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Shipley J, Grigorian A, Emigh B, Dilday J, Kuza C, Schubl S, Swentek L, Brown N, Nahmias J. Is Adolescent Obesity Associated With a Higher Risk for Pelvic Fractures in Motor Vehicle Collisions? J Surg Res 2024; 295:261-267. [PMID: 38048749 DOI: 10.1016/j.jss.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/21/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION The impact of obesity on the incidence of blunt pelvic fractures in adults is unclear, and adolescents may have an increased risk of fracture due to variable bone mineral density and leptin levels. Increased subcutaneous adipose tissue may provide protection, though the association between obesity and pelvic fractures in adolescents has not been studied. This study hypothesized that obese adolescents (OAs) presenting after motor vehicle collision (MVC) have a higher rate of pelvic fractures, and OAs with such fractures have a higher associated risk of complications and mortality compared to non-OAs. METHODS The 2017-2019 Trauma Quality Improvement Program database was queried for adolescents (12-16 y old) presenting after MVC. The primary outcome was a pelvic fracture. Adolescents with a body mass index ≥30 (OA) were compared to adolescents with a body mass index <30 (non-OA). Subgroup analyses for high-risk and low-risk MVCs were performed. Multivariable logistic regression analyses were also performed adjusting for age and sex. RESULTS From 22,610 MVCs, 3325 (14.7%) included OAs. The observed rate of pelvic fracture was similar between all OA and non-OA MVCs (10.2% versus 9.4%, P = 0.16), as well as subanalyses of minor or high-risk MVC (both P > 0.05). OAs presenting with a pelvic fracture after high-risk MVC had a similar risk of complications, pelvic surgery, and mortality compared to non-OAs (all P > 0.05). However, OAs with a pelvic fracture after minor MVC had a higher associated risk of complications (OR 2.27, CI 1.10-4.69, P = 0.03), but a similar risk of requiring pelvic surgery, and mortality (all P > 0.05). CONCLUSIONS This national analysis found a similar observed incidence of pelvic fractures for OAs versus non-OAs involved in an MVC, including subanalyses of minor and high-risk MVC. Furthermore, there was no difference in the associated risk of morbidity and mortality except for OAs involved in a minor MVC had a higher risk of complication.
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Affiliation(s)
- Jonathan Shipley
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California
| | - Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California
| | - Brent Emigh
- Department of Surgery, Brown University, Providence, Rhode Island
| | - Joshua Dilday
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Catherine Kuza
- Department of Anesthesia, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Sebastian Schubl
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California
| | - Lourdes Swentek
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California
| | - Nolan Brown
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, California.
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Larson KR, Demers LA, Holding EZ, Williams CN, Hall TA. Variability Across Caregiver and Performance-Based Measures of Executive Functioning in an Acute Pediatric Neurocritical Care Population. Neurotrauma Rep 2023; 4:97-106. [PMID: 36895819 PMCID: PMC9989517 DOI: 10.1089/neur.2022.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Youth admitted to the pediatric intensive care unit (PICU) for traumatic brain injury (TBI) commonly struggle with long-term residual effects in the domains of physical, cognitive, emotional, and psychosocial/family functioning. In the cognitive domain, executive functioning (EF) deficits are often observed. The Behavior Rating Inventory of Executive Functioning, Second Edition (BRIEF-2) is a parent/caregiver-completed measure that is regularly utilized to assess caregivers' perspectives of daily EF abilities. Using parent/caregiver-completed measures like the BRIEF-2 in isolation as outcome measures for capturing symptom presence and severity might be problematic given that caregiver ratings are vulnerable to influence from external factors. As such, this study aimed to investigate the association between the BRIEF-2 and performance-based measures of EF in youth during the acute recovery period post-PICU admission for TBI. A secondary aim was to explore associations among potential confounding factors, including family-level distress, injury severity, and the impact of pre-existing neurodevelopmental conditions. Participants included 65 youths, 8-19 years of age, admitted to the PICU for TBI, who survived hospital discharge and were referred for follow-up care. Non-significant correlations were found between BRIEF-2 outcomes and performance-based measures of EF. Measures of injury severity were strongly correlated with scores from performance-based EF measures, but not BRIEF-2. Parent/caregiver-reported measures of their own health-related quality of life were related to caregiver responses on the BRIEF-2. Results demonstrate the differences captured by performance-based versus caregiver-report measures of EF, and also highlight the importance of considering other morbidities related to PICU admission.
