Epidemiological characteristics of pediatric trauma and the role of the Injury Severity Score in predicting mortality risk: a multicenter study.

Pediatric trauma remains a leading cause of mortality among children. This study aimed to analyze the characteristics and influencing factors of pediatric trauma across different age groups, with a focus on injury causes, anatomical injury sites, and temporal distribution patterns. Clinical data were collected from 24 hospitals across 16 provinces in China between April 1, 2021, and December 31, 2022. We conducted a comprehensive analysis to describe trends, demographic characteristics, injury patterns, and associated risk factors related to trauma hospitalizations. A total of 732 pediatric patients with trauma were included in this multicenter study. The mean age and body weight were 5.59 ± 3.86 years and 22.52 ± 12.93 kg, respectively. The leading causes of trauma were, in order, traffic accidents (45.77%), low falls (≤ 3 m) (24.45%), and high falls (> 3 m) (23.63%). Most cases involved children aged 0-3 years (36.48%), and male children accounted for 62.84% of all cases. Injuries mostly occurred between 12:00 and 18:00 (38.93%) and on non-working days (53.28%). The most frequent injury locations were by roadsides (47.54%) and in urban areas (48.36%). After active intensive care unit treatment, 672 patients (91.80%) survived and 60 (8.20%) died. The ISS was significantly higher in the deceased group than in the survived group (42.55 ± 14.93 vs. 20.45 ± 10.75, P < 0.001). The area under the receiver operating characteristics curve for ISS in predicting mortality was 0.892 (95% confidence interval: 0.858-0.927; P < 0.001), with a sensitivity of 0.983, specificity of 0.671, Youden's index of 0.654, and an optimal cutoff value of 24.5.

conclusionOur results show that traffic accidents and falls remain major causes of pediatric trauma. Boys and children aged 0-3 years are at particularly high risk, emphasizing the need for enhanced supervision and public education to prevent injuries. An ISS > 24.5 upon admission is linked to a significantly increased risk of mortality. These findings provide important insights for clinical management and prevention strategies aimed at reducing the incidence and severity of pediatric trauma. WHAT IS KNOWN: • Pediatric trauma is a leading cause of childhood mortality, with traffic accidents and falls recognized as common mechanisms of injury, particularly among young children and males. WHAT IS NEW: • This multicenter study identifies an Injury Severity Score (ISS) cutoff of 24.5 as a highly sensitive predictor of mortality in pediatric trauma patients and characterizes distinct epidemiological patterns-including peak injury times, locations, and age-specific risks-providing actionable data for targeted prevention and clinical triage in China.