Serious pediatric trauma in South Korea: a nationwide study from 2016 to 2020

Background: This study analyzed national data on serious pediatric trauma cases presenting at emergency departments in Korea.Methods: We analyzed data from the National Emergency Department Information System of Korea.The inclusion criteria for the dataset included: age under 20 years, a Korean Triage Acuity System (KTAS) level of 1 or 2, a visit to the emergency department due to trauma, and data from the years 2016 to 2020 during which the KTAS level was systematically recorded.Results: A total of 10,680 patients (2,136/year) were included in the dataset (KTAS levels 1 and 2: 13.1% and 86.9%, respectively).There were 1,141 deaths (10.7%, 228/year).The number of patients with traumatic cardiac arrest (TCA) on arrival was 860 (8.1%), and their mortality rate was 94.4%.Patients with intentional injuries had a higher frequency of mortality, TCA on arrival, KTAS level 1, ambulance usage, and most critical procedures than those with non-intentional injuries.Excluding patients with TCA because of incomplete evaluation and underestimation of injuries, injuries involving the head, chest, abdomen, spine, and pelvis showed higher mortality rates (odds ratio [OR]=2.2,5.3, 3.1, 2.2, and 5.5, respectively), and injuries involving the upper extremity showed lower mortality rates than their counterparts (OR=0.6).In multivariate regression, the following factors were associated with higher mortality: TCA on arrival, stuporous or comatose mentality, intentional injury, fall from a height (OR=29, 71.8, 1.9, and 2.0, respectively).For patients without TCA on arrival only, head, chest, and abdomen injuries were also associated with higher mortality (OR=1.6,2.0, and 1.5, respectively).Conclusion: Annually, there were 2,172 pediatric patients with serious trauma and 228 deaths (2.4/100,000) in Korea.Intentional injuries were significantly associated with mortality and required a high burden of medical services.Initial cardiac rhythm and mental status on arrival showed higher associations with mortality than other clinical characteristics.