International Study of the Epidemiology of Paediatric Trauma: PAPSA Research Study

Abstract

Objectives: Trauma is a significant cause of morbidity and mortality worldwide. The literature on paediatric trauma epidemiology in low- and middle-income countries (LMICs) is limited. This study aims to gather epidemiological data on paediatric trauma.

Methods: This is a multicentre prospective cohort study of paediatric trauma admissions, over 1 month, from 15 paediatric surgery centres in 11 countries. Epidemiology, mechanism of injury, injuries sustained, management, morbidity and mortality data were recorded. Statistical analysis compared LMICs and high-income countries (HICs).

Results: There were 1377 paediatric trauma admissions over 31 days; 1295 admissions across ten LMIC centres and 84 admissions across five HIC centres. Median number of admissions per centre was 15 in HICs and 43 in LMICs. Mean age was 7 years, and 62% were boys. Common mechanisms included road traffic accidents (41%), falls (41%) and interpersonal violence (11%). Frequent injuries were lacerations, fractures, head injuries and burns. Intra-abdominal and intra-thoracic injuries accounted for 3 and 2% of injuries. The mechanisms and injuries sustained differed significantly between HICs and LMICs. Median length of stay was 1 day and 19% required an operative intervention; this did not differ significantly between HICs and LMICs. No mortality and morbidity was reported from HICs. In LMICs, in-hospital morbidity was 4.0% and mortality was 0.8%.

Conclusion: The spectrum of paediatric trauma varies significantly, with different injury mechanisms and patterns in LMICs. Healthcare structure, access to paediatric surgery and trauma prevention strategies may account for these differences. Trauma registries are needed in LMICs for future research and to inform local policy.

Fig. 1

Map demonstrating the location of each of the 15 participating units, along with the economic classification of each of these countries

Fig. 2

Map and bar chart demonstrating the average number of trauma admissions per unit over 1 month for each participating country (created using Statplanet online tool)

Fig. 3

Graph demonstrating the distribution of age at injury in low- and middle-income countries (LMICs) and high-income countries (HICs)

Fig. 4

Chart demonstrating the proportions for the most common mechanisms of injury for paediatric trauma seen in units based in low- and middle-income countries (LMICs) compared to high-income countries (HICs). Asterisk indicates a statistically significant difference (p < 0.001)

Fig. 5

Chart demonstrating the proportion of patients presenting with the most common injuries observed in paediatric trauma attending units based in low- and middle-income countries (LMICs) as compared to high-income countries (HICs). Asterisk indicates a statistically significant difference (p < 0.001)