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Schuster A, Klute L, Kerschbaum M, Kunkel J, Schaible J, Straub J, Weber J, Alt V, Popp D. Injury Pattern and Current Early Clinical Care of Pediatric Polytrauma Comparing Different Age Groups in a Level I Trauma Center. J Clin Med 2024; 13:639. [PMID: 38276145 PMCID: PMC10816860 DOI: 10.3390/jcm13020639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Introduction: Pediatric polytrauma is a complex condition with unique characteristics and requirements for early clinical care. This study aimed to analyze the injury patterns, early clinical care, and outcomes of pediatric polytrauma patients in a Level I trauma center. The focus was on evaluation between different age groups and the recognition of injuries as potential factors influencing outcomes. Methods: A prospective cohort study model of pediatric polytrauma patients (ISS ≥ 16) was conducted over a 13-year period, stratified by age groups (Group A: 0-5 years; Group B: 6-10 years; Group C: 11-15 years; and Group D: 16-18 years). A comparison of the groups was conducted to examine variations in early clinical care, trauma mechanisms, distribution of affected body regions (as per AIS and ISS criteria), and trauma-related mortality. Additionally, factors contributing to mortality were evaluated. Results: The median age of patients was 16 years, with a male predominance (64.7%). The Injury Severity Score (ISS) varied across age groups, with no significant difference. The 30-day mortality rate was 19.0%, with no significant age-related differences. Trauma mechanisms varied across age groups, with motor vehicle accidents being the most common mechanism in all age groups except 0-5 years, where falls were prevalent. Analysis of injury patterns by AIS body regions indicated that head trauma was a significant predictor of mortality (Hazard Ratio 2.894, p < 0.001), while chest, abdominal, and extremity trauma showed no significant association with mortality. Multiple regression analysis identified the ISS and preclinical GCS as valid predictors of mortality (p < 0.001 and p = 0.006, respectively). Conclusions: While age-related differences in injury severity and clinical interventions were limited, head trauma emerged as a critical predictor of mortality. Early recognition and management of head injuries are crucial in improving outcomes. Additionally, the ISS and preclinical GCS were identified as valid predictors of mortality, emphasizing the importance of early assessment and resuscitation. A tailored approach to pediatric polytrauma care, considering both age and injury patterns, might contribute to survival benefits in this vulnerable population.
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Affiliation(s)
- Anna Schuster
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany (J.S.); (J.W.); (V.A.)
| | - Lisa Klute
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany (J.S.); (J.W.); (V.A.)
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany (J.S.); (J.W.); (V.A.)
| | - Jürgen Kunkel
- Department of Pediatrics, KUNO University Children’s Hospital Regensburg, 93053 Regensburg, Germany
| | - Jan Schaible
- Conradia Radiologie München, 80798 München, Germany;
| | - Josina Straub
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany (J.S.); (J.W.); (V.A.)
| | - Johannes Weber
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany (J.S.); (J.W.); (V.A.)
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany (J.S.); (J.W.); (V.A.)
| | - Daniel Popp
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany (J.S.); (J.W.); (V.A.)
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Gerlach R, Kluwe W. [Prehospital care of pediatric traumatic brain injury]. Med Klin Intensivmed Notfmed 2023; 118:626-637. [PMID: 37450022 DOI: 10.1007/s00063-023-01046-3] [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: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) in children and adolescents is associated with significant morbidity and, in severe TBI, mortality. The aim of this article is to provide an overview of the spectrum of TBI, its pathophysiology, and current treatment recommendations for prehospital management of children and adolescents with TBI. MATERIALS AND METHODS The current literature was reviewed for studies on the management of TBI in children and adolescents. RESULTS In recent years, a large number of scientific studies have been published that have resulted in evidence-based guidelines for primary care of children with TBI. The primary aim is to minimize secondary brain damage following TBI, for which immediate assessment of the severity of TBI at the scene based on clinical findings and the accident mechanism and initiation of specific treatment measures to prevent hypoxia, hypotension, and hypothermia are critical. Not only prehospital management, but also the rapid transfer of children with severe TBI to centers with high neurosurgical, pediatric surgical, and pediatric intensive care expertise is of particular importance to improve survival and neurological outcome after severe TBI. CONCLUSION Structured prehospital management may help reduce secondary brain injury after TBI and lead to improved clinical outcomes.
