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Epidemiology and aetiology of paediatric traumatic cardiac arrest in England and Wales
  1. James Vassallo1,2,3,
  2. Melanie Webster4,
  3. Edward B G Barnard3,
  4. Mark D Lyttle4,5,
  5. Jason E Smith3
  6. On behalf of PERUKI (Paediatric Emergency Research in the UK and Ireland)
  1. 1 Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
  2. 2 Institute of Naval Medicine, Gosport, UK
  3. 3 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK
  4. 4 Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
  5. 5 Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
  1. Correspondence to Dr James Vassallo, Institute of Naval Medicine, Gosport PO12 2DL, UK; vassallo{at}doctors.org.uk

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.

  • paediatric trauma
  • epidemiology
  • paediatric traumatic cardiac arrest
  • cardiac arrest
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Footnotes

  • Twitter @jamievassallo, @DefProfEM, @mdlyttle, @PERUKItweep

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JV, EB and JES are serving members of the Royal Navy.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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