Epidemiology and Prehospital Care of Pediatric Unintentional Injuries Among Countries with Different Economic Status in Asia: A Cross-National, Multi-Center Observational Study

Abstract

Objective

Injury is a major cause of morbidity and mortality in children. However, the epidemiology and prehospital care for pediatric unintentional injuries in Asia are still unclear.

Methods

A total of 9,737 pediatric patients aged <18 years with unintentional injuries cared for at participating centers of the Pan-Asian Trauma Outcome Study (PATOS) from October 2015 to December 2020 were reviewed retrospectively. Patients were divided into two groups: those <8 and those ≥8 years of age. Variables such as patient demographics, injury epidemiology, Injury Severity Score (ISS), and prehospital care were collected. Injury severity and administered prehospital care stratified by gross national income were also analyzed.

Results

Pediatric unintentional injuries accounted for 9.4% of EMS-transported trauma cases in the participating Asian centers, and the mortality rate was 0.88%. The leading cause of injury was traffic injuries in older children aged ≥8 years (56.5%), while falls at home were common among young children aged <8 years (43.9%). Compared with younger children, older children with similar ISS tended to receive more prehospital interventions. Uneven disease severity was found in that older children in lower-middle and upper-middle-income countries had higher ISS compared with those in high-income countries. The performance of prehospital interventions also differed among countries with different gross national incomes. Immobilizations were the most performed prehospital intervention followed by oxygen administration, airway management, and pain control; only one patient received prehospital thoracentesis. Procedures were performed more frequently in high-income countries than in upper-middle-income and lower-middle-income countries.

Conclusions

The major cause of injury was road traffic injuries in older children, while falls at home were common among young children. Prehospital care in pediatric unintentional injuries in Asian countries was not standardized and might be insufficient, and the economic status of countries may affect the implementation of prehospital care.

Authors and Contributions

M.-C. Lee was responsible for the conceptualization, formal analysis, and writing of the original draft of this study. K.J. Hong, S.F. Jamaluddin, D.N. Son, J.-T. Sun, L.-M. Hsu, H. Tanaka, S. Riyapan, and A. Haedar were responsible for data curation. M.-C. Lee, W.-C. Chiang, and J.-T. Sun were responsible for the methodology. S.D. Shin, J.-T. Sun, and W.-C. Chiang were responsible for the project administration and resources. J.-T. Sun, E. P.-C. Huang, M.-J. Hsieh, M. H.-M. Ma, L.-M. Hsu, H.-Y. Lin, W.-C. Tseng, and W.-C. Chiang were responsible for the supervision of this study. M.C. Lee and W.C. Chiang were responsible for validation and the review and editing of the article.

Acknowledgments

The authors acknowledge all participating PATOS sites for excellent collaboration, as well as the data quality assurance of the PATOS coordination center at Seoul National University Hospital, to improve prehospital and in-hospital care for trauma patients in Asia. The authors also like to thank Su-Mei Wang and Chin-Hao Chang, staff of the National Taiwan University Hospital Statistical Consulting Unit for help in statistical consultation.

Disclosure Statement

The authors have declared that no competing interests exist.

Additional information

Funding

This study was funded by the National Taiwan University Hospital Yun-Lin Branch (NTUHYL.111.S017) and Taiwan Ministry of Science and Technology (MOST) (MOST 108-2314-B-002-130-MY3, MOST 105-2314-B-002-200-MY3, and MOST 109-2314-B-002-154-MY2).