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Affiliation(s)
- Kera R Larson
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Lauren A Demers
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Emily Z Holding
- Developmental Medical Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Cydni N Williams
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Trevor A Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
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Advanced Automatic Crash Notification Algorithm for Children. Acad Pediatr 2022; 22:1057-1064. [PMID: 35314363 DOI: 10.1016/j.acap.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Advanced automatic crash notification (AACN) can improve triage decision-making by using vehicle telemetry to alert first responders of a motor vehicle crash and estimate an occupant's likelihood of injury. The objective was to develop an AACN algorithm to predict the risk that a pediatric occupant is seriously injured and requires treatment at a Level I or II trauma center. METHODS Based on 3 injury facets (severity; time sensitivity; predictability), a list of Target Injuries associated with a child's need for Level I/II trauma center treatment was determined. Multivariable logistic regression of motor vehicle crash occupants was performed creating the pediatric-specific AACN algorithm to predict risk of sustaining a Target Injury. Algorithm inputs included: delta-v, rollover quarter-turns, belt status, multiple impacts, airbag deployment, and age. The algorithm was optimized to achieve under-triage ≤5% and over-triage ≤50%. Societal benefits were assessed by comparing correctly triaged motor vehicle crash occupants using the AACN algorithm against real-world decisions. RESULTS The pediatric AACN algorithm achieved 25% to 49% over-triage across crash modes, and under-triage rates of 2% for far-side, 3% for frontal and near-side, 8% for rear, and 14% for rollover crashes. Applied to real-world motor vehicle crashes, improvements of 59% in under-triage and 45% in over-triage are estimated: more appropriate triage of 32,320 pediatric occupants annually. CONCLUSIONS This AACN algorithm accounts for pediatric developmental stage and will aid emergency personnel in correctly triaging pediatric occupants after a motor vehicle crash. Once incorporated into the trauma triage network, it will increase triage efficiency and improve patient outcomes.
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Lynch SD, Weaver AA, Barnard RT, Kiani B, Stitzel JD, Zonfrillo MR. Age-based differences in the disability of spine injuries in pediatric and adult motor vehicle crash occupants. TRAFFIC INJURY PREVENTION 2022; 23:358-363. [PMID: 35709315 PMCID: PMC9756938 DOI: 10.1080/15389588.2022.2086980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The objective was to develop a disability-based metric for quantifying disability rates as a result of motor vehicle crash (MVC) spine injuries and compare functional outcomes between pediatric and adult subgroups. METHODS Disability rate was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System for the top 95% most frequent Abbreviated Injury Scale (AIS) 3 spine injuries (14 unique injuries). Pediatric (7-18 years), young adult (19-45 years), middle-aged adult (46-65 years), and older adult (66+ years) MVC occupants with FIM scores available and at least one of the 14 spine injuries were included. FIM scores of 1 or 2 at time of discharge were used to define disability and correspond to full functional or modified dependence in self-feeding, locomotion, and/or verbal expression. Disability rate was evaluated on a per injury basis for each AIS 3 spine injury and calculated as the proportion of cases associated with disability (i.e. FIM of 1 or 2) out of the total cases of that particular injury. Disability rates were calculated with and without the exclusion of cases with severe co-injuries (AIS 4+) to minimize bias from additional non-spinal injuries that could have contributed to disability. Associations between adjusted disability rates and existing mortality rates were investigated. RESULTS Locomotion impairment alone was the most frequent disability type for the top 14 AIS 3 spine injuries (7 cervical, 4 thoracic, and 3 lumbar) across all age groups and spine regions. Adjusted and unadjusted disability rates ranged from 0-69%. Adjusted disability rates increased with age: 14.8 ± 10% (mean ± SD) in pediatrics to 16.2 ± 6.6% (young adults), 29.2 ± 10.9% (middle-aged adults), and 45.0 ± 12.2% (older adults). Among all adult populations, adjusted mortality and disability rates were positively correlated (R2>0.24), with disability rates consistently greater than corresponding mortality rates. CONCLUSIONS Older adults had significantly greater disability rates associated with MVC spine injuries across all spinal regions. MVC disability rates for pediatrics were considerably lower. Overall, rates of mortality were significantly lower than rates of disability. The adjusted disability rates developed can supplement existing injury metrics by accounting for age- and location-specific functional implications of MVC spine injuries.