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Affiliation(s)
- Rüdiger Gerlach
- Klinik für Neurochirurgie, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Deutschland.
| | - Wolfram Kluwe
- Klinik für Kinderchirurgie und Kinderurologie, Helios Klinikum Erfurt, Erfurt, Deutschland
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Herren A, Palmer CS, Landolt MA, Lehner M, Neuhaus TJ, Simma L. Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1377. [PMID: 37628376 PMCID: PMC10453385 DOI: 10.3390/children10081377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Trauma is one of the most common causes of death in childhood, but data on severely injured Swiss children are absent from existing national registries. Our aim was to analyze trauma activations and the profiles of critically injured children at a tertiary, non-academic Swiss pediatric emergency department (PED). In the absence of a national pediatric trauma database, this information may help to guide the design of infrastructure, processes within organizations, training, and policies. METHODS A retrospective analysis of pediatric trauma patients in a prospective resuscitation database over a 2-year period. Critically injured trauma patients under the age of 16 years were included. Patients were described with established triage and injury severity scales. Statistical evaluation included logistic regression analysis. RESULTS A total of 82 patients matched one or more of the study inclusion criteria. The most frequent age group was 12-15 years, and 27% were female. Trauma team activation (TTA) occurred with 49 patients (59.8%). Falls were the most frequent mechanism of injury, both overall and for major trauma. Road-traffic-related injuries had the highest relative risk of major trauma. In the multivariate analysis, patients receiving medicalized transport were more likely to trigger a TTA, but there was no association between TTA and age, gender, or Injury Severity Score (ISS). Nineteen patients (23.2%) sustained major trauma with an ISS > 15. Injuries of Abbreviated Injury Scale severity 3 or greater were most frequent to the head, followed by abdomen, chest, and extremities. The overall mortality rate in the cohort was 2.4%. Conclusions: Major trauma presentations only comprise a small proportion of the total patient load in the PED, and trauma team activation does not correlate with injury severity. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED. Our findings indicate that high priority should be given to training in the management of severely injured children in the PED. The leading major trauma mechanisms were preventable, which should prompt further efforts in injury prevention.
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Affiliation(s)
- Anouk Herren
- Department of Pediatrics, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
- Department of Pediatrics, University’s Children Hospital Zurich, University of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
| | - Cameron S. Palmer
- Trauma Service, The Royal Children’s Hospital, Melbourne, VIC 3052, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Markus A. Landolt
- Department of Psychosomatics and Psychiatry and Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Binzmuehlestrasse 14, CH-8050 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, CH-8032 Zurich, Switzerland
| | - Markus Lehner
- Department of Pediatric Surgery, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
| | - Thomas J. Neuhaus
- Department of Pediatrics, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
| | - Leopold Simma
- Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, CH-8032 Zurich, Switzerland
- Emergency Department, Children’s Hospital Lucerne, Spitalstrasse, CH-6000 Lucerne, Switzerland
- Emergency Department, University’s Children Hospital Zurich, University of Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
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Fylli C, Schipper IB, Krijnen P. Pediatric Trauma in The Netherlands: Incidence, Mechanism of Injury and In-Hospital Mortality. World J Surg 2023; 47:1116-1128. [PMID: 36806556 PMCID: PMC10070213 DOI: 10.1007/s00268-022-06852-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 02/21/2023]
Abstract
BACKGROUND In the Netherlands, there are no specialized or certified pediatric trauma centers, especially for severely injured children. National and regional agreements on centralization of pediatric trauma care are scarce. This study aims to describe the incidence, injury mechanism and in-hospital mortality of pediatric trauma in the Netherlands, as a prelude to the further organization of pediatric trauma care. METHODS A retrospective cohort analysis of data from the Dutch National Trauma Registry in 2009-2018, concerning all children (0-16 years) hospitalized due to injury in the Netherlands. RESULTS The annual number of admitted injured children increased from 8666 in 2009 to 13,367 in 2018. Domestic accidents were the most common cause of non-fatal injury (67.9%), especially in children aged 0-5 years (89.2%). Severe injury (injury severity score ≥ 16) accounted for 2.5% and 74% of these patients were treated in level-1 trauma centers. In both deceased and surviving patients with severe injuries, head injuries were the most common (72.1% and 64.3%, respectively). In-hospital mortality after severe injury was 8.2%. Road-traffic accidents (RTAs) were the leading cause of death (46.5%). CONCLUSIONS Domestic accidents are the most common cause of injury, especially in younger children, whereas RTAs are the lead cause of fatal injury. Severe pediatric trauma in the Netherlands is predominantly managed in level-1 trauma centers, where a multidisciplinary team of experts is available. Improving the numbers of severely injured patients primarily brought to level-1 trauma centers may help to further reduce mortality.
