Adolescents trauma is an increasing issue for both paediatric and adult emergency departments. This month brings a publication in EMJ describing the causes and nature of adolescent trauma.
Why was this study necessary?
We know that adolescence is the period where young people are most likely to die (1300 UK adolescents deaths in 2014), and that the leading cause of adolescent mortality is trauma.
The goal of this paper is to describe trends in adolescent trauma, with a view to informing public health policy and health promotion strategies. There are no previous papers using the TARN database adolescent patient group.
What age is an adolescent?
This isn’t an easy question to answer, and that is reflected by a variation on where these patients are treated. Adolescent trauma patients are often treated in Adult EDs, Paeds EDs, or mixed EDs depending on many factors.
Who were the patients?
Patient information was taken from the TARN database (Trauma Audit Research Network). They included adolescents (10-24 years old) from English sites over a ten year period (2008-2017). During that time there were 40,680 cases of adolescent trauma. 79% were male and 80% fell into the 16-24 year old group.
What were the most common causes of trauma?
Road traffic accidents were responsible for 50.3% of adolescent trauma. In the 10-15 year group, this was most commonly as pedestrians or cyclists, whereas in the 16-24 year group this was most commonly as drivers, motorcyclists, or passengers.
The proportion of stabbings increased from 6.9% in 2008 to 10.2% of all adolescent trauma in 2017. The actual number of stabbings reported increased from 140 in 2008 to 544 in 2017.
20% of cases showed evidence of alcohol or drug use at the time of injury. And those who had ingested alcohol or drugs had a higher median ISS (14 v 10) but lower mortality (2.6% v 4.2%).
Most patients presented between Friday and Sunday (53%) and the peak presentation month was May. In 2008, 45% were treated in an MTC, but by 2017 63% of adolescent trauma was treated in an MTC (rather than a Trauma Unit).
What were the outcomes and what can we learn?
17% had polytrauma and 32% required rehabilitation. There was a mortality rate of 4.1% and this was higher in the 16-24 year age group (4.4% v 3.2%) but this is only those who died in hospital and does not include pre-hospital deaths
Adolescent trauma is more common in males, and in the older adolescent age group. It is most common in the summer and at weekends, with those 10-15 years old presenting mainly between 0800 and midnight (94%).
Road traffic accidents are the most common cause of trauma in adolescents. However, we need to take note that the incidence of stabbings doubled between 2014 and 2017.
Author commentary by Stephen Mullen
It was a surprise that the data identified a 2.6-fold increase in adolescent trauma during the study period. One may assume that better reporting and increasing hospital numbers are the major driving force behind this increase but even when this is taken into account an increasing trend remained. An interesting, but not unexpected finding was an increase in the proportion of trauma reported due to violence. This rise is in keeping with the almost daily media coverage of knife crime in urban English settings.
Our study paints the picture of adolescent trauma in England over the last 10 years, with some headline grabbing results. These include the high proportion of road traffic collisions, the increase in presentations related to violence, in particular stabbings and the concerning role that alcohol, drugs as well as psychiatric co-morbidities may play in these presentations. We hope the key message from this paper is the need for prevention. Legislators and health care authorities should act to protect our youth and prioritise appropriate resources to do so. Without this we may be reporting the same results in 5 years time.