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Affiliation(s)
- S. Delanie Lynch
- Department of Biomedical Engineering, Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, North Carolina
| | - Ashley A. Weaver
- Department of Biomedical Engineering, Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, North Carolina
| | - Ryan T. Barnard
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Bahram Kiani
- Department of Radiology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, North Carolina
| | - Joel D. Stitzel
- Department of Biomedical Engineering, Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, North Carolina
| | - Mark R. Zonfrillo
- Department of Emergency Medicine, Alpert Medical School of Brown University and Hasbro Children’s Hospital, Providence, Rhode Island
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Evans LL, Jensen AR, Meert KL, VanBuren JM, Richards R, Alvey JS, Carcillo JA, McQuillen PS, Mourani PM, Nance ML, Holubkov R, Pollack MM, Burd RS. All body region injuries are not equal: Differences in pediatric discharge functional status based on Abbreviated Injury Scale (AIS) body regions and severity scores. J Pediatr Surg 2022; 57:739-746. [PMID: 35090715 DOI: 10.1016/j.jpedsurg.2021.09.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Functional outcomes have been proposed for assessing quality of pediatric trauma care. Outcomes assessments often rely on Abbreviated Injury Scale (AIS) severity scores to adjust for injury characteristics, but the relationship between AIS severity and functional impairment is unknown. This study's primary aim was to quantify functional impairment associated with increasing AIS severity scores within body regions. The secondary aim was to assess differences in impairment between body regions based on AIS severity. METHODS Children with serious (AIS≥ 3) isolated body region injuries enrolled in a multicenter prospective study were analyzed. The primary outcome was functional status at discharge measured using the Functional Status Scale (FSS). Discharge FSS was compared (1) within each body region across increasing AIS severity scores, and (2) between body regions for injuries with matching AIS scores. RESULTS The study included 266 children, with 16% having abnormal FSS at discharge. Worse FSS was associated with increasing AIS severity only for spine injuries. Abnormal FSS was observed in a greater proportion of head injury patients with a severely impaired initial Glasgow Coma Scale (GCS) (GCS< 9) compared to those with a higher GCS score (43% versus 9%; p < 0.01). Patients with AIS 3 extremity and severe head injuries had a higher proportion of abnormal FSS at discharge than AIS 3 abdomen or non-severe head injuries. CONCLUSIONS AIS severity does not account for variability in discharge functional impairment within or between body regions. Benchmarking based on functional status assessment requires clinical factors in addition to AIS severity for appropriate risk adjustment. LEVEL OF EVIDENCE 1 (Prognostic and Epidemiological).
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Affiliation(s)
- Lauren L Evans
- Department of Surgery, Division of Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, 744 52nd Street, 4th Floor OPC2, Oakland CA 94609, United States
| | - Aaron R Jensen
- Department of Surgery, Division of Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, 744 52nd Street, 4th Floor OPC2, Oakland CA 94609, United States.
