England & Wales 2 YEARS OF SEVERE INJURY IN CHILDREN

England & Wales

2 YEARS OF SEVERE INJURY IN CHILDREN

January 2013-December 2014

THE TRAUMA AUDIT AND RESEARCH NETWORK


The TARNlet Committee Mr Ross FisherCo-chairman of TARNletConsultant in Paediatric SurgerySheffield Children’s NHS Foundation Trust

Dr Ian MaconochieCo-chairman of TARNletConsultant in Paediatric Emergency MedicineImperial College Healthcare NHS Trust

Professor Tim CoatsProfessor of Emergency MedicineUniversity of Leicester

Dr Naomi DavisConsultant in Paediatric Orthopaedic SurgeryRoyal Manchester Children’s Hospital

Dr Lorcan DuaneConsultant in Emergency MedicineRoyal Manchester Children’s Hospital

Antoinette EdwardsOperations Director, Deputy to the Executive DirectorThe Trauma Audit & Research Network

Dr Chris FitzsimmonsConsultant in Emergency MedicineSheffield Children’s NHS Foundation Trust

Nathan GriffithsPaediatric Nurse ConsultantSalford Royal NHS Foundation Trust

Professor Fiona LeckyProfessor of Emergency MedicineUniversity of Sheffield

Dr Ciara MartinConsultant in Emergency MedicineThe Adelaide and Meath Hospital, Incorporating The National Children’s Hospital, Tallaght, Dublin

Dr Samantha NegusRadiologistSt George’s University Hospitals NHS Foundation Trust

Mr Roberto RamirezConsultant in Paediatric NeurosurgeryRoyal Manchester Children’s Hospital

Maralyn WoodfordExecutive DirectorThe Trauma Audit & Research Network

Acknowledgements

We would like to thank the staff at each trauma receiving hospital and Mr Thomas Lawrence, Program Developer and Registry Manager at the Trauma Audit and Research Network.

THE TRAUMA AUDIT AND RESEARCH NETWORK2222

Contents

3 Introduction

4 Summary

6 Data completeness

7 Demographics

8 Injury mechanism

9 Patients injured in road traffic incident

10 Injury type

11 Time of arrival at hospital

12 Month of arrival at hospital

13 Mode of arrival at hospital

14 Type of first admitting hospital

15 Transfer between hospitals

16 ICU / HDU admissions

17 Definitive airway management & Length of stay in hospital

18 Mortality rates

19 Injuries associated with death

20 Interaction of AIS 3+ injuries & associated mortality

21 Grade of most senior clinician in the ED

22 Grade of most senior clinician involved in surgery

23 Time to first surgery from arrival

24 Glossary


Introduction This is the second report produced by the TARNlet committee, providing data on children with severe injury from January 2013 to December 2014 in England & Wales, and comparing these data with that produced in the first report on data from 2012. The Trauma Audit and Research Network (TARN) registry contains information on over 5,402 children under the age of 16 injured from January 2013 to December 2014, as compared with data on 4,720 in 2012.

The TARNlet committee is comprised of clinicians, managers and academics who are involved in the management of children who have sustained injury and are keen that this resource should be used to improve the care of paediatric trauma cases; in this report data have been interpreted to suggest guidance towards prevention of injury, or that networks of care could be reviewed to see if further improvement for the delivery of services to children could be achieved.

Those that died at the incident scene and were not transported to hospital are not reported to TARN. Further information about the data methodology can be found at www.tarn.ac.uk.

Injury produces a significant health burden for children, being a leading cause of both death and disability, with the numbers of different severities being shown above. In 2012, there were 737 children with ISS > 15 within the TARN database, similar to the numbers per year in this report. Estimates of children attending with trauma to EDs vary between 30-60% of their total workloads, depending on the location of the ED, with rural EDs seeing more trauma than inner city ones.

The overall picture is that there are about 4 million attendances by children to EDs each year.

This report concentrates on the 1,511 ‘recorded’ children from January 2013 to December 2014 who sustained the most serious injuries - an injury severity score (ISS) greater than 15. The true figure may be higher than this but, as will be seen, the completeness of data transfer from hospitals reporting to TARN continues to improve.

