Epidemiologie, Risikostratifizierung und Behandlungsergebnisse nach schwerem kindlichen Trauma

Zusammenfassung

Unfälle und Verletzungen gehören zu den häufigsten Gründen für eine stationäre Krankenhausbehandlung im Kindes- und Jugendalter und sind je nach Altersgruppe für den größten Anteil an Todesfällen verantwortlich. Altersabhängige Unterschiede bestehen neben dem Verletzungsmuster auch in der präklinischen und in der frühen klinischen Versorgungsphase.

Zur Beurteilung des vorliegenden Schweregrades der Verletzung werden in der Regel Scoring-Systeme von Erwachsenen verwendet. Als wichtigster Mortalitätsfaktor beim pädiatrischen Polytrauma gilt das Ausmaß der Schädel-Hirn-Verletzung. Weiterhin konnte die akute trauma-assoziierte Gerinnungsstörung als ein weiterer wesentlicher Risikofaktor identifiziert werden. Diese ist oft multifaktoriell getriggert und wird insbesondere durch das koinzidentielle Vorliegen eines Schädel-Hirn-Traumas verstärkt.

Alle bisher veröffentlichten Traumascores für Kinder und Jugendliche haben Limitationen in Bezug auf eine einfach anzuwendende und akkurate Prognoseeinschätzung. Der pädiatrische BIG-Score wurde als Prognosescore insbesondere zur Anwendung beim kindlichen Trauma entwickelt und beinhaltet mit dem Base Excess, der INR (International Normalized Ratio) und dem GCS (Glasgow Coma Scale) die wesentlichen Risikofaktoren für das Versterben des Patienten. Der Score wurde sowohl für stumpfe als auch penetrierende Verletzungen evaluiert.

Eine frühzeitige Risikoeinschätzung ist wichtig, da bei schwerstverletzten Kindern und Jugendlichen je nach Altersgruppe von 9% bis 15% Todesfälle ausgegangen werden muss und in allen Altersgruppen ca. 50% der Patienten innerhalb der ersten 24 Stunden nach Trauma versterben.

Abstract

Accidents and trauma are the leading cause of hospital admissions and major contributors to mortality in children and adolescents. There are age-specific injury patterns and differences in the clinical presentation of pediatric trauma and treatment both at the scene and in the emergency department can be observed. In general, pediatric trauma-scores to appreciate injury severity are adapted from the adult population.

The most important factor to increase mortality in the severely injured pediatric population is the extent of a concomitant traumatic brain injury (TBI). In addition, the acute trauma-associated coagulopathy, which is triggered multifactorial, is an independent prognostic marker for mortality in severe trauma. The complexity of all currently available trauma-scores for the pediatric population is one reason why these scores are not unequivocal recommended for the early use in pediatric trauma care.

The pediatric BIG-Score was developed to allow an early prognostic stratification for pediatric trauma patients and includes with base excess (BE), INR (International Normalized Ratio) and GCS (Glasgow Coma Scale) relevant prognostic factors for poor outcome.

Early risk stratification is crucial in pediatric trauma due to mortality rates ranging between 9% and 15% and with 50% of all fatalities to occur within the first 24 h of hospital admission.

Schlüsselwörter

Kinder - Polytrauma - Risikostratifizierung - Prognose - Outcome

Key words

pediatric trauma - risk stratification - prognosis - outcome

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