| | - Kathleen L Meert
- Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI 48201, United States
| | - John M VanBuren
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Rachel Richards
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Jessica S Alvey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Joseph A Carcillo
- Department of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Patrick S McQuillen
- Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA
| | - Peter M Mourani
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO
| | - Michael L Nance
- Division of Pediatric Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Richard Holubkov
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Murray M Pollack
- Department of Pediatrics, Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington DC 20010, United States
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, DC 20010, United States
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Gaffley M, Weaver AA, Talton JW, Barnard RT, Stitzel JD, Zonfrillo MR. Age-based differences in the disability of extremity injuries in pediatric and adult occupants. TRAFFIC INJURY PREVENTION 2019; 20:S63-S68. [PMID: 31560215 PMCID: PMC7035195 DOI: 10.1080/15389588.2019.1658873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/13/2019] [Accepted: 08/17/2019] [Indexed: 06/10/2023]
Abstract
Objective: The objective was to develop a disability-based metric for motor vehicle crash (MVC) upper and lower extremity injuries and compare functional outcomes between children and adults.Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 3 extremity injuries (22 unique injuries). Pediatric (7-18 years), young adult (19-45 years), middle-aged (46-65 years), and older adult (66+ years) MVC occupants with an FIM score and at least one of the 22 extremity injuries were included. DR was calculated for each injury as the proportion of occupants who were disabled of those sustaining the injury. A maximum AIS-adjusted disability risk (DRMAIS) was also calculated for each injury, excluding occupants with AIS 4+ co-injuries.Results: Locomotion impairment was the most frequent disability type across all ages. DR and DRMAIS of the extremity injuries ranged from 0.06 to 1.00 (6%-100% disability risk). Disability risk increased with age, with DRMAIS increasing from 25.9% ± 8.6% (mean ± SD) in pediatric subjects to 30.4% ± 6.3% in young adults, 39.5% ± 6.6% in middle-aged adults, and 60.5 ± 13.3% in older adults. DRMAIS for upper extremity fractures differed significantly between age groups, with higher disability in older adults, followed by middle-aged adults. DRMAIS for pelvis, hip, shaft, knee, and other lower extremity fractures differed significantly between age groups, with older adult DRMAIS being significantly higher for each fracture type. DRMAIS for hip and lower extremity shaft fractures was also significantly higher in middle-aged occupants compared to pediatric and young adult occupants. The maximum AIS-adjusted mortality risk (MRMAIS, proportion of fatalities among occupants sustaining an MAIS 3 injury) was not correlated with DRMAIS for extremity injuries in pediatric, young adult, middle-aged, and older adult occupants (all R2 < 0.01). Disability associated with each extremity injury was higher than mortality risk.Conclusions: Older adults had significantly greater disability for MVC extremity injuries. Lower disability rates in children may stem from their increased physiological capacity for bone healing and relative lack of bone disease. The disability metrics developed can supplement AIS and other severity-based metrics by accounting for the age-specific functional implications of MVC extremity injuries.
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Affiliation(s)
- Michaela Gaffley
- General Surgery, Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Ashley A. Weaver
- School of Biomedical Engineering and Sciences, Virginia Tech–Wake Forest University, Winston–Salem, North Carolina
| | - Jennifer W. Talton
- Wake Forest School of Medicine, Division of Public Health Sciences, Winston–Salem, North Carolina
| | - Ryan T. Barnard
- Wake Forest School of Medicine, Division of Public Health Sciences, Winston–Salem, North Carolina
| | - Joel D. Stitzel
- School of Biomedical Engineering and Sciences, Virginia Tech–Wake Forest University, Winston–Salem, North Carolina
| | - Mark R. Zonfrillo
- Department of Emergency Medicine, Alpert Medical School of Brown University and Hasbro Children’s Hospital, Providence, Rhode Island
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Schoell SL, Weaver AA, Talton JW, Barnard RT, Baker G, Stitzel JD, Zonfrillo MR. Functional outcomes of motor vehicle crash thoracic injuries in pediatric and adult occupants. TRAFFIC INJURY PREVENTION 2018; 19:280-286. [PMID: 29185785 PMCID: PMC6233316 DOI: 10.1080/15389588.2017.1409894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Characterization of the severity of injury should account for both mortality and disability. The objective of this study was to develop a disability metric for thoracic injuries in motor vehicle crashes (MVCs) and compare the functional outcomes between the pediatric and adult populations. METHODS Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank for the most frequently occurring Abbreviated Injury Scale (AIS) 2-5 thoracic injuries. Occupants with thoracic injury were classified as disabled or not disabled based on the FIM scale, and comparisons were made between the following age groups: pediatric, adult, middle-aged, and older occupants (ages 7-18, 19-45, 46-65, and 66+, respectively). For each age group, DR was calculated by dividing the number of patients who were disabled and sustained a given injury by the number of patients who sustained a given injury. To account for the effect of higher severity co-injuries, a maximum AIS adjusted DR (DRMAIS) was also calculated for each injury. DR and DRMAIS could range from 0 to 100% disability risk. RESULTS The mean DRMAIS for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DRMAIS values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, and rib and sternum fracture compared to the other age groups. The pediatric population possessed a higher DRMAIS value for flail chest compared to the other age groups. CONCLUSION Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can influence future age-specific modifications to AIS.