All children attending ED following injury

All children in the TARN database

n = 5,402

ISS > 15n = 1,511

Figure 1 (January 2013-December 2014 data).

https://www.tarn.ac.uk/

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2 Years of Severe Injury in Children

Summary

During January 2013 to December 2014 there were 1,511 severely injured children treated in England & Wales. Road traffic incidents and resulting head injuries still predominate as the major causes of severe injury and mortality; however, as a proportion of injury mechanisms, asphyxia and drowning have the highest percentages for death. This is shown in the new data on the injury mechanisms (Page 8) and in the breakdown of patients injured in road traffic incidents (Page 9). Many of the same data sets that were provided in the 2012 report have been repeated so allowing for comparisons over time to be made.These are detailed below.

Other additional data sets have been included in the 2013-14 report, for example a new feature is the division of the injury type from 3 categories in 2012 to 6 which separates out polytrauma, spinal injury, and divides the previous category of thoracic/abdominal into 2 distinct categories (Page 10).

Additional data sets include:

1. The numbers and proportion of children with definitive airway management (and where this occurred)

2. When a definitive airway was secured

3. The length of stay in hospital

4. Mortality data where cause of death was known

5. The most severe injury pattern associated with the death

6. Interaction of injuries with the risk of mortality

7. The grade of surgeon involved with operations

As trauma systems evolve and mature there will be changes in the way in which the healthcare system responds to severely injured children. The TARNlet reports will aim to present the best information that is available about our care of children and young people and strive to produce data that will assist in the improvement of the delivery of trauma services. The addition of these new data sets in this report will allow for greater comparison in future reports on progress made in paediatric trauma management.

COMPARISONS OF 2012 WITH 2013-14

The data from 2013-14 shows many similarities with 2012, with an improved completeness of data returned by TARN involved hospitals, from 73.7% to 80.7%.

The number of severely injured children is similar on a yearly basis, with a similar picture of seasonality (from April to October) and with more cases occurring at weekends and in the afternoon and evenings. The pattern of arrival of severely injured children implies that staffing for paediatric trauma needs to be matched to a pattern that includes high rates of arrival outside the conventional working day (especially in the evening and at weekends), and low rates of arrival after midnight. This may play a part in resource implications for Major Trauma Centres in terms of staffing, but nonetheless, optimally trained staff should be available to ensure the best care that can be given.

It is still worrying that about 25% of severely injured children are taken by transport means other than ambulance or helicopter, meaning that many parents/carers are taking these children to Trauma Units, so adding to the delay for definite treatment to be delivered. Trauma systems need to anticipate that children will continue to arrive at Trauma Units or non-designated hospitals and have systems to ensure that children are not disadvantaged by initially presenting to the “wrong” hospital. There is a public health message that needs to get to parents and carers about the trauma network; time to definite treatment may be reducible in severely injured children by the use of prehospital triage systems. Staff in all hospitals need sufficient ongoing training to enable them to provide initial care until either a specialist team arrives or an inter-hospital transfer is carried out. The data showed that most severely injured children are moved to a specialist Trauma Centre, which emphasises the need for a prompt inter-hospital transfer system.


Severe traumatic brain injury is still the leading numeric cause associated with death, but new categories for the mechanism of trauma show that proportionately asphyxia and drowning have high relative risks for mortality. Again, a public health policy aimed at reducing these mechanisms could be conceived with any effects being monitored in future TARN publications.

Common themes in the first and this report on trauma are that more males are severely injured, non-accidental injury still makes up about 10% of the causes for severe injury (under the age of 2 years) – further work may be undertaken to drill down into this important and possibly reducible cause of morbidity1. The other peak for severe trauma lies between 6 to 13 years (Page 7), when looking at both reports.

Road traffic incidents are high on the list for causing severe injury too, accounting for about 40% consistently across the years. About half of the children are involved as pedestrians, and cyclists are recorded as being 20% of these road traffic incident figures.

Time to surgery is related to outcome therefore an efficient transport and transfer system that minimises delays is important for those children who have not been brought to a centre where the appropriate management can be conducted.

