Department of Surgery, New York University School of Medicine, New York, NY, USA.
Department of Surgery, New York University School of Medicine, New York City, New York, USA.
Inj Prev. 2019 Apr;25(2):136-143. doi: 10.1136/injuryprev-2017-042435. Epub 2017 Oct 22.
Traumatic injury is the leading cause of paediatric morbidity and mortality in the USA. We present updated national data on emergency department (ED) discharges for traumatic injury for a recent 7-year period.
We conducted a descriptive epidemiological analysis of the Nationwide Emergency Department Sample Survey, the largest and most comprehensive database in the USA, for 2006-2012. Among children and adolescents, we tracked changes in injury mechanism and severity, cost of care, injury intent and the role of trauma centres.
There was an 8.3% (95% CI 7.7 to 8.9) decrease in the annual number of ED visits for traumatic injury in children and adolescents over the study period, from 8 557 904 (SE=5861) in 2006 to 7 846 912 (SE=5191) in 2012. The case-fatality rate was 0.04% for all injuries and 3.2% for severely injured children. Children and adolescents with high-mortality injury mechanisms were more than three times more likely to be treated at a level 1 trauma centre (OR=3.5, 95% CI 3.3 to 3.7), but were more no more likely to die (OR=0.96, 95% CI 0.93 to 1.00). Traumatic brain injury diagnoses increased 22.2% (95% CI 20.6 to 23.9) during the study period. Intentional assault accounted for 3% (SE=0.1) of all child and adolescent ED injury discharges and 7.2% (SE=0.3) of discharges among 15-19 year-olds. There was an 11.3% (95% CI 10.0 to 12.6) decline in motor vehicle injuries from 2009 to 2012. The total cost of care was $23 billion (SE=0.01), a 78% increase from 2006 to 2012.
This analysis presents a recent portrait of paediatric trauma across the USA. These analyses indicate the important role and value of trauma centre care for injured children and adolescents, and that the most common causes and mechanisms of injury are preventable.
在美国，创伤是导致儿童发病和死亡的主要原因。我们呈现了最近 7 年关于创伤性急诊科（ED）出院的全国性数据。
我们对全美急诊抽样调查进行了描述性流行病学分析，该调查是美国最大和最全面的数据库，涵盖了 2006 年至 2012 年的数据。在儿童和青少年中，我们跟踪了损伤机制和严重程度、护理成本、损伤意图以及创伤中心作用的变化。
研究期间，儿童和青少年因创伤性损伤而前往急诊科就诊的年度数量减少了 8.3%（95%置信区间 7.7 至 8.9），从 2006 年的 8557904 例（SE=5861）降至 2012 年的 7846912 例（SE=5191）。所有损伤的病死率为 0.04%，严重损伤儿童的病死率为 3.2%。高死亡率损伤机制的儿童和青少年接受 1 级创伤中心治疗的可能性是三倍以上（OR=3.5，95%置信区间 3.3 至 3.7），但死亡的可能性并没有增加（OR=0.96，95%置信区间 0.93 至 1.00）。研究期间，创伤性脑损伤诊断增加了 22.2%（95%置信区间 20.6 至 23.9）。故意攻击占所有儿童和青少年急诊科损伤出院的 3%（SE=0.1）和 15-19 岁青少年出院的 7.2%（SE=0.3）。2009 年至 2012 年，机动车事故减少了 11.3%（95%置信区间 10.0 至 12.6）。护理总成本为 230 亿美元（SE=0.01），比 2006 年至 2012 年增长了 78%。
本分析描绘了美国近期儿童创伤的概况。这些分析表明，创伤中心对受伤儿童和青少年的护理具有重要作用和价值，而且最常见的损伤原因和机制是可以预防的。