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Affiliation(s)
- Samantha L. Schoell
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC, USA
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ashley A. Weaver
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC, USA
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jennifer W. Talton
- Wake Forest School of Medicine, Division of Public Health Sciences, Winston-Salem, NC, USA
| | - Ryan T. Barnard
- Wake Forest School of Medicine, Division of Public Health Sciences, Winston-Salem, NC, USA
| | - Gretchen Baker
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC, USA
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joel D. Stitzel
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC, USA
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mark R. Zonfrillo
- Alpert Medical School of Brown University and Hasbro Children’s Hospital, Providence, RI, USA
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Doud AN, Schoell SL, Talton JW, Barnard RT, Petty JK, Stitzel JD, Weaver AA. Characterization of the occult nature of frequently occurring pediatric motor vehicle crash injuries. ACCIDENT; ANALYSIS AND PREVENTION 2018; 113:12-18. [PMID: 29367055 DOI: 10.1016/j.aap.2017.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/27/2017] [Accepted: 12/31/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Occult injuries are those likely to be missed on initial assessment by first responders and, though initially asymptomatic, they may present suddenly and lead to rapid patient decompensation. No scoring systems to quantify the occultness of pediatric injuries have been established. Such a scoring system will be useful in the creation of an Advanced Automotive Crash Notification (AACN) system that assists first responders in making triage decisions following a motor vehicle crash (MVC). STUDY DESIGN The most frequent MVC injuries were determined for 0-4, 5-9, 10-14 and 15-18 year olds. For each age-specific injury, experts with pediatric trauma expertise were asked to rate the likelihood that the injury may be missed by first responders. An occult score (ranging from 0-1) was calculated by averaging and normalizing the responses of the experts polled. RESULTS Evaluation of all injuries across all age groups demonstrated greater occult scores for the younger age groups compared to older age groups (mean occult score 0-4yo: 0.61 ± 0.23, 5-9yo: 0.53 ± 0.25, 10-14yo: 0.48 ± 0.23, and 15-18yo: 0.42 ± 0.22, p < 0.01). Body-region specific occult scores revealed that experts judged abdominal, spine and thoracic injuries to be more occult than injuries to other body regions. CONCLUSIONS The occult scores suggested that injuries are more difficult to detect in younger age groups, likely given their inability to express symptoms. An AACN algorithm that can predict the presence of clinically undetectable injuries at the scene can improve triage of children with these injuries to higher levels of care.
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Affiliation(s)
- Andrea N Doud
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, United States; Childress Institute for Pediatric Trauma, 575 N Patterson Ave, Suite 148, Winston-Salem, NC, 27103, United States.
| | - Samantha L Schoell
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, United States; Virginia Tech-Wake Forest University Center for Injury Biomechanics, 575 N. Patterson Ave, Suite 120, Winston-Salem, NC, 27101, United States.
| | - Jennifer W Talton
- Wake Forest School of Medicine, Division of Public Health Sciences, Medical Center Blvd, Winston-Salem, NC, 27157, United States.
| | - Ryan T Barnard
- Wake Forest School of Medicine, Division of Public Health Sciences, Medical Center Blvd, Winston-Salem, NC, 27157, United States.
| | - John K Petty
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, United States; Childress Institute for Pediatric Trauma, 575 N Patterson Ave, Suite 148, Winston-Salem, NC, 27103, United States.
| | - Joel D Stitzel
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, United States; Virginia Tech-Wake Forest University Center for Injury Biomechanics, 575 N. Patterson Ave, Suite 120, Winston-Salem, NC, 27101, United States; Childress Institute for Pediatric Trauma, 575 N Patterson Ave, Suite 148, Winston-Salem, NC, 27103, United States.
| | - Ashley A Weaver
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, United States; Virginia Tech-Wake Forest University Center for Injury Biomechanics, 575 N. Patterson Ave, Suite 120, Winston-Salem, NC, 27101, United States.