1 A profile of suspected child abuse as a subgroup of major trauma patientsFfion C Davies, Timothy J Coats, Ross Fisher, Thomas Lawrence, Fiona E LeckyEmerg Med J 2015;32:921-925 doi:10.1136/emermed-2015-205285

http://emj.bmj.com/content/32/12/921.full


Trauma in children

Data Completeness

All Submissions Deaths

Trust n HESCompletion

%Deaths HES

Completion%

England & Wales 5,402 6,692 80.7 119 138 86.2

This is displayed as a percentage and represents the number of patients submitted to TARN compared to the number of patients expected based on the 2013 Hospital Episode Statistics (HES) dataset. The HES dataset is used as a general baseline.

These data refer to submissions to TARN, however the same patient may be submitted more than once if they undergo an inter-hospital transfer. Reducing the dataset to individual cases results in 4,802 children who met the TARN entry criteria admitted to hospitals in the area covered by this report.

1,511 children had severe injuries that were assigned an injury severity score (ISS) of more than 15 and 119 died of those injuries.


2 Years of Severe Injury in Children (ISS > 15)

Demographics of severely injured children 2013-14

Age (Years) Number of severely injured children (%)

Two thirds of injured children are male. There is a peak in the first year of life followed by another from 6 years old.

Total 1,511 (100%)

age < 1 307 (20.3%)

1 - 2 172 (11.4%)

3 - 5 202 (13.4%)

6 - 10 305 (20.2%)

11 - 13 269 (17.8%)

14 - 15 256 (16.9%)

Median Age (IQR) 6.5 (2.3 - 12.1)

Gender and Median ISS

Female (percentage) 31.4

Male (percentage) 68.6

Median ISS (Interquartile Range) 16 (16-25)

0

5

10

15

20

25

age <1 year age 1 - 2 years age 3 - 5 years age 6 - 10 years age 11 - 13 years age 14 - 15 years

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2013 & 2014 2012



Injury Mechanism

Mechanism Number of cases (%)

Analysis of injury mechanism data shows a preponderance of road traffic incidents and falls of less than 2 metres. 9.7% of patients were injured intentionally (Non-Accidental Injury) and were under 2 years of age.

Road Traffic Incident 628 (41.6%)

Fall < 2m 305 (20.2%)

Fall > 2m 175 (11.6%)

NAI under 2 years 147 (9.7%)

NAI over 2 years 31 (2.1%)

Blows 90 (6%)

Other (e.g. sport) 42 (2.8%)

Drowning 46 (3%)

Penetrating 12 (0.8%)

Asphyxia 35 (2.3%)

Total 1,511 (100%)

0

10

20

30

40

50

Road Traffic Fall < 2m Fall > 2m NAI Blows Drowning Asphyxia NAI Other Penetrating Incident under 2 years over 2 years (e.g. sport)

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2013 & 2014 2012



Breakdown of patients injured in road traffic incident

Road traffic incident Number of cases (%)

Pedestrian 312 (49.7%)

Cyclist 149 (23.7%)

Vehicle occupant 122 (19.4%)

Motorcyclist/Quad biker 38 (6.1%)

Not known 7 (1.1%)

Total 628 (100%)

0

10

20

30

40

50

Pedestrian Cyclist Vehicle Occupant Motorcyclist/ Not known Quad Biker

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2013 & 2014 2012



Injury Type (AIS 3+)*

Anatomical injury location Number of patients with this injury (%)

Severe head injury is present in a large proportion of severely injured children, emphasising the importance of neurointensive and neurosurgical care within the Trauma Networks.

*The severity of an injury can be described using the Abbreviated Injury Scale (AIS) score. The score can range from 1 (minor) to 6 (fatal). AIS 3+ describes injuries that are severe.

