Global variation in injury patterns, interventions, and post-operative outcomes for children and adolescents undergoing trauma laparotomy: an international cohort study

BACKGROUND: Trauma is the leading cause of death and disability in children and adolescents worldwide; however, paediatric trauma care is often neglected during health system development. We aimed to understand current global standards of laparotomy care for paediatric patients with blunt or penetrating traumatic injury and variation in patient injury patterns, intervention, and post-operative outcomes. METHODS: This is a planned post-hoc analysis of the international, multicentre, prospective, observational cohort from the Global Outcomes After Laparotomy for Trauma (GOAL-Trauma) Study, which was conducted between April 1 and Dec 31, 2024. Patients aged 18 years or younger with a blunt or penetrating traumatic injury who underwent a laparotomy within 5 days of presentation were eligible. Countries were stratified by the Human Development Index (HDI), and the primary outcome was post-operative in-hospital 30-day mortality. Adjusted mortality risk was calculated using least absolute shrinkage and selection operator regression analysis. The study was registered with ClinicalTrials.gov (NCT06180668). FINDINGS: 237 paediatric patients who underwent a trauma laparotomy were recruited from 85 hospitals in 32 countries, with the highest proportion of patients living in countries in the lower HDI tertile (110 [20%] of 563 cases overall). The median age among paediatric cases was 16·0 years (IQR 12·0-18·0), and most patients were male (195 [82%] of 237 patients) and had sustained a blunt injury (135 [57%] patients). The median time globally from injury to operation was 7·4 h (IQR 3·5-18·8; n=235), with longer times observed across the patient pathway for patients in the lower and middle HDI tertiles than for those in the upper HDI tertile (p=0·0008). The overall 30-day in-hospital crude mortality rate was 8% (19 of 237 patients); however, after adjustment, patients in the lower HDI tertile were nearly six times more likely to die post-operatively than those in the upper HDI tertile (odds ratio 5·69 [95% CI 1·58-20·44], p=0·0079). INTERPRETATION: Proportionally more children undergo trauma laparotomy in lower-resource settings than in higher-resource settings; however, their mortality risk is substantially higher. Marked variation exists in paediatric pathways globally, and policy makers and health-care leaders should prioritise the development of paediatric trauma care worldwide. FUNDING: Royal College of Surgeons Ratanji Dalal Research Fellowship and the Engineering and Physical Sciences Research Council.

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Journal
The Lancet Child & Adolescent Health
Published
2026-05-01
DOI
https://doi.org/10.1016/s2352-4642(26)00069-6
Primary Topic
Trauma and Emergency Care Studies
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article
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article

Global variation in injury patterns, interventions, and post-operative outcomes for children and adolescents undergoing trauma laparotomy: an international cohort study

Auwal Adamu, Eder Cáceres, Kokila Lakhoo, Norah Alsubaie et al.
The Lancet Child & Adolescent Health
Trauma and Emergency Care Studies
article

Global variation in injury patterns, interventions, and post-operative outcomes for children and adolescents undergoing trauma laparotomy: an international cohort study

