(337) Epidemiology and Outcomes of Patients With Injuries Admitted to the PICU: A Single-Center Study

Introduction: In the United States, injuries are the leading cause of death for children aged 1 to 18 years. While the epidemiology of pediatric injuries resulting in fatalities is known, the outcomes and resource utilization of critically injured patients has not been well studied in the United States. The aim of this study is to describe the epidemiology and outcomes of children with injuries admitted to the pediatric ICU (PICU), hypothesizing that patient demographics and outcomes would vary by mechanism and that such variation can be utilized to identify specific targets for future interventions.

Methods: This was a single center retrospective cohort study using the Virtual Pediatric System (VPS) database for a large, quaternary ICU in a level I pediatric trauma center. We included all patients under the age of 18 years who were admitted to the PICU with a diagnosis of injury between January 1, 2013, and December 31, 2022. Injury was defined using standardized ICD-10 codes; these ICD-10 codes were mapped to VPS proprietary diagnosis codes (STAR codes) to identify additional patients. We performed standard descriptive statistics to summarize cohort characteristics and outcomes.

Results: We identified 1479 patients admitted to our PICU with a diagnosis of injury, of which 80 died (mortality rate 5.4%). Patients predominantly identified as White (45%) and Black or African American (29%). While there was significant variability by mechanism, the overall age was evenly distributed with 22% ages 1-23 months, 21% ages 2-5 years, 29% ages 6-12 years, and 28% ages 13-18 years. The most common mechanism of injury was falls (46%) followed by motor vehicle related (22%), and struck by or against (11%). The mechanism of injury with the highest mortality was suffocation (39%) followed by burns (33%), and drowning (21%). The median PICU length of stay was 1.5 days.

Conclusions: This study is the first to demonstrate the epidemiology of patients with injuries admitted to the PICU using granular clinical data. We found a high mortality rate with variability based on mechanism of injury. Further work is needed to understand drivers of mortality within specific mechanisms, and to identify interventions to target these drivers and improve outcomes for injured children.