Global variation in injury patterns, interventions, and post-operative outcomes for children and adolescents undergoing trauma laparotomy: An international cohort study

BACKGROUND

Trauma is the leading cause of death and disability in children and adolescents worldwide; however, paediatric trauma care is often neglected during health system development. We aimed to understand current global standards of laparotomy care for paediatric patients with blunt or penetrating traumatic injury and variation in patient injury patterns, intervention, and post-operative outcomes.

METHODS

This is a planned post-hoc analysis of the international, multicentre, prospective, observational cohort from the Global Outcomes After Laparotomy for Trauma (GOAL-Trauma) Study, which was conducted between April 1 and Dec 31, 2024. Patients aged 18 years or younger with a blunt or penetrating traumatic injury who underwent a laparotomy within 5 days of presentation were eligible. Countries were stratified by the Human Development Index (HDI), and the primary outcome was post-operative in-hospital 30-day mortality. Adjusted mortality risk was calculated using least absolute shrinkage and selection operator regression analysis. The study was registered with ClinicalTrials.gov (NCT06180668).

FINDINGS

237 paediatric patients who underwent a trauma laparotomy were recruited from 85 hospitals in 32 countries, with the highest proportion of patients living in countries in the lower HDI tertile (110 [20%] of 563 cases overall). The median age among paediatric cases was 16·0 years (IQR 12·0-18·0), and most patients were male (195 [82%] of 237 patients) and had sustained a blunt injury (135 [57%] patients). The median time globally from injury to operation was 7·4 h (IQR 3·5-18·8; n=235), with longer times observed across the patient pathway for patients in the lower and middle HDI tertiles than for those in the upper HDI tertile (p=0·0008). The overall 30-day in-hospital crude mortality rate was 8% (19 of 237 patients); however, after adjustment, patients in the lower HDI tertile were nearly six times more likely to die post-operatively than those in the upper HDI tertile (odds ratio 5·69 [95% CI 1·58-20·44], p=0·0079).

INTERPRETATION

Proportionally more children undergo trauma laparotomy in lower-resource settings than in higher-resource settings; however, their mortality risk is substantially higher. Marked variation exists in paediatric pathways globally, and policy makers and health-care leaders should prioritise the development of paediatric trauma care worldwide.