**AIS 3+ injuries in multiple body regions

3+ Head 1,122 (74.2%)

3+ Thoracic 306 (20.2%)

3+ Abdominal 197 (13%)

3+ Limb / Pelvis 172 (11.4%)

Polytrauma** 106 (7%)

3+ Spinal 71 (4.7%)

0

10

20

30

40

50

60

70

80

3+ Head Injury 3+ Thoracic Injury 3+ Abdominal 3+ Limb/Pelvis Polytrauma 3+ Spinal Injury Injury Injury

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2013 & 2014 2012



Arrival time at hospital 2013-2014

Hour Weekday Weekend Hour Weekday Weekend

0 2.3 1.8

1 2.0 2.0

2 2.4 2.3

3 1.1 2.3

4 1.4 2.7

5 1.0 1.7

6 1.3 1.0

7 1.2 2.5

8 2.5 2.0

9 4.3 2.3

10 4.3 5.0

11 2.8 4.5

13 4.4 6.3

14 5.2 9.3

15 4.5 8.5

16 9.7 12.5

17 10.2 12.0

18 9.5 11.0

19 9.8 8.8

20 5.7 8.5

21 5.4 6.8

22 4.2 3.8

23 4.0 5.5

Average number of severely injured children attending by hour and day of week during 2013-2014.

12 4.7 7.5

01

2

3

4

5

6

7

8

9

1011

1213

14

15

16

17

18

19

20

21

2223 8.0

7.0

6.0

5.0

4.0

3.0

2.0

2013/14 weekday 2013/14 weekend 2012 weekday 2012 weekend

1.0

0.0

Severely injured children attend hospital mainly during daytime hours, although a small percentage attends after midnight. Many injured children attend at the weekend and in the evenings. This pattern of attendance has an implication for the staffing of paediatric trauma services which need to be geared to receive severely injured children during the evening and at weekends. The relatively low number of severe injuries occurring at night raises a question about the cost effectiveness of on-site paediatric trauma expertise during the night.



When children with severe injuries present by month

Month Number of severely injured children (%)

January 104 (6.9%)

February 80 (5.3%)

March 123 (8.1%)

April 137 (9.1%)

May 135 (8.9%)

June 170 (11.3%)

July 161 (10.7%)

August 167 (11.1%)

September 141 (9.3%)

October 104 (6.9%)

November 92 (6.1%)

December 97 (6.4%)

Total 1,511 (100%)

0

2

4

6

8

10

12

14

January February March April May June July August September October November December

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2013 & 2014 2012



Mode of arrival at hospital

Direct admissions only = 1,169

Mode of transport Number of severely injured children (%)

A large proportion of severely injured children are not brought to hospital by ambulance or helicopter. This has a continuing significant implication for the future configuration of paediatric trauma services, as the trauma system must anticipate that more than a quarter of patients will continue to arrive at the nearest hospital (which may or may not be part of the trauma system).

For some children there is no information recorded about their initial hospital stay, including their mode of arrival.

Ambulance 657 (56.2%)

Helicopter 200 (17.1%)

Arrived by other means (e.g. car) 312 (26.7%)

Total 1,169 (100%)

0

10

20

30

40

50

60

Arrived by ambulance Arrived by helicopter Arrived by other means (eg. car)

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2013 & 2014 2012



Type of first admitting hospital

First admitting hospital Number of severely injured children (%)

*MTC - Major Trauma Centre

Just under 50% of children are initially treated in a specialist paediatric or adult major trauma centre whilst over half are still initially treated in a hospital accredited as a Trauma Unit.

This means that the trauma network should ensure a system for the initial resuscitation of injured children in all hospitals followed by an efficient inter-hospital transfer system. There is an important public health message that should be disseminated to the parents and carers of children.

Adult & Children’s MTC* 411 (27.2%)

Adult MTC* 122 (8.1%)

Children’s MTC* 195 (12.9%)

Trauma Unit 783 (51.8%)

Total 1,511 (100%)

0

10

20

30

40

50

60

Adult & Children’s MTC* Adult MTC* Children’s MTC* Trauma Unit

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2013 & 2014 2012



Transfer between hospitals

Type of hospital where severely injured children were admitted Number of cases (%)

*MTC - Major Trauma Centre

Most children are eventually cared for in an appropriate hospital with few remaining outside of the Major Trauma Centres. This emphasises once more the importance of the transfer system and should promote an assessment by the network of the location of specialist paediatric services.

