Mortality risk higher in pediatric trauma patients with chronic conditions

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1. Of pediatric trauma patients, 24.6% had at least one chronic condition. The most prevalent chronic condition were mental disorders, respiratory disorders, and nervous/sensory organs. 

2. Pediatric trauma patients with chronic conditions had significantly longer hospital stay (5.2 days vs 2.5 days), hospital charges that were more than twice as high, and 26 times higher in-hospital mortality rate, compared to patients without a chronic condition. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Many studies have shown that chronic conditions affect the health outcomes of adult trauma patients, but the effect of chronic conditions on the pediatric trauma patient population has not been clearly defined. The prevalence of chronic conditions in pediatric patients is also increasing, with 43% of children having at least one chronic condition. This study showed that almost 25% of pediatric trauma patients had at least one preexisting chronic condition, with mental disorders being the most common chronic condition. Respiratory disorders and disorders of the nervous system and sensory organs were also common. Compared to patients without a chronic condition, patients with a chronic condition had significantly longer hospital stays, higher hospital charges, and 26 times higher in-hospital mortality rate. One limitation of this study is that the database used in the study was an administrative database, and counted each readmission of a patient as a new patient in the database, which could be a confounding factor. Furthermore, there was an association between injury severity and prevalence of chronic conditions. This could be due to higher severity injuries requiring longer hospital stay, allowing physicians more time to diagnose chronic conditions.

Click to ready the study in Journal of Trauma and Acute Care Surgery

Relevant Reading: The Increase of Childhood Chronic Conditions in the United States

In-Depth [retrospective study]: This study examined pediatric trauma patients aged 1 year to 15 years in the 2009 KID (Kid’s Inpatient Database). The study used ICD-9-CM codes to identify trauma patients and chronic conditions. A total of 93,218 pediatric trauma patients were identified, and of those, 22,965 (24.6%) had at least one chronic condition. The most common chronic conditions were mental disorders (7.8%), respiratory disorders (7.7%), and diseases of the nervous system and sensory organs (6.3%).

Male patients were more likely than females to have a chronic condition (26.3% vs 22.4%). Black patients were the most likely to have  a chronic condition (30.7%), while Hispanic patients were the least likely (21.9%). Patients with a chronic condition had longer hospital stays than patients without a chronic condition (5.2 days vs 2.5 days). The mean hospital charges for patients with chronic conditions was more than twice that of patients without a chronic conditions ($50,815 vs $23,655). The rate of in-hospital mortality for patients with a chronic condition was 2.6 (95% CI: 2.3-2.9%), while the rate in patients without chronic conditions was 0.1% (95% CI: 0.1-0.1%).

By James Jiang and Allen Ho

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