Management of pediatric trauma

PEDIATRICS (Impact Factor: 5.47). 05/2008; 121(4):849-54. DOI: 10.1542/peds.2008-0094
Source: PubMed


Injury is the number 1 killer of children in the United States. In 2004, injury accounted for 59.5% of all deaths in children younger than 18 years. The financial burden to society of children who survive childhood injury with disability continues to be enormous. The entire process of managing childhood injury is complex and varies by region. Only the comprehensive cooperation of a broadly diverse group of people will have a significant effect on improving the care and outcome of injured children. This statement has been endorsed by the American Association of Critical-Care Nurses, American College of Emergency Physicians, American College of Surgeons, American Pediatric Surgical Association, National Association of Children's Hospitals and Related Institutions, National Association of State EMS Officials, and Society of Critical Care Medicine.

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    • "Such screening, however, is not current practice in this setting. In 2008, the American Academy of Pediatrics (AAP) released a position statement on the management of pediatric trauma stating that psychological support is a vital component of pediatric trauma care [22]. The AAP has also recently released a report describing the importance of the role of ED healthcare professionals in the stabilization and discovery of pediatric mental health, and advocating for improved recognition and treatment of mental health needs [23]. "
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    ABSTRACT: Pediatric injury is highly prevalent and has significant impact both physically and emotionally. The majority of pediatric injuries are treated in emergency departments (EDs), where treatment of physical injuries is the main focus. In addition to physical trauma, children often experience significant psychological trauma, and the development of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) is common. The consequences of failing to recognize and treat children with ASD and PTSD are significant and extend into adulthood. Currently, screening guidelines to identify children at risk for developing these stress disorders are not evident in the pediatric emergency setting. The goal of this systematic review is to summarize evidence on the psychometric properties, diagnostic accuracy, and clinical utility of screening tools that identify or predict PTSD secondary to physical injury in children. Specific research objectives are to: (1) identify, describe, and critically evaluate instruments available to screen for PTSD in children; (2) review and synthesize the test-performance characteristics of these tools; and (3) describe the clinical utility of these tools with focus on ED suitability. Computerized databases including MEDLINE, EMBASE, CINAHL, ISI Web of Science and PsycINFO will be searched in addition to conference proceedings, textbooks, and contact with experts. Search terms will include MeSH headings (post-traumatic stress or acute stress), (pediatric or children) and diagnosis. All articles will be screened by title/abstract and articles identified as potentially relevant will be retrieved in full text and assessed by two independent reviewers. Quality assessment will be determined using the QUADAS-2 tool. Screening tool characteristics, including type of instrument, number of items, administration time and training administrators level, will be extracted as well as gold standard diagnostic reference properties and any quantitative diagnostic data (specificity, positive and negative likelihood/odds ratios) where appropriate. Identifying screening tools to recognize children at risk of developing stress disorders following trauma is essential in guiding early treatment and minimizing long-term sequelae of childhood stress disorders. This review aims to identify such screening tools in efforts to improve routine stress disorder screening in the pediatric ED setting.Trials registration: PROSPERO registration: CRD42013004893.
    Systematic Reviews 03/2014; 3(1):19. DOI:10.1186/2046-4053-3-19
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    ABSTRACT: The objective of this study was to determine whether age <or=8 y is an independent predictor of mortality in noncoalition trauma patients at a US combat support hospital. A retrospective chart review was conducted of 1132 noncoalition trauma patients who were admitted to a combat support hospital between December 2003 and December 2004. Data on age, severity of injury indices, and in-hospital mortality rates were analyzed. All variables that were associated with death on univariate analysis were analyzed by multivariate logistic regression to determine independent associations with mortality. There were 38 young pediatric patients (aged <or=8 years) and 1094 older pediatric and adult patients (aged >8 years). Penetrating trauma accounted for 83% of all injuries. Young pediatric patients compared with older pediatric and adult patients had increased severity of injury indicated by decreased Glasgow Coma Scale score; increased incidence of hypotension, base deficit, and serum pH on admission; red blood cell transfusion amount; and increased injury severity scores on admission. Young pediatric patients compared with older pediatric and adult patients also had increased ICU lengths of stay (median 2 [interquartile range 0-5] vs median 0 [interquartile range 0-2] days) and in-hospital mortality rate (18% vs 4%), respectively. Multivariate logistic regression indicated that base deficit, injury severity score of >or=15, Glasgow Coma Scale score of <or=8, and age of <or=8 years were independently associated with mortality. Young children who present to a combat support hospital have increased severity of injury compared with older children and adults. In a population with primarily penetrating injuries, after adjustment for severity of injury, young children may also have an independent increased risk for death compared with older children and adults. Providing forward-deployed medical staff with pediatric-specific equipment and training in the acute care of young children with severe traumatic injuries may improve outcomes in this population.
    PEDIATRICS 11/2008; 122(5):e959-66. DOI:10.1542/peds.2008-1244 · 5.47 Impact Factor
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    ABSTRACT: BACKGROUND: More than 30,000,000 children receive care in emergency departments each year, of which approximately 20% receive care by pediatric emergency medicine physicians (PEMPs) defined as board-certified pediatrician with fellowship training in PEM or EM board certified with PEM fellowship training. OBJECTIVE: To determine the clinical impact on children cared for in systems without access to PEMPs. METHODS: Systematic literature review, including key terms in Medline and Google Scholar, with "balloon" search of references. RESULTS: 19 studies were identified, of which 7 focused on trauma, 3 on febrile children, and 5 on other issues (DKA, croup, analgesia, asthma and bronchiolitis). 1 article evaluated the more general impact of pediatric emergency consultants. The articles on trauma indicated that after controlling for injury severity scores, child mortality, splenectomy rates, and hospital costs were significantly lower when children were cared for at a pediatric trauma center compared to adult trauma center with added qualifications in pediatrics compared or general adult trauma centers. The articles on fever found that general emergency medicine physicians ordered significantly more ancillary tests than PEMPs, and PEMPs were more likely to adhere to established fever guidelines. None of these studies considered true healthcare outcomes. CONCLUSION: These data suggest that children suffering from trauma have better health outcomes if they receive care in pediatric trauma centers or adult trauma centers with added qualifications in pediatrics; however, this is more a measure of surgical expertise, and not directly related to access to PEMPs. The information on fever is more limited, since only process measures of care have been evaluated. Although we believe that children should be cared for by PEMPs, there are few data supporting this contention.
    Archives of Disease in Childhood 05/2009; 94(8):573-6. DOI:10.1136/adc.2008.137885 · 2.90 Impact Factor
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