Multiple hospitals, not MTC* 62 (4.1%)

Multiple hospitals, adult MTC* 17 (1.1%)

Multiple hospitals, children’s MTC* 661 (43.8%)

Single hospital, not MTC* 151 (10%)

Single hospital, adult MTC* 48 (3.2%)

Single hospital, children’s MTC* 572 (37.8%)

Total 1,511 (100%)

0

10

20

30

40

50

60

Multiple hospitals, Multiple hospitals, Multiple hospitals, Single hospital, Single hospital, Single hospital, not MTC* adult MTC* children’s MTC* not MTC* adult MTC* children’s MTC*

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2013 & 2014 2012



ICU / HDU admissions

Patient group by anatomical injury Total number of severely injured children Number (%)

*AIS 3+ injuries in multiple body regions

The percentage values represent the proportion of patients in each group that visited ICU/HDU.

All patients 1,511 795 (52.6%)

Polytrauma* 106 66 (62.3%)

Isolated AIS 3+ thoracic injuries 55 32 (58.2%)

Isolated AIS 3+ head injuries 872 398 (45.6%)

Isolated AIS 3+ limb / pelvic injuries 49 21 (42.9%)

Isolated AIS 3+ abdominal injuries 103 38 (36.9%)

0

10

20

30

40

50

60

70

80

All patients Polytrauma* Isolated AIS 3+ Isolated AIS 3+ Isolated AIS 3+ Isolated AIS 3+ thoracic injuries head injuries limb / pelvic injuries abdominal injuries

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2013 & 2014 2012



Definitive airway management 2013-2014

Direct admissions to hospital = 1,169 Number (%*)

*The percentage values shown here for patients with definitive airway management pre-hospital and in the ED use the total number of patients with definitive airway management as the denominator. Definitive airway management is defined as intubation, cricothyroidotomy or tracheostomy.

Length of stay in hospital n = 1,511 Length of stay Median days Interquartile range (days)

**Length of stay is calculated from the date of admission to hospital/ICU/HDU to the date of discharge from hospital/ICU/HDU.

There may be some underestimation as the complete length of stay for patients treated at more than one hospital may be unknown if one of those hospitals has not submitted data on the patient to TARN.

LOS** (IQR) 6 4.0 - 12.0

Number of children with definitive airway management 444 (38%)

LOS, patients transferred (IQR) 7 4.0 - 14.0

Pre-hospital 131 (8.7%)

LOS in ICU/HDU (IQR) 2 1.0 - 5.0

ED 313 (20.7%)

LOS, patients that went to ICU/HDU (IQR) 9 5.0 - 19.0

Median hours to definitive airway management from incident (Interquartile Range) 1.2 hours (0.8 - 1.6)



Mortality Confirmed cases of death analysed in relation to injury type and mechanisms

Category Total number Number of Mortality* 95% confidence of cases of deaths due % interval severely injured to severe children injury Lower Upper

Injury Type

Injury Mechanism

*As a proportion of all severely injured children in that category

In absolute numbers, severe traumatic brain injury is the most common injury type to cause death, but as a proportion for the mechanism of mortality, asphyxia and drowning have the highest percentages. This information is important when considering public health measures. 130 children (8.6%) were transferred out where final outcome is unknown.

All admissions 1,381 119 8.6% 7.1 10.1

of which have a GCS < 15 597 107 18.0% 14.9 21

Asphyxia 32 25 78.1% 63.8 92.4

Blows 82 4 4.9% 0.2 9.5

Drowning 44 20 45.5% 30.7 60.2

Fall < 2m 282 1 0.4% 0.0 1.0

Fall > 2m 162 4 2.5% 0.1 4.9

AIS 3+ head injuries 1,018 65 6.4% 4.9 7.9

NAI over 2 years 29 8 27.6% 14.6 46.0

AIS 3+ limb / pelvis / spine injuries 215 22 10.2% 6.2 14.3

NAI under 2 years 128 10 7.8% 3.2 12.5

Other (e.g. sport) 34 5 14.7% 2.8 26.6

Penetrating 10 2 20.0% 4.9 52.2

Road Traffic Incident 578 40 6.9% 4.9 9.0

Total 1,381 119

AIS 3+ thoracic / abdominal injuries 395 39 9.9% 6.9 12.8

Polytrauma 98 6 6.1% 1.4 10.9



Most severe injury associated with death

Category Total number Number of Mortality* 95% confidence of cases deaths % interval Lower Upper

*As a proportion of all severely injured children in that category

Head injury is the most important injury in fatal paediatric trauma, although there is a significant contribution from asphyxia, drowning and polytrauma.

