Factors influencing outcomes of severely injured children in a South African context
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Date
2017
Authors
Koekemoer, Heinrich Pieter
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Abstract
INTRODUCTION
Paediatric trauma is a significant health burden and a leading cause of death among children
in South Africa and globally.
OBJECTIVE
To determine the factors influencing the outcomes of severely injured children in a South
African context.
METHODS
A retrospective study on factors influencing mortality in a paediatric cohort (≤ 14 years)
admitted to the intensive care units of two hospitals in Gauteng, South Africa, from 1 January
2006 to 31 December 2013 after suffering major trauma (ISS>10).
RESULTS
The total cohort (n=166) consisted of public (n=125) and private (n=41) cohorts with actual
death 15.7% (n=26) of the total cohort. There was a significant difference in probability of
survival in survivors (92%) versus deaths (82%) (p=0.004). Factors that influenced the risk of
mortality included time spent in the paediatric ICU [odds ratio of 0.706 (95% CI, 0.544-
0.915)] and whether a patient received public or private care [odds ratio of 5.43 (95% CI,
1.178-25.012)]. Both the Injury Severity Score (p=0.004) and Revised Trauma Score
(p=0.034) systems played a significant role in the ability to predict mortality.
CONCLUSION
The outcome of severe paediatric trauma is influenced by multiple factors. The strongest
predictors of mortality according to this study are time spent in PICU and the private health
sector; numerous limitations of this study require replication with much larger data sets using
paediatric specific trauma outcome scores.
Description
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of
Master of Medicine in the branch of Paediatrics
Johannesburg 2017.