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Weaver AA, Schoell SL, Talton JW, Barnard RT, Stitzel JD, Zonfrillo MR. Functional outcomes of thoracic injuries in pediatric and adult occupants. TRAFFIC INJURY PREVENTION 2018; 19:S195-S198. [PMID: 29584488 PMCID: PMC6776991 DOI: 10.1080/15389588.2018.1426927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To develop a disability metric for motor vehicle crash (MVC) thoracic injuries and compare functional outcomes between pediatric and adult populations. METHODS Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank (NTDB) for the top 95% most frequently occurring AIS 2, 3, 4, and 5 thoracic injuries in NASS-CDS 2000-2011. The NTDB contains a truncated form of the FIM score, including three items (self-feed, locomotion, and verbal expression), each graded from full functional dependence to full functional independence. Pediatric (ages 7-18 years), adult (19-45), middle-aged adult (46-65), and older adult (66+) MVC occupants were classified as disabled or not disabled based on the FIM scale. The DR was calculated for each injury within each age group by dividing the number of patients who were disabled that sustained the specific injury by the number of patients who sustained the specific injury. To account for the impact of more severe co-injuries, a maximum Abbreviated Injury Scale (MAIS) adjusted DR (DRMAIS) was also calculated. DR and DRMAIS could range from 0 (0% disability risk) to 1 (100% disability risk). RESULTS The mean DRMAIS for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DRMAIS values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, rib fracture, and sternum fracture compared to the other age groups. The pediatric population possessed a higher DRMAIS value for flail chest compared to the other age groups. CONCLUSIONS Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can impact future age-specific modifications to AIS.
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Affiliation(s)
- Ashley A. Weaver
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC, USA
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Samantha L. Schoell
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC, USA
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jennifer W. Talton
- Wake Forest School of Medicine, Division of Public Health Sciences, Winston-Salem, NC, USA
| | - Ryan T. Barnard
- Wake Forest School of Medicine, Division of Public Health Sciences, Winston-Salem, NC, USA
| | - Joel D. Stitzel
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC, USA
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mark R. Zonfrillo
- Alpert Medical School of Brown University and Hasbro Children’s Hospital, Providence, RI, USA
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10
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Tadros A, Owen S, Hoffman SM, Davis SM, Sharon MJ. Emergency department visits by pediatric patients sustained as a passenger on a motorcycle. TRAFFIC INJURY PREVENTION 2018; 19:71-74. [PMID: 28613096 DOI: 10.1080/15389588.2017.1341629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Currently only 5 out of the 50 states in the United States have laws restricting the age of passengers permitted to ride on a motorcycle. This study sought to characterize the visits by patients under the age of 16 to U.S. emergency departments (EDs) for injuries sustained as a passenger on a motorcycle. METHODS In this retrospective cohort study, data were obtained from the Nationwide Emergency Department Sample (NEDS) for the years 2006 to 2011. Pediatric patients who were passengers on a motorcycle that was involved in a crash were identified using International Classification of Diseases, Ninth Revision (ICD-9) External Cause of Injury codes. We also examined gender, age, disposition, regional differences, common injuries, and charges. RESULTS Between 2006 and 2011 there were an estimated 9,689 visits to U.S. EDs by patients under the age of 16 who were passengers on a motorcycle involved in a crash. The overall average patient age was 9.4 years, and they were predominately male (54.5%). The majority (85%) of these patients were treated and released. The average charges for discharged patients were $2,116.50 and amounted to roughly $17,500,000 during the 6 years. The average cost for admission was $51,446 per patient and totaled over $54 million. The most common primary injuries included superficial contusions; sprains and strains; upper limb fractures; open wounds of head, neck, and trunk; and intracranial injuries. CONCLUSION Although there were only about 9,700 visits to U.S. EDs for motorcycle crashes involving passengers less than 16 years old for 2006 to 2011, the total cost of visits that resulted in either ED discharge or hospital admission amounted to over $71 million.
