{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:08:28Z","timestamp":1781629708932,"version":"3.54.5"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Justus-Liebig-Universit\u00e4t Gie\u00dfen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Emerg Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early deaths among severely injured children are mainly due to exsanguination and severe traumatic brain injury, some of which may be preventable with timely emergency interventions. However, data on potentially reversible causes of death and the role of advanced prehospital procedures in paediatric trauma are scarce. This study aims to assess post-mortem findings to identify cases where advanced emergency interventions could have been applicable in children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective, single-centre study analysed forensic files of deceased children and adolescents (age\u2009&lt;\u200918 years) regarding the potential benefit of advanced emergency procedures (e.g. prehospital transfusion, thoracotomy and resuscitative endovascular ballon occlusion of the aorta [REBOA]). Three independent reviewers systematically assessed each case to determine whether a potentially reversible cause of death was present and if advanced emergency interventions might have been applicable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 243 paediatric cases were included. The majority of deaths occurred prehospitally (91.6%). While the cause of death showed a significant association with age group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01), severe traumatic brain injury (TBI) was present across all age groups without significant variation. Cardiopulmonary resuscitation was performed in 68.5% of cases, achieving return of spontaneous circulation only in 12.1%. Advanced emergency procedures were deemed feasible in only two cases (0.8%), including thoracotomy (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092), REBOA (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091), and prehospital transfusion (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study reveals age-dependent patterns in paediatric trauma mortality and a very limited but relevant potential for advanced interventions. A rare subset, adolescents without severe TBI, might have benefited. Findings support structured trauma systems, targeted training, and selected use of prehospital transfusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12873-025-01469-5","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T16:33:44Z","timestamp":1767976424000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reversible causes of death and the potential benefit of invasive emergency techniques in paediatric and adolescent trauma: a 12-years retrospective forensic analysis"],"prefix":"10.1186","volume":"26","author":[{"given":"Leila","family":"Malolepszy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Heidl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Markmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas S.","family":"Zajonz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niko","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Koch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Hartwig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Sander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Schneck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"1469_CR1","unstructured":"5. Bundesanstalt f\u00fcr Stra\u00dfenwesen. Volkswirtschaftliche Kosten von Stra\u00dfenunf\u00e4llen. 2022. https:\/\/www.bast.de\/DE\/Statistik\/Unfaelle\/volkswirtschaftliche_kosten.pdf%3F__blob%3DpublicationFile%26v%3D9. Accessed 21 Apr 2023."},{"key":"1469_CR2","unstructured":"Bericht des deutschen. Traumaregister 2021 der deutschen Gesellschaft f\u00fcr Unfallchirurgie. 2021."},{"key":"1469_CR3","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1055\/s-0033-1343145","volume":"29","author":"C Buschmann","year":"2013","unstructured":"Buschmann C, Poloczek S, Giesecke M, Kleber C. Vermeidbare Todesf\u00e4lle nach Trauma. Der Notarzt. 