0

10

20

30

40

50

60

Head Asphyxia Drowning Abdomen Polytrauma Chest Other Spine Limbs

Num

ber

of d

eath

s

Head 952 58 6.1% 4.6 7.6

Asphyxia 31 24 77.4% 62.7 92.1

Drowning 44 20 45.5% 30.7 60.2

Abdomen 119 6 5% 1.1 9.0

Polytrauma 98 6 6.1% 1.4 10.9

Chest 75 2 2.7% 0.0 6.3

Other 4 2 50% 15.4 84.6

Spine 11 1 9.1% 0.0 40.2

Limbs 47 0 0% 0.0 0.0

Total 1,381 119



Interaction of AIS 3+ injuries & associated mortality

Head Spine Chest Abdomen Limbs Pelvis

Head 11 (27.5%) 30 (19.9%) 10 (34.5%) 10 (12.2%) 2 (16.7%)

Spine 11 (27.5%) 6 (21.4%) 4 (50%) 2 (22.2%) 1 (25%)

Chest 30 (19.9%) 6 (21.4%) 12 (16.2%) 10 (17.9%) 2 (10.5%)

Abdomen 10 (34.5%) 4 (50%) 12 (16.2%) 1 (6.7%) 1 (11.1%)

Limbs 10 (12.2%) 2 (22.2%) 10 (17.9%) 1 (6.7%) 1 (6.3%)

Pelvis 2 (16.7%) 1 (25%) 2 (10.5%) 1 (11.1%) 1 (6.3%)

Values are in the format of; number of patients that died (mortality %) within each category i.e. 12 patients with AIS 3+ injuries to the chest and abdomen died representing a mortality rate of 16.2% for patients in this group. Please note patients may appear in multiple groups.



Most senior clinician in the ED

Direct admissions to hospital = 1,169

Most senior in ED Number of cases (%) All Children’s MTC TU Adult MTC

All patients directly admitted visited the ED.

76.5% of severely injured children were resuscitated by consultants, 49% were seen by a paediatric specialist in the ED.

0

10

20

30

40

50

60

70

80

Consultant Associate Specialist ST FY/ST 1-2 Other/not recorded

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2013 & 2014 2012

Consultant 894 (76.5%) 534 (90.1%) 269 (57.8%) 91 (82%)

Associate Specialist 34 (2.9%) 29 (6.2%) 5 (4.5%)

ST3 and above 103 (8.8%) 38 (6.4%) 58 (12.5%) 7 (6.3%)

FY / ST 1-2 76 (6.5%) 15 (2.5%) 58 (12.5%) 3 (2.7%)

Other / Not recorded 62 (5.3%) 6 (1%) 51 (11%) 5 (4.5%)

Total 1,169 (100%) 593 (100%) 465 (100%) 111 (100%)



Grade of most senior clinician involved in patient’s first operation during the time in hospital

Direct admissions to hospital

All operations n = 305

Category Consultant Associate ST3 and FY / ST 1-2 Other / Not Specialist above recorded

*Paediatric surgeons are a subset of all surgeons with a paediatric speciality.

73.7% of all operations were carried out by consultants, 72.2% of those operations carried out by paediatric specialists were performed by consultants and 66.2% of severely injured children were anaesthetised for their operation by a consultant anaesthetist.

0

10

20

30

40

50

60

70

80

Consultant Associate Specialist ST3 and above FY / ST 1-2 Other / Not recorded

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Grade of surgeon Grade of paediatric surgeon Grade of anaesthetist

Grade of surgeon 225 (73.7%) 2 (0.7%) 65 (21.3%) 9 (3.0%) 4 (1.3%)

Grade of paediatric surgeon* 39 (72.2%) 0 (0%) 12 (22.2%) 2 (3.7%) 1 (1.9%)

Grade of anaesthetist 202 (66.2%) 2 (0.7%) 56 (18.4%) 10 (3.3%) 35 (11.5%)



Time to first surgery from arrival at hospital

Direct admissions to hospital

Category* Number of severely Median hours Interquartile injured children with to operation range (hours) operations recorded

*Patients can appear in multiple groupsOperations 24 hours after admission are excluded

The majority of surgical intervention takes place in a timely fashion although improvement may follow as trauma systems develop.