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Affiliation(s)
- Allison Tadros
- a School of Medicine, Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia
| | - Stephanie Owen
- a School of Medicine, Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia
| | - Shelley M Hoffman
- a School of Medicine, Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia
| | - Stephen M Davis
- a School of Medicine, Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia
| | - Melinda J Sharon
- a School of Medicine, Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia
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Doud AN, Schoell SL, Weaver AA, Talton JW, Barnard RT, Petty JK, Meredith JW, Stitzel JD. Expert Perspectives on Time Sensitivity and a Related Metric for Children Involved in Motor Vehicle Crashes. Acad Pediatr 2017; 17:243-250. [PMID: 28108126 DOI: 10.1016/j.acap.2016.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Advanced Automatic Crash Notification (AACN) uses vehicle telemetry data to predict risk of serious injury among motor vehicle crash occupants and can thus improve the accuracy with which injured children are triaged by first responders. To better define serious injury for AACN systems (which typically use Abbreviated Injury Scale [AIS] metrics), an age-specific approach evaluating severity, time sensitivity (TS), and predictability of injury has been developed. This study outlines the development of the TS score. METHODS The 95% most frequent AIS 2+ injuries in a national motor vehicle crash data set spanning 2000 to 2011 were determined for the following age groups: 0 to 4, 5 to 9, 10 to 14, and 15 to 18 years. For each age-specific injury, clinicians with pediatric trauma expertise were asked if treatment at a trauma center was required and were asked about the urgency of treatment. A TS score (range 0-1) was calculated by combining the mean trauma center decision and urgency scores. RESULTS A total of 30 to 32 responses were obtained for each age-specific injury. The most frequent motor vehicle crash-induced injuries in the younger groups received significantly higher scores than those in the older groups (median TS score 0 to 4 years: 0.89, 5-9 years: 0.87, 10-14 years: 0.82, 15-18 years: 0.72, P < .001). Large variations in TS existed within each AIS severity level; for example, scores among AIS 2 injuries in 0- to 4-year-olds ranged from 0.12 to 0.98. CONCLUSIONS The TS of common pediatric injuries varies on the basis of age and may not be accurately reflected by AIS metrics. AIS may not capture all aspects of injury that should be considered by AACN systems.
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Affiliation(s)
- Andrea N Doud
- Wake Forest School of Medicine, Winston-Salem, NC; Childress Institute for Pediatric Trauma, Winston-Salem, NC
| | - Samantha L Schoell
- Wake Forest School of Medicine, Winston-Salem, NC; Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC
| | - Ashley A Weaver
- Wake Forest School of Medicine, Winston-Salem, NC; Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC.
| | - Jennifer W Talton
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ryan T Barnard
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - John K Petty
- Wake Forest School of Medicine, Winston-Salem, NC; Childress Institute for Pediatric Trauma, Winston-Salem, NC
| | - J Wayne Meredith
- Wake Forest School of Medicine, Winston-Salem, NC; Childress Institute for Pediatric Trauma, Winston-Salem, NC
| | - Joel D Stitzel
- Wake Forest School of Medicine, Winston-Salem, NC; Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC; Childress Institute for Pediatric Trauma, Winston-Salem, NC
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12
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Abstract
BACKGROUND Mortality rates among children in motor vehicle crashes (MVCs) are typically low; however, nonfatal injuries can vary in severity by imposing differing levels of short- and long-term disability. To better discriminate the severity of nonfatal MVC injuries, a pediatric-specific disability risk (DR) metric was created. METHODS The National Automotive Sampling System 2000 to 2011 was used to define the top 95% most common Abbreviated Injury Scale (AIS) 2+ injuries among pediatric MVC occupants. Functional Independence Measure scores were abstracted from the National Trauma Data Bank 2002 to 2006. Multiple imputation was used to account for missing data. The DR and coinjury-adjusted DR (DRMAIS) of the most common AIS 2+ MVC-induced injuries were calculated for 7-year-old to 18-year-old children by determining the proportion of those disabled after an injury to those sustaining the injury. DR and DRMAIS values ranged from 0 to 1, representing 0% to 100% DR. RESULTS The mean DR and DRMAIS of all injuries were 0.290 and 0.191, respectively. DR and DRMAIS were greatest for injuries to the head (DR, 0.340; DRMAIS, 0.279), thorax (DR, 0.320; DRMAIS, 0.233), and spine (DR, 0.315; DRMAIS, 0.200). The mean DR and DRMAIS increased with increasing AIS severity but there was significant variation and overlapping values across AIS severity levels. Comparison of DRMAIS to coinjury-adjusted mortality risk (MRMAIS) revealed that among 118 injuries with MRMAIS of 0.000, DRMAIS ranged from 0.000 to 0.429. CONCLUSION Incorporation of DR metrics into injury severity metrics may improve the ability to distinguish between the severity of different nonfatal injuries. This is especially crucial in the pediatric population where permanent disability can result in a high number of years lost due to disability. The accuracy of such severity metrics is crucial to the success of pediatric triage algorithms such as Advanced Automatic Crash Notification algorithms. LEVEL OF EVIDENCE Epidemiologic/prognostic study, level III.