2013;29:91\u20138. https:\/\/doi.org\/10.1055\/s-0033-1343145.","journal-title":"Der Notarzt"},{"key":"1469_CR4","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/j.resuscitation.2013.11.009","volume":"85","author":"C Kleber","year":"2014","unstructured":"Kleber C, Giesecke MT, Lindner T, Haas NP, Buschmann CT. Requirement for a structured algorithm in cardiac arrest following major trauma: epidemiology, management errors, and preventability of traumatic deaths in Berlin. Resuscitation. 2014;85:405\u201310. https:\/\/doi.org\/10.1016\/j.resuscitation.2013.11.009.","journal-title":"Resuscitation"},{"key":"1469_CR5","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1016\/j.injury.2019.03.003","volume":"50","author":"B Beck","year":"2019","unstructured":"Beck B, Smith K, Mercier E, Bernard S, Jones C, Meadley B, et al. Potentially preventable trauma deaths: a retrospective review. Injury. 2019;50:1009\u201316. https:\/\/doi.org\/10.1016\/j.injury.2019.03.003.","journal-title":"Injury"},{"key":"1469_CR6","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1016\/j.injury.2010.04.007","volume":"42","author":"TP Saltzherr","year":"2011","unstructured":"Saltzherr TP, Wendt KW, Nieboer P, Nijsten MWN, Valk JP, Luitse JSK, et al. Preventability of trauma deaths in a dutch level-1 trauma centre. Injury. 2011;42:870\u20133. https:\/\/doi.org\/10.1016\/j.injury.2010.04.007.","journal-title":"Injury"},{"key":"1469_CR7","doi-asserted-by":"publisher","DOI":"10.5505\/tjtes.2015.94658","author":"YE Eyi","year":"2015","unstructured":"Eyi YE. Evaluation of autopsy reports of traumatic deaths from the point of preventability. Turkish J Trauma Emerg Surg. 2015. https:\/\/doi.org\/10.5505\/tjtes.2015.94658.","journal-title":"Turkish J Trauma Emerg Surg"},{"key":"1469_CR8","doi-asserted-by":"publisher","first-page":"2125","DOI":"10.1007\/s00268-012-1650-9","volume":"36","author":"C Kleber","year":"2012","unstructured":"Kleber C, Giesecke MT, Tsokos M, Haas NP, Schaser KD, Stefan P, et al. Overall distribution of trauma-related deaths in Berlin 2010: advancement or stagnation of German trauma management? World J Surg. 2012;36:2125\u201330. https:\/\/doi.org\/10.1007\/s00268-012-1650-9.","journal-title":"World J Surg"},{"key":"1469_CR9","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1007\/s00101-017-0383-4","volume":"66","author":"B Ondruschka","year":"2017","unstructured":"Ondruschka B, Baier C, Dre\u00dfler J, H\u00f6ch A, Bernhard M, Kleber C, et al. Additive not\u00e4rztliche Ma\u00dfnahmen beim traumaassoziierten Herz-Kreislauf-Stillstand. Anaesthesist. 2017;66:924\u201335. https:\/\/doi.org\/10.1007\/s00101-017-0383-4.","journal-title":"Anaesthesist"},{"key":"1469_CR10","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.jss.2021.11.012","volume":"273","author":"A Liu","year":"2022","unstructured":"Liu A, Nguyen J, Ehrlich H, Bisbee C, Santiesteban L, Santos R, et al. Emergency resuscitative thoracotomy for civilian thoracic trauma in the field and emergency department settings: a systematic review and meta-analysis. J Surg Res. 2022;273:44\u201355. https:\/\/doi.org\/10.1016\/j.jss.2021.11.012.","journal-title":"J Surg Res"},{"key":"1469_CR11","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s13049-022-01010-8","volume":"30","author":"B Stretch","year":"2022","unstructured":"Stretch B, Gomez D. Resuscitative thoracotomy in blunt traumatic cardiac arrest. Scand J Trauma Resusc Emerg Med. 2022;30:30. https:\/\/doi.org\/10.1186\/s13049-022-01010-8.","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"1469_CR12","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1016\/j.resuscitation.2021.02.011","volume":"161","author":"C Lott","year":"2021","unstructured":"Lott C, Truhl\u00e1\u0159 A, Alfonzo A, Barelli A, Gonz\u00e1lez-Salvado V, Hinkelbein J, et al. European resuscitation Council guidelines 2021: cardiac arrest in special circumstances. Resuscitation. 