Management of pediatric trauma.

PEDIATRICS (Impact Factor: 5.3). 05/2008; 121(4):849-54. DOI: 10.1542/peds.2008-0094
Source: PubMed

ABSTRACT 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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    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 · 5.30 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 · 2.91 Impact Factor
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    ABSTRACT: Improving trauma care and preparing for a disaster require data collection and analysis. Trauma registries capture data for research, measure trauma system outcomes, and support quality improvement through assessment of the appropriateness and effectiveness of the trauma system. The purpose of this article is to evaluate the role of trauma registries in disaster planning for the pediatric population by: (1) describing the history and current state of pediatric trauma registries; (2) providing examples of functioning trauma registries and their application to assist in disaster planning; and (3) a summary of the applicability to pediatric disaster planning as well as recommendations for future efforts. The National Pediatric Trauma Registry was discontinued in 2002. A detailed plan and design have been developed for the National Trauma Registry for Children; however, the funding has not been available to implement. The National Trauma Data Bank is the largest repository of trauma records in the United States; however, it has not focused specifically on pediatric data collection. The most highly reported use of trauma registry data for studying mass casualties and disaster planning has been conducted outside of the United States and related to terrorist attacks. Aggregating existing data from state trauma registries or using the National Trauma Data Bank may facilitate development of statistical models to help predict survival, injury patterns, and important physiological thresholds. However, representative pediatric-specific trauma registry data are needed to obtain an adequate sample size in pediatric population to extrapolate data to represent the scale of a disaster.
    The Journal of trauma 09/2009; 67(2 Suppl):S172-8. DOI:10.1097/TA.0b013e3181af0aeb · 2.96 Impact Factor


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