C. Pennell1, E. Lindholm1, J. Latreille2, S. Kadakia2, A. D. Nanassy1, S. Ciullo1, L. Arthur1, H. Grewal1, R. Prasad1 1St. Christopher’s Hospital for Children,Department Of Pediatric General, Thoracic, And Minimally Invasive Surgery,Philadelphia, PA, USA 2Drexel University,College Of Medicine,Philadelphia, PA, USA
Introduction: Pediatric train trauma can result in severe injuries requiring significant resource utilization. We sought to review train injuries in the state of Pennsylvania to determine the burden of these injuries on the pediatric trauma system.
Methods: We queried the Pennsylvania Trauma Outcomes Study Database to identify all patients <21 years of age suffering traumatic injuries resulting from a train accident between 2007-2016. Demographics, hospital course, outcomes, and health resource utilization was reviewed.
Results: Forty-eight patients suffered train-related injuries in the study period with an average age of 15.3 years (range 1-20). A majority of patients were male (77.1%), Caucasian (60.4%), and resided in urban environments (81.3%). Injuries occurred most often in the spring (31.3%) and least often in the winter (16.7%). Alcohol screen was positive in 50% of patients. Transfer from the initial hospital was required in 22.9% of cases and usually occurred within 24 hours of arrival (81.2%). The average length of stay was 12.4 days (range 0-121) and overall mortality of 10.4%. Over half of patients (56.3%) required ICU admission with an average ICU stay of 5.3 days. Injury Severity Score on arrival and Functional Independence Measure (FIM) Score on discharge averaged 17.3 and 16.4, respectively. On average, 7.1 services were consulted per patient with the most common being physical and occupational therapy (64.5%), social services (60.4%), and orthopedic surgery (52.1%). Among the 48 patients included, 41.7% experienced at least 1 long-bone or pelvic fracture. Intracranial hemorrhage occurred in 25.5% of patients, major traumatic amputation in 16.7%, concussion in 27.7%, and pneumothorax in 20.8%. Solid organ injuries occurred in 12.5% of patients with the most common being spleen (6.3%), kidney (6.3%), and liver (4.2%) injuries. Surgical management of injuries was common with 60.4% of patients requiring at least one operative intervention, most commonly internal fixation of a fracture (33.3%) or amputation (20.8%). Laparotomy was rare (6.3%) as was thoracotomy (4.2%). Overall, 75.0% of patients experienced a major injury, defined as one resulting in death, requiring surgical repair, or discharge to a rehabilitation or long-term care facility.
Conclusion: Injuries caused by trains can be severe, with a majority of admitted patients experiencing a major injury. Orthopedic injuries are the most common followed by traumatic brain injuries. Train traumas in children can be costly injuries that require a multi-disciplinary approach to care.