OUTCOME OF CARDIOVASCULAR COLLAPSE IN PEDIATRIC BLUNT TRAUMA

Study objectives: To determine the survival and functional outcome of pediatric blunt trauma victims demonstrating cardiovascular collapse, including pulseless cardiopulmonary arrest or severe hypotension, on i nitial presentation in an emergency department. Design: Seven-year con secutive case-control series. Setting: Level I trauma center and unive rsity teaching hospital. Participants: Two thousand one hundred twenty consecutive pediatric victims of blunt trauma less than 16 years old admitted to a Level I trauma center from August 1984 through December 1991 had a mortality of 5.2%. Thirty-eight patients (1.8%) demonstrate d pulseless cardiac arrest or severe hypotension (systolic blood press ure of 50 mm Hg or less) on initial presentation in the ED. Interventi ons: All patients received basic and advanced life support consistent with guidelines published by the American Heart Association, American Academy of Pediatrics, and American College of Surgeons. Measurements and main results: Survival, functional outcome, and donor status were reviewed. Outcome of ED resuscitation (death or reanimation), post-ED destination (morgue, operating room, or pediatric ICU) length of hospi talization, functional outcome after hospital discharge, time to death (time from admission to ED to declaration of death), cause of death, total hospital costs, total hospital charges, and organ donation were reviewed. There were no functional survivors among 38 pediatric victim s of blunt trauma who presented to the ED in pulseless cardiac arrest or with severe hypotension. Eleven of the 12 patients who were transfe rred to the pediatric ICU died, the single survivor demonstrated profo und neurologic impairment six years after hospitalization. Six of thes e 12 patients were eligible potential donors and resulted in four mult iorgan donors during the seven-year study. The mean hospital unreimbur sed care for the 38 study patients was $3,514 per patient. Conclusion: No child who presented with pulseless cardiac arrest or severe hypote nsion following blunt trauma achieved functional survival. Reimbursed care for pediatric victims of blunt trauma demonstrating cardiovascula r collapse is disproportionately poor compared with that for pediatric patients who maintain hemodynamic integrity in the ED. Half of all pa tients who were stabilized sufficiently for transfer to the pediatric ICU were eligible potential organ donors. Therefore aggressive resusci tation of these patients may be justified if organ donation is serious ly contemplated and aggressively pursued.