Background: Trauma in pediatric patients is a major cause of death. This study investigated differences betweendecedents and survivors. Furthermore, an analysis of preventable and potential preventable trauma deaths wasconducted and errors in the acute trauma care were investigated.

Methods: All patients aged less than 16 years with an Injury Severity Score (ISS)≥16 upon primary admission tothe hospital between July 2002 and December 2011 were included in this study. Decedents were compared withsurvivors and an analysis of deceased children for preventable and potential preventable deaths was conducted.The acute trauma care was investigated regarding errors in treatment.

Results: Significant differences were found in Glasgow Coma Scale, Injury Severity Score, Revised Trauma Score,New ISS, Revised Injury Severity Classification, and Trauma and Injury Severity Score. Decedents had a worse headtrauma with associated coagulopathy. The overall mortality rate was 13.4%. The majority of death occurred soonafter arrival. No long term intensive care unit stay was found.No preventable but one potential preventable death was analyzed. Most errors occurred in fluid volumemanagement and in a delay of starting the therapy for hemorrhage and coagulopathy.Prolonged preclinical rescue time and surgery time within the first 24 hours was found.

Conclusions: Head trauma is the determinant factor for mortality in severely injured pediatric patients. Deathoccurred shortly after arrival and long term intensive care stays might be an exception. In treatment of severelyinjured children volume management, hemorrhage and coagulopathy management, rescue time, and total surgerytime should receive more attention.