Auwal Adamu, Eder Cáceres, Kokila Lakhoo, Norah Alsubaie, Gökhan Alıcı, Mohannad M. Aladawi, Ömer Acar, Zane Perkins, Sarah Magdy Abdelmohsen, Kwasi Agyen‐Mensah, Carlos M. Nuño‐Guzmán, Saleh Husam Aldeligan, Thomas Agyen, Alaa Aldirani, Shobhana Nagraj, Osama Al Shaqran, Riaz Aziz, Ibrahim Mutwakil Gamal Ahmed, Ahmed Abouelnaga, Sondous Abdelaal, Amr Abusuliman, Raoof Saleh, Abdulaziz Mohammed Alotaibi, Suresh Agarwal, Gamal Mutwakil Gamal Ahmed, Abdullah Alfandi, Nazir Ahmed, Saleh Al wageeh, Abdihakim Elmi Abdishakur, Bayan Alnaser, Ward Abboud, Anwar Abdalla Mohamed Abdalazeez, Iddrisu Tidoo Abdull-Karim, Hager Adly Mohamed Aboelfadl, Rona Cansu Kavar Ağcabay, Alaa Abdeltawab Abouammar, Yassir Al Azzawi, Azhar Ali Hamoud Abdo Al Yafrosi, Mahamad Ahmed Adam Alhadi, Bilal Alkas, Nawaf Hamad Almadi, Ahmad Almahjaa, Amran Mohammad Alnaser, Essiane Meva’a Aloys, Abdulaziz M Alrwais, Mohammad Alshraiedeh, Marwa Abdulkareem, Katharina Kohler, Laura Hobbs, Mohammad Al Ahmad, T C Hardcastle, Isaac Chukwu, Hossam Ibrahim Abdelhady, Nii Ama Adu-Aryee, Makama Adamu Abdullahi, Akanni Bolaji Abdulazeez, Abdishakur Mohamed Abdi, Ovuo Adolphus, Michael F Bath, Arwa S. Alabide, Mohamed Abdellatif El-Tayeb Ali, Tom Bashford, Mohamed Sheikh Hassan Sh Ahmed, Nelson Kosi Affram, Muhammad Akbar, Olalekan Adepoju, Ali Hasan Abdulla, Marta Seid Ahmed, Brandon G Smith, Emmanuel Akpo, Merve Aktas, Bashiru Mutiu Adebayo, Joachim Amoako, Mohamed Abdelhady, Omar Abdelfattah, Salma Adam, Malak M.A. Alsharif, Aiman Aamir, Abdulrhman Abdulmoneim Khalifa Ahmed, Faustin Awinbilla Akum, Emmanuel Acquah, Mojtaba Mohammed Almamoon Abdallah, Ihsan Ahmed, Mohamed Abdalla Mohamed Abdalla, Daphne K Karusoke, Hamza Ahmed, Marcos Alejo-Rivera, Ivan Abbott, Thomas G Weiser, Zakaruyyah Shaheed Ahmad, Hamdoon Abu-Arish, Abass Oluwaseyi Ajayi, Nawaf AlShahwan, Malaz khalid Yousif Ahmed, Galal Abouelnagah, Elaf Ahmed, Abanob Adel, Shahzad Ahmed, Maryam Alfa-Wali
article en

Abstract

BACKGROUND: Trauma is the leading cause of death and disability in children and adolescents worldwide; however, paediatric trauma care is often neglected during health system development. We aimed to understand current global standards of laparotomy care for paediatric patients with blunt or penetrating traumatic injury and variation in patient injury patterns, intervention, and post-operative outcomes. METHODS: This is a planned post-hoc analysis of the international, multicentre, prospective, observational cohort from the Global Outcomes After Laparotomy for Trauma (GOAL-Trauma) Study, which was conducted between April 1 and Dec 31, 2024. Patients aged 18 years or younger with a blunt or penetrating traumatic injury who underwent a laparotomy within 5 days of presentation were eligible. Countries were stratified by the Human Development Index (HDI), and the primary outcome was post-operative in-hospital 30-day mortality. Adjusted mortality risk was calculated using least absolute shrinkage and selection operator regression analysis. The study was registered with ClinicalTrials.gov (NCT06180668). FINDINGS: 237 paediatric patients who underwent a trauma laparotomy were recruited from 85 hospitals in 32 countries, with the highest proportion of patients living in countries in the lower HDI tertile (110 [20%] of 563 cases overall). The median age among paediatric cases was 16·0 years (IQR 12·0-18·0), and most patients were male (195 [82%] of 237 patients) and had sustained a blunt injury (135 [57%] patients). The median time globally from injury to operation was 7·4 h (IQR 3·5-18·8; n=235), with longer times observed across the patient pathway for patients in the lower and middle HDI tertiles than for those in the upper HDI tertile (p=0·0008). The overall 30-day in-hospital crude mortality rate was 8% (19 of 237 patients); however, after adjustment, patients in the lower HDI tertile were nearly six times more likely to die post-operatively than those in the upper HDI tertile (odds ratio 5·69 [95% CI 1·58-20·44], p=0·0079). INTERPRETATION: Proportionally more children undergo trauma laparotomy in lower-resource settings than in higher-resource settings; however, their mortality risk is substantially higher. Marked variation exists in paediatric pathways globally, and policy makers and health-care leaders should prioritise the development of paediatric trauma care worldwide. FUNDING: Royal College of Surgeons Ratanji Dalal Research Fellowship and the Engineering and Physical Sciences Research Council.

The Lancet Child & Adolescent Health
Universidad de La Sabana (CO), Queen Mary University of London (GB), Barts Health NHS Trust (GB), University of Cambridge (GB), Cambridge University Hospitals NHS Foundation Trust (GB), Korle Bu Teaching Hospital (GH), University of Oxford (GB), Federal Medical Centre (NG), Hospital Civil de Guadalajara (MX), Cambridgeshire and Peterborough NHS Foundation Trust (GB), Médecins Sans Frontières (FR), International Hospital Kampala (UG), Aswan University (EG), University of KwaZulu-Natal (ZA), Stanford University (US)
Royal College of Surgeons of England, Engineering and Physical Sciences Research Council
Openalex Percentile: Top 6%
Trauma and Emergency Care Studies
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