2021;161:152\u2013219. https:\/\/doi.org\/10.1016\/j.resuscitation.2021.02.011.","journal-title":"Resuscitation"},{"key":"1469_CR13","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","volume":"310","author":"World Medical Association Declaration of Helsinki","year":"2013","unstructured":"World Medical Association Declaration of Helsinki. JAMA. 2013;310:2191. https:\/\/doi.org\/10.1001\/jama.2013.281053.","journal-title":"JAMA"},{"key":"1469_CR14","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","volume":"61","author":"E von Elm","year":"2008","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344\u20139. https:\/\/doi.org\/10.1016\/j.jclinepi.2007.11.008.","journal-title":"J Clin Epidemiol"},{"key":"1469_CR15","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1097\/PEC.0b013e31826d1e9a","volume":"28","author":"K Bechtel","year":"2012","unstructured":"Bechtel K. Sudden unexpected infant death. Pediatr Emerg Care. 2012;28:1085\u20139. https:\/\/doi.org\/10.1097\/PEC.0b013e31826d1e9a.","journal-title":"Pediatr Emerg Care"},{"key":"1469_CR16","doi-asserted-by":"publisher","unstructured":"Cottengim C, Batra E, Erck Lambert AB, Parks SE, Colarusso T, Bundock E, et al. Unexplained infant deaths without unsafe sleep factors: 2011 to 2020. Pediatrics. 2024;154. Supplement 3. https:\/\/doi.org\/10.1542\/peds.2024-067043G.","DOI":"10.1542\/peds.2024-067043G"},{"key":"1469_CR17","doi-asserted-by":"publisher","first-page":"E75","DOI":"10.1097\/TA.0b013e3181f6f72f","volume":"70","author":"GE Davies","year":"2011","unstructured":"Davies GE, Lockey DJ. Thirteen survivors of prehospital thoracotomy for penetrating trauma: a prehospital physician-performed resuscitation procedure that can yield good results. J Trauma: Injury Infect Crit Care. 2011;70:E75\u20138. https:\/\/doi.org\/10.1097\/TA.0b013e3181f6f72f.","journal-title":"J Trauma: Injury Infect Crit Care"},{"key":"1469_CR18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13054-023-04630-3","volume":"27","author":"S Katzenschlager","year":"2023","unstructured":"Katzenschlager S, Kelpanides IK, Ristau P, Huck M, Seewald S, Brenner S, et al. Out-of-hospital cardiac arrest in children: an epidemiological study based on the German resuscitation registry identifying modifiable factors for return of spontaneous circulation. Crit Care. 2023;27:1\u201313. https:\/\/doi.org\/10.1186\/s13054-023-04630-3.","journal-title":"Crit Care"},{"key":"1469_CR19","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/j.wneu.2016.03.045","volume":"91","author":"MC Dewan","year":"2016","unstructured":"Dewan MC, Mummareddy N, Wellons JC, Bonfield CM. Epidemiology of global pediatric traumatic brain injury: qualitative review. World Neurosurg. 2016;91:497\u2013509.e1. https:\/\/doi.org\/10.1016\/j.wneu.2016.03.045.","journal-title":"World Neurosurg"},{"key":"1469_CR20","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1097\/PCC.0000000000001736","volume":"20","author":"PM Kochanek","year":"2019","unstructured":"Kochanek PM, Tasker RC, Carney N, Totten AM, Adelson PD, Selden NR, et al. Guidelines for the management of pediatric severe traumatic brain injury, third edition: update of the brain trauma foundation guidelines, executive summary. Pediatr Crit Care Med. 2019;20:280\u20139. https:\/\/doi.org\/10.1097\/PCC.0000000000001736.","journal-title":"Pediatr Crit Care Med"},{"key":"1469_CR21","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1007\/s00104-020-01180-0","volume":"91","author":"M Wortmann","year":"2020","unstructured":"Wortmann M, Engelhart M, Elias K, Popp E, Zerwes S, Hyhlik-D\u00fcrr A. Resuscitative endovascular balloon occlusion of the aorta (REBOA). Chirurg. 2020;91:934\u201342. https:\/\/doi.org\/10.1007\/s00104-020-01180-0.","journal-title":"Chirurg"},{"key":"1469_CR22","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1016\/j.jpedsurg.2020.09.011","volume":"56","author":"CM Theodorou","year":"2021","unstructured":"Theodorou CM, Trappey AF, Beyer CA, Yamashiro KJ, Hirose S, Galante JM, et al. Quantifying the need for pediatric REBOA: a gap analysis. J Pediatr Surg. 2021;56:1395\u2013400. https:\/\/doi.org\/10.1016\/j.jpedsurg.2020.09.011.","journal-title":"J Pediatr Surg"},{"key":"1469_CR23","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/j.jpedsurg.2014.10.042","volume":"50","author":"CJ Allen","year":"2015","unstructured":"Allen CJ, Valle EJ, Thorson CM, Hogan AR, Perez EA, Namias N, et al. Pediatric emergency department thoracotomy: a large case series and systematic review. J Pediatr Surg. 