Predicting survival in pediatric trauma patients receiving cardiopulmonary resuscitation in the prehospital setting.

OBJECTIVES: To determine survival in pediatric trauma patients receiving cardiopulmonary resuscitation (CPR) in the prehospital setting and to identify subgroups of patients who may have increased survival rates.

METHODS: Records were obtained from the National Pediatric Trauma Registry on all pediatric trauma patients (age <19 years) over an 82-month period who received CPR at the scene of the injury. Data were recorded as to type of injury, need for additional CPR at the receiving hospital, and intubation in the field. Patient outcome was defined as: dead on arrival, dead at trauma center discharge, or alive at trauma center discharge. Univariate and logistic regression analyses were performed to identify statistical differences in survivors compared with nonsurvivors.

RESULTS: Seven hundred twenty-nine patients were identified. The median age was 7.0 years, with a mean of 7.9 years; 62% were male, 37% were female, and 1% had no gender recorded. Age and gender distributions were not statistically different for the three outcomes. Eighty-seven patients (12%) were dead on arrival and an additional 458 (63%) were dead at trauma center discharge, while 184 (25%) were alive at trauma center discharge. Motor vehicle crashes accounted for 27% of admissions, and pedestrians struck by vehicle accounted for 23%. Intentional violence accounted for 18% of the accrued patients. Predictors of death in the patients who were alive at admission were penetrating injury (p = 0.001) and requirement of additional CPR at the trauma center (p = 0.001). Prehospital intubation was associated with decreased survival. Of the 641 patients who arrived at the hospital alive, 29% lived to trauma center discharge, but of the 534/641 who received prehospital intubation, only 19% lived. The mean Functional Independence Measure (FIM) scores were 38.9 (range 18 to 126).

CONCLUSIONS: Survival of pediatric trauma patients after receiving CPR in the prehospital setting is significantly higher than expected in adult patients. Penetrating trauma, the need for additional CPR at the trauma center, and prehospital intubation are all predictors of a worse outcome.