Retrospective evaluation of trauma patients followed in the pediatric intensive care unit

Trauma is a leading cause of death and disability in children. According to the World Health Organization, more than 1 million children die every year worldwide due to traumatic injuries (1, 2). It is important to predict death in trauma patients hospitalized in pediatric intensive care units. Many studies have been carried out for this purpose. This thesis study aims to determine the demographic data of the patients followed for trauma in the pediatric intensive care unit; vital signs, laboratory parameters, imaging data, respiratorycirculatory support treatments, and scoring characteristics, which have an impact on this patient's mortality, morbidity, length of stay in hospital and intensive care unit. In addition, it revealed factors affecting the discharge GOS, 6th month GOS and PRISM III. Patients followed up in the pediatric intensive care unit due to trauma between June 2014 and December 2021 were included in the study. The demographic data, trauma mechanisms, trauma-affected systems, vital signs, laboratory and imaging findings, applied treatments, and the operations of 425 patients included in the study were recorded retrospectively.Whether intubation was performed, the duration of the days remaining in the mechanical ventilator, and the length of stay in the hospital and intensive care unit are recorded. GCS, PTS and PRISM III scores of the patients are calculated and recorded. While no statistically significant correlation was found between the number of centers that patients applied to our hospital and mortality (p=0.141); The rate of patients who were brought to our hospital as the first center to have good results according to GOS at discharge was significantly higher than those who were brought to our hospital as the second or third center (p=0.001). When the relationship between laboratory findings and mortality was analyzed, blood glucose (p<0.001), WBC (p=0.046), CK (p=0.036), creatinine (p<0.001), ALT (p<0.001), AST (p<0.001), amylase (p=0.012), lactate (p<0.001), troponin I (p=0.001), INR (p<0.001) and aPTT (p<0.001) levels were significantly higher in the deceased than in the survivors. Fibrinogen (p=0.003), pH (p<0.001) and PLR (platelet lymphocyte ratio) (p=0.006) were significantly lower in the deceased than in the survivors. The Hb level was significantly lower in the deceased than in the survivors (cutoff point < 10.25; AUC: 0.702; sensitivity 64.5%; specificity 83%). While PTS with a pediatric trauma score was significantly lower in those who died than in those who survived (p<0.001); PRISM III mortality score was significantly higher in the deceased than in the survivors (p<0.001). The mortality rate was significantly higher in patients who needed blood products (p<0.001). When mortality was evaluated according to seizure status, it was found that the mortality rate was higher in patients who had seizures during intensive care hospitalization (p=0.028). The average of the first 24 measurement measurements with the highest blood glucose value >200 g/dl; death rates (p<0.001), rate of having poor results in GOS at discharge (p<0.001), rate of having poor results in terms of GOS at 6 months after discharge (p=0.04), length of hospital stay (p=0.000) and intensive care unit length of stay (p=0.000) were found to be higher than those with blood glucose of 100-200 g/dl and <100 g/dl. In the logistic regression analysis, the need for inotropes, the need for albumin, brain edema and GCS were found to be significant in predicting exitus. Among them, the strongest parameter in predicting the exitus was the need for inotropes. By predicting the mortality of pediatric trauma patients admitted to intensive care, the treatment of critically ill patients should be carried out more carefully. In order to reduce hospital infections, examinations and treatments should be performed quickly and hospital and intensive care hospitalization periods should be shortened as much as possible. We believe that palliative care and rehabilitation centers should be established for patients with neurological deficits and discharged by tracheostomy during discharge from intensive care, ensuring that these patients receive the best possible care and that hospital and intensive care beds should be used for more critical patients. Keywords: pediatric trauma; death; PRISM III; PTS; injury