0

4

8

12

16

20

All surgery, ISS > 15 Neurosurgery Abdominal surgery Cardiothoracic surgery Orthopaedic surgery

Med

ian

Hou

rs T

o

2013 & 2014 2012

All surgery, ISS > 15 228 3.35 1.8 - 7.0

Abdominal surgery 22 2.5 1.7 - 4.1

Cardiothoracic surgery 11 2.1 1.4 - 2.8

Neurosurgery 123 2.7 1.5 - 4.8

Orthopaedic surgery 63 5.8 3.0 - 15.3


Glossary

AIS Abbreviated Injury Scale score. A value between 1 (minor) and 6 (fatal) is assigned to each injury.

AIS 3+ Injuries with an AIS severity score of 3 or more.

Child A patient under the age of 16 years

Definitive Airway Management

Intubation, cricothyroidotomy or tracheostomy.

Direct admissions Describes care in the first treating hospital.

GCS Glasgow Coma Scale. A measure of consciousness ranging from 3, indicating complete uncon-sciousness, to 15, indicating a state of normal alertness. GCS is composed of eye, verbal and motor scores.

HDU High Dependency Unit

HES Hospital Episode Statistics. Data collected in hospitals on all admissions. These data are used to produce an expected number of eligible patients that should be submitted to TARN.

ICU Intensive Care Unit

ISS Injury Severity Score. A score ranging from 1, (minor) to 75 (severe injuries that are likely to result in death). An ISS between 9 and 15 is considered moderate. An ISS of 16 or more is considered severe. ISS is calculated using the Abbreviated Injury Scale (AIS).

LOS Length of Stay. Calculated from the date of admission to hospital/ICU/HDU to the date of discharge from hospital/ICU/HDU.

MTC Major Trauma Centre

NAI Non-Accidental Injury

Polytrauma AIS 3+ injuries in more than one body region.

TARN The Trauma Audit & Research Network.

TARNlet The TARNlet committee, consisting of clinicians, managers and academics who focus on injured children, was established to address specific questions relating to paediatric trauma care.

TU Trauma Unit

Grades of Doctor

Consultant Consultant

Associate Specialist Associate Specialist

ST3 and above Specialist Registrar, Speciality Trainee, Clinical Fellow, Senior Registrar, Staff Grade

FY / ST 1-2 Foundation Year / Speciality Trainee 1-2 / Trust Grade

Other / Not recorded Not known / recorded, Nurse Consultant, Advanced Practitioner

2 YEARS OF SEVERE INJURY IN CHILDREN2 YEARS OF SEVERE INJURY IN CHILDREN2 YEARS OF SEVERE INJURY IN CHILDREN2 YEARS OF SEVERE INJURY IN CHILDREN2 YEARS OF SEVERE INJURY IN CHILDREN2 YEARS OF SEVERE INJURY IN CHILDREN2 YEARS OF SEVERE INJURY IN CHILDREN2 YEARS OF SEVERE INJURY IN CHILDREN2 YEARS OF SEVERE INJURY IN CHILDREN2 YEARS OF SEVERE INJURY IN CHILDREN2 YEARS OF SEVERE INJURY IN CHILDREN2 YEARS OF SEVERE INJURY IN CHILDREN2 YEARS OF SEVERE INJURY IN CHILDREN2 YEARS OF SEVERE INJURY IN CHILDREN2 YEARS OF SEVERE INJURY IN CHILDREN

The University of ManchesterManchester Academic Health Science Centre (MAHSC)

3rd Floor, The Mayo Building Salford Royal NHS Foundation TrustStott LaneSalford M6 8HD

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Documents

England & Wales 2 YEARS OF SEVERE INJURY IN CHILDREN