Pediatric Head and Neck Trauma: Trends, Risk Factors, and Outcomes

Introduction: Pediatric head and neck (HN) trauma is a medical emergency resulting in significant costs for children and hospitals. Few studies provide epidemiological predictors of pediatric HN trauma on a national scale. The present study aims to identify risk factors of HN injury and mortality in the pediatric population.

Methods: A retrospective cohort study was conducted for patients (age < 18 years) using the US National Trauma Data Bank (NTDB 2007-2019). Demographic, injury, and physiologic outcome data were analyzed. HN injury was defined as a head or neck Abbreviated Injury Scale (AIS) > 0. Logistic regression identified independent predictors of mortality following HN trauma.

Results: Of the 1.42 million pediatric patients analyzed, 44.05% had HN injury. In patients aged 0-4, the most common mechanism was falls (47.67% in this age group). In patients aged 14-17, motor vehicle/transport accidents (MVTs) were the most common mechanism (56.06% in this age group). MVT (OR 1.75, 95% CI 1.70-1.80) and documented abuse (OR 2.52, 95% CI 1.21-5.28) were strongly predictive of HN trauma. Controlling for demographics, comorbidities and injury severity, HN injury was associated with increased odds of mortality (OR 3.47, 95% CI 3.15 - 3.83). HN injury mortality was strongly predicted by firearm exposure (OR 18.4, 95% CI 15.28-22.16), age < 4 (OR 2.44, 95% CI 1.96-3.04), and lack of health insurance (OR 1.93, 95% CI 1.71-2.18).

Conclusions: NTDB data demonstrates that the rate of pediatric HN trauma has decreased over time but is associated with increased odds of mortality. Demographic features such as age and insurance status predicted mortality from HN trauma with falls and MVTs being the most common mechanisms of injury. These data have implications for future public health efforts in this patient population.