2015;50:177\u201381. https:\/\/doi.org\/10.1016\/j.jpedsurg.2014.10.042.","journal-title":"J Pediatr Surg"},{"key":"1469_CR24","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1001\/jamasurg.2024.7245","volume":"160","author":"ZB Perkins","year":"2025","unstructured":"Perkins ZB, Greenhalgh R, ter Avest E, Aziz S, Whitehouse A, Read S, et al. Prehospital resuscitative thoracotomy for traumatic cardiac arrest. JAMA Surg. 2025;160:432. https:\/\/doi.org\/10.1001\/jamasurg.2024.7245.","journal-title":"JAMA Surg"},{"key":"1469_CR25","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.resuscitation.2015.07.017","volume":"95","author":"A Truhl\u00e1\u0159","year":"2015","unstructured":"Truhl\u00e1\u0159 A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, et al. European resuscitation council guidelines for resuscitation 2015: Sect. 4. Cardiac arrest in special circumstances. Resuscitation. 2015;95:148\u2013201. https:\/\/doi.org\/10.1016\/j.resuscitation.2015.07.017.","journal-title":"Resuscitation"},{"key":"1469_CR26","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1001\/jamapediatrics.2023.1291","volume":"177","author":"KM Morgan","year":"2023","unstructured":"Morgan KM, Abou-Khalil E, Strotmeyer S, Richardson WM, Gaines BA, Leeper CM. Association of prehospital transfusion with mortality in pediatric trauma. JAMA Pediatr. 2023;177:693. https:\/\/doi.org\/10.1001\/jamapediatrics.2023.1291.","journal-title":"JAMA Pediatr"},{"key":"1469_CR27","doi-asserted-by":"publisher","first-page":"e001740","DOI":"10.1136\/tsaco-2024-001740","volume":"10","author":"JS Hatchimonji","year":"2025","unstructured":"Hatchimonji JS, Haddad DN, Maurer L, Dowzicky PM, Benjamin AJ, Martin ND, et al. REBOA in shocked penetrating abdominal trauma patients: impact on outcomes. Trauma Surg Acute Care Open. 2025;10:e001740. https:\/\/doi.org\/10.1136\/tsaco-2024-001740.","journal-title":"Trauma Surg Acute Care Open"},{"key":"1469_CR28","doi-asserted-by":"publisher","unstructured":"Jansen JO, Hudson J, Kennedy C, Cochran C, MacLennan G, Gillies K, et al. The UK resuscitative endovascular balloon occlusion of the aorta in trauma patients with life-threatening torso haemorrhage: the (UK-REBOA) multicentre RCT. Health Technol Assess (Rockv). 2024;1\u2013122. https:\/\/doi.org\/10.3310\/LTYV4082.","DOI":"10.3310\/LTYV4082"},{"key":"1469_CR29","doi-asserted-by":"publisher","unstructured":"Hurson T, Schaefer R, Carico C, Griffin R, Bank E, Krohmer J, et al. Evaluating reimbursement for prehospital blood transfusions: a nationwide survey. Transfus (Paris). 2025;65. https:\/\/doi.org\/10.1111\/trf.18217.","DOI":"10.1111\/trf.18217"},{"key":"1469_CR30","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1001\/jamasurg.2021.4529","volume":"156","author":"KA Hrebinko","year":"2021","unstructured":"Hrebinko KA, Sperry JL, Guyette FX, Brown JB, Daley BJ, Miller RS, et al. Evaluating the cost-effectiveness of prehospital plasma transfusion in unstable trauma patients. JAMA Surg. 2021;156:1131. https:\/\/doi.org\/10.1001\/jamasurg.2021.4529.","journal-title":"JAMA Surg"}],"container-title":["BMC Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12873-025-01469-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12873-025-01469-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12873-025-01469-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:31:46Z","timestamp":1781627506000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12873-025-01469-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1469"],"URL":"https:\/\/doi.org\/10.1186\/s12873-025-01469-5","relation":{},"ISSN":["1471-227X"],"issn-type":[{"value":"1471-227X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]},"assertion":[{"value":"21 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Ethics Committee of Justus Liebig University Giessen (Giessen, Germany; approval number AZ 200\/23). A consent to participate was not required. The study was conducted in accordance with the principles of the Declaration of Helsinki. Methods and results are reported in line with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics and consent to participate declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"29"}}