J. Murry1, D. Hoang1, G. Barmparas1, A. Zaw1, M. Nuno1, K. Catchpole1, B. Gewertz1, E. J. Ley1 1Cedars-Sinai Medical Center,Los Angeles, CA, USA
Introduction: The optimal heart rate (HR) for children after trauma is based on resting values for a given age, sometime with the use of a Broselow tape. Given the stages of shock are based in part on HR and blood pressure, treatment plan may vary if these values are abnormal. Admission HRs for children after trauma were analyzed to determine which ranges were associated with lowest mortality.
Methods: The NTDB (2007-2011) was queried for all injured patients ages 1 to 14 years admitted (n = 398,544). Age groups were analyzed at ranges to match those provided by the Broselow tape (1 year, 2-3 years, 4 years, 5-6 years, 7-8 years, 9-11 years, 12-13 years). Exclusions included any Abbreviated Injury Scale=6, Injury Severity Score=75, ED demise, or missing information.
Results: After exclusions, admission HRs from 135,590 pediatric trauma patients were analyzed, overall mortality was 0.7% (table). At 1 year the HR range with the lowest OR for mortality was 100 to 179. Starting at age 7 years lowest mortality was observed for HR range 80-99.
Conclusion: The HR associated with lowest mortality after pediatric trauma frequently differs from current standards. Starting at age 7 years, the HR range of 80 to 99 predicts lower mortality. Our data indicates that at age 7 years a child with HR of 120 may be in stage III shock and treatment might include admission, intravenous fluids and probably blood products. Traditional HR ranges suggest that the normal HR for this child includes 120 and therefore aggressive treatment might not be considered. Knowing when HR is critically high or low in the pediatric trauma population might guide treatment options such as ED observation, hospital admission, ICU admission and even emergent surgery.
