CLINICAL CONSEQUENTIAL RISKS OF FATAL OUTCOMES IN CHILDREN INJURED IN ROAD TRAFFIC ACCIDENTS

Road traffic injuries represent a leading cause of disability and mortality among the active, working-age population and constitute the primary cause of violent death in children worldwide. The aim of the study. To determine and evaluate the clinical consequential risks of fatal outcomes in children injured in road traffic accidents, as a basis for developing and implementing clinical protocols and patient care pathways in the provision of medical assistance to victims. Research materials and methods. This retrospective study analyzed 259 cases of road traffic injury (RTI) in children, forming the primary study cohort. The cohort was selected by irreversible randomization from a larger array of 1671 victims injured in road traffic accidents in rural and urban areas during 2022–2023, stratified by age. The study was conducted in accordance with evidence-based medicine principles and the requirements of the Declaration of Helsinki. The protocol was approved by the Bioethics Commission of the State Institution “Ukrainian Scientific and Practical Center of Emergency Medical Care and Disaster Medicine” of the Ministry of Health of Ukraine. Research results. The study demonstrated that the clinical consequential risk of an adverse outcome in the traumatic process is influenced by both clinical-epidemiological and clinical-nosological risk factors, albeit with varying degrees of impact. The most substantial effects were observed for the factors “severity of injury,” “damaged anatomical-functional area,” and “mode of participation in traffic.” The least influential factors included “number of damaged anatomical-functional areas,” “gender,” and “age of the victim.” Boys exhibited the highest risk of an adverse outcome (significant risk). Among modes of participation in traffic, pedestrians were at significant risk. Damage to two, three, or five anatomical-functional areas (AFA) was associated with insignificant risk. Among mode “damaged AFA damage to the pelvis and abdomen carried significant risk. On the New Injury Severity Score (NISS), values exceeding 35 points indicated significant risk, while values exceeding 45 points indicated catastrophic risk. Conclusions. 1. The clinical consequential risk of an adverse outcome in the traumatic process among children with road traffic injuries is multifactorial, resulting from the combined influence of multiple risk factors, with an overall risk level that is generally low (0.15), although ranging from theoretically absent (0) to catastrophic (0.81). 2. Both clinical-epidemiological and clinical-nosological risk factors contribute to the formation of this risk, but with differing intensities. 3. Among clinical-epidemiological factors, mode of participation in traffic exerts the greatest influence; among clinical-nosological factors, injury severity is predominant. 4. The highest risk of an adverse outcome is observed in boys (significant risk), school-aged (insignificant risk) and pedestrians (significant risk).