from the resuscitation of children in TCA, with overall survival comparable to that reported in adults. The highest survival was observed in those with a pre-hospital only TCA, and those who were transported to an MTC. Early identification and aggressive management of paediatric TCA is advocated.