Impact of transportation methods on pediatric and adolescent severely injured vehicle occupants.

Abstract

BACKGROUND Road traffic collisions (RTCs) are the leading cause of death globally. Reducing the transportation time to definitive care and training bystanders in trauma management may impact clinical outcome. We aimed to study the impact of transportation methods on pediatric and adolescent severely injured vehicle occupants in Abu Dhabi Emirate, United Arab Emirates. METHODS The Abu Dhabi Trauma Registry prospectively collects data of all hospitalized trauma patients from seven major trauma centers in Abu Dhabi Emirate. We have studied all severely injured (ISS ≥ 12) road traffic collision patients, who were less than 19 years old (January 2014 to December 2023). Demography and clinical outcome of those transported by ambulance (n = 466) were compared with those transported by private vehicles (n = 47). RESULTS Univariate analysis showed that patients who were transferred by private vehicles were significantly younger, (median (IQR range) age: 12 (6-15) years compared with 15.5 (12-17) years, p < 0.001), stayed significantly longer in the Emergency Department (median (IQR range) 275 (186-333) minutes compared with 214 (135-299) minutes, p = 0.01), were admitted significantly less to the ICU (31.9% compared with 51.9%, p = 0.009); and had significantly less hospital stay (median (IQR range) 3.5 (1-8) days compared with 7 (3-14) days, p = 0.003). There was no significant difference in mortality between the two groups (2.1% compared with 6.7%, p = 0.34). Logistic regression showed that mode of arrival did not significantly affect ICU admission (p = 0.26). The most significant factors that affected ICU admission were GCS, p < 0.001, OR 0.66 (95% CI 0.57-0.77) and ISS, p < 0.001, OR 1.12 (95% CI 1.08-1.16). A general linear model showed that GCS (p = 0.022) and RTS (p = 0.006) significantly affected length of hospital stay while mode of arrival did not (p = 0.38). CONCLUSIONS Private vehicles appear to be safe for the transportation of selected major trauma children and adolescents with no adverse effects on ICU admission, hospital stay, or mortality. The role of bystanders in prehospital management and transportation of RTC victims should be further investigated.