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13
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Schoell SL, Weaver AA, Talton JW, Baker G, Doud AN, Barnard RT, Stitzel JD, Zonfrillo MR. Functional outcomes of motor vehicle crash head injuries in pediatric and adult occupants. TRAFFIC INJURY PREVENTION 2016; 17 Suppl 1:27-33. [PMID: 27586099 PMCID: PMC6211837 DOI: 10.1080/15389588.2016.1201203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/07/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The objective of the study was to develop a disability-based metric for motor vehicle crash (MVC) injuries, with a focus on head injuries, and compare the functional outcomes between the pediatric and adult populations. METHODS Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System (NTDB-RDS) for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 3, 4, and 5 head injuries in NASS-CDS 2000-2011. Pediatric (ages 7-18), adult (19-45), middle-aged (46-65), and older adult (66+) patients with an FIM score available who were alive at discharge and had an AIS 3, 4, or 5 injury were included in the study. The NTDB-RDS contains a truncated form of the FIM instrument, including 3 items (self-feed, locomotion, and verbal expression), each graded on a scale of 1 (full functional dependence) to 4 (full functional independence). Patients within each age group were classified as disabled or not disabled based on the FIM scale. The DR was calculated for each age group by dividing the number of patients who sustained a specific injury and were disabled by the number of patients who sustained the specific injury. To account for the impact of more severe associated coinjuries, a maximum AIS (MAIS) adjusted DR (DRMAIS) was also calculated for each injury. DR and DRMAIS ranged from 0 (0% disability risk) to 1 (100% disability risk). RESULTS An analysis of the most frequent FIM components associated with disabling MVC head injuries revealed that disability across all 3 items (self-feed, locomotion, and expression) was the most frequent for pediatric and adult patients. Only locomotion was the most frequent for middle-aged and older adults. The mean DRMAIS for MVC head injuries was 35% for pediatric patients, 36% for adults, 38% for middle-aged adults, and 44% for older adults. Further analysis was conducted by grouping the head injuries into 8 groups based on the structure of injury and injury type. The pediatric population possessed higher DRMAIS values for brain stem injuries as well as loss of consciousness injuries. Older adults possessed higher DRMAIS values for contusion/hemorrhage injuries, epidural hemorrhage, intracerebral hemorrhage, skull fracture, and subdural/subarachnoid hemorrhage. CONCLUSION At-risk populations such as pediatric and older adult patients possessed higher DRMAIS values for different head injuries. Disability in pediatric patients is critical due to loss of quality life years. Disability risk can supplement severity metrics to improve the ability of such metrics to discriminate the severity of different injuries that do not lead to death. Understanding of age-related differences in injury outcomes when compared to adults could inform future age-specific modifications to the AIS.
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Affiliation(s)
- Samantha L. Schoell
- Virginia Tech–Wake Forest University Center for Injury Biomechanics, Winston–Salem, North Carolina
- Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Ashley A. Weaver
- Virginia Tech–Wake Forest University Center for Injury Biomechanics, Winston–Salem, North Carolina
- Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Jennifer W. Talton
- Wake Forest School of Medicine, Division of Public Health Sciences, Winston–Salem, North Carolina
| | - Gretchen Baker
- Virginia Tech–Wake Forest University Center for Injury Biomechanics, Winston–Salem, North Carolina
| | - Andrea N. Doud
- Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Ryan T. Barnard
- Wake Forest School of Medicine, Division of Public Health Sciences, Winston–Salem, North Carolina
| | - Joel D. Stitzel
- Virginia Tech–Wake Forest University Center for Injury Biomechanics, Winston–Salem, North Carolina
- Wake Forest School of Medicine, Winston–Salem, North Carolina
| | - Mark R. Zonfrillo
- Alpert Medical School of Brown University and Hasbro Children’s Hospital, Providence, Rhode Island
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