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Affiliation(s)
- Christina Fylli
- Department of Surgery, Post Zone K6-R, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. .,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Inger B Schipper
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieta Krijnen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Ringen AH, Baksaas-Aasen K, Skaga NO, Wisborg T, Gaarder C, Naess PA. Close to zero preventable in-hospital deaths in pediatric trauma patients - An observational study from a major Scandinavian trauma center. Injury 2023; 54:183-188. [PMID: 35961867 DOI: 10.1016/j.injury.2022.07.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND In line with international trends, initial treatment of trauma patients has changed substantially over the last two decades. Although trauma is the leading cause of death and disability in children globally, in-hospital pediatric trauma related mortality is expected to be low in a mature trauma system. To evaluate the performance of a major Scandinavian trauma center we assessed treatment strategies and outcomes in all pediatric trauma patients over a 16-year period. METHODS A retrospective cohort study of all trauma patients under the age of 18 years admitted to a single institution from 1st of January 2003 to 31st of December 2018. Outcomes for two time periods were compared, 2003-2009 (Period 1; P1) and 2010-2018 (Period 2; P2). Deaths were further analyzed for preventability by the institutional trauma Mortality and Morbidity panel. RESULTS The study cohort consisted of 3939 patients. A total of 57 patients died resulting in a crude mortality of 1.4%, nearly one quarter of the study cohort (22.6%) was severely injured (Injury Severity Score > 15) and mortality in this group decreased from 9.7% in P1 to 4.1% in P2 (p<0.001). The main cause of death was brain injury in both periods, and 55 of 57 deaths were deemed non-preventable. The rate of emergency surgical procedures performed in the emergency department (ED) decreased during the study period. None of the 11 ED thoracotomies in non-survivors were performed after 2013. CONCLUSION A dedicated multidisciplinary trauma service with ongoing quality improvement efforts secured a low in-hospital mortality among severely injured children and a decrease in futile care. Deaths were shown to be almost exclusively non-preventable, pointing to the necessity of prioritizing prevention strategies to further decrease pediatric trauma related mortality.
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Affiliation(s)
- Amund Hovengen Ringen
- Department of Traumatology, Oslo University Hospital Ullevaal, Oslo, Norway; Department of Anesthesia, Oslo University Hospital Ullevaal, PB 4950 Nydalen, Oslo 0424, Norway; Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Kjersti Baksaas-Aasen
- Department of Traumatology, Oslo University Hospital Ullevaal, Oslo, Norway; Department of Anesthesia, Oslo University Hospital Ullevaal, PB 4950 Nydalen, Oslo 0424, Norway; Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nils Oddvar Skaga
- Department of Anesthesia, Oslo University Hospital Ullevaal, PB 4950 Nydalen, Oslo 0424, Norway; Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Torben Wisborg
- University of Tromsø, The Arctic University of Norway, Hammerfest, Norway; Department of Anesthesia and Intensive Care, Finnmark Health trust, Hammerfest Hospital, Hammerfest, Norway; Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Christine Gaarder
- Department of Traumatology, Oslo University Hospital Ullevaal, Oslo, Norway; Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Paal Aksel Naess
- Department of Traumatology, Oslo University Hospital Ullevaal, Oslo, Norway; Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Özcan S, Gunes MSA, Havan M, Perk O, Azapağası E, Gün E, Botan E, Ergun E, Ates U, Kahilogullari G, Kendirli T. Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children. ULUS TRAVMA ACIL CER 2022; 28:456-463. [PMID: 35485520 PMCID: PMC10443131 DOI: 10.14744/tjtes.2022.86617] [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: 09/13/2021] [Accepted: 01/27/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Motor vehicle collisions (MVCs) are the number one cause of death in the pediatric age group. The aim of this study was to determine the differences between MVCs and other trauma mechanisms (OTMs) in patients who were followed up at a pediatric intensive care unit (PICU). METHODS Data were retrospectively collected for pediatric trauma patients hospitalized at a third level PICU between 2014 and 2018. Patients have been divided into two groups as MVC and OTM. Demographic data, pre-PICU interventions (cardiopulmonary resuscitation, intubation, injury severity scores, time period before intensive care), intensive care interventions (invasive mechanical ventilation, non-invasive mechanical ventilation, need for surgery, type of surgery, need for transfusion, and inotrope therapy) were compared between two groups. Outcomes were evaluated by survival, discharge from hospital, Pediatric Cerebral Performance Cate-gory (PCPC) at discharge, tracheotomy presence, and amputation performed. RESULTS During the 5-year study period, 135 patients were hospitalized for trauma. The injured body regions were the head and neck (61.5%), abdomen and lumbar spine (39.4%), and extremities and pelvis (36.3%). Multiple trauma was mostly seen in the MVC trauma group (p=0.001). The need for invasive mechanical ventilation and inotrope therapy was greater in the MVC group (p=0.002, 0.001 respectively). One hundred and twenty-three patients (91.1%) survived. The mortality rate was higher in the MVC group (p=0.026). The PCPC results were better in the OTM group (p=0.017). CONCLUSION MVCs lead to more multiple trauma cases than OTMs. Invasive mechanical ventilation, inotropes, and other inten-sive care interventions were necessary much more often in MVC victims than in OTM patients.
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Affiliation(s)
- Serhan Özcan
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara-Turkey
| | | | - Merve Havan
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Oktay Perk
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Ebru Azapağası
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Emrah Gün
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Edin Botan
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Ergun Ergun
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Ufuk Ates
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Gokmen Kahilogullari
- Department of Neurosurgery, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Tanıl Kendirli
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara-Turkey
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Svantner J, Dolci M, Heim C, Schoettker P. Pediatric Trauma: Six Years of Experience in a Swiss Trauma Center. Pediatr Emerg Care 2021; 37:e1133-e1138. [PMID: 31842199 DOI: 10.1097/pec.0000000000001925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to provide an internationally comparable overview of pediatric trauma of the University Hospital of Lausanne to improve the care of children. METHODS We analyzed the data from all injured children (<16 years of age) listed in our trauma registry from 2011 to 2016. These children were admitted to the resuscitation room after prehospital triage. Our data were analyzed using descriptive statistics. RESULTS We included 327 children. Sixty-three percent were male, and the median age was 8 years. Severe trauma (Injury Severity Score (ISS), >15) occurred in 97 children. The principal mechanisms of injury were falls (45%), traffic accidents (29%), and burns (14%). The most frequently affected areas were the head and external body regions. Intensive care admissions amounted to 27%. Twenty percent of patients underwent immediate surgery (wound care, neurosurgery, and orthopedic surgery). The overall mortality rate was 5.5%, with a median ISS of 9. The mortality of severe trauma was 17.5%, with a median ISS of 22. Half of the children died within 6 hours. The main causes of death were falls from greater than 5 m and traffic accidents as pedestrians. CONCLUSIONS The demographics and patterns of injury in the pediatric trauma population are similar to other European pediatric trauma centers, but the mortality and the severity of injuries can vary (United Kingdom, 3.7%, median ISS of 9; Denmark, 7.3%, median ISS of 9; and Germany, 13.4%, median ISS of 25). The elevated early mortality rate suggests that improvements in prehospital care and early resuscitation could decrease mortality.
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Affiliation(s)
- Julianna Svantner
- From the Department of Anesthesiology, Pediatric Anesthesia Unit, Lausanne University Hospital, Lausanne, Switzerland
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Helicopter Emergency Medical Service and Hospital Treatment Levels Affect Survival in Pediatric Trauma Patients. J Clin Med 2021; 10:jcm10040837. [PMID: 33670679 PMCID: PMC7922049 DOI: 10.3390/jcm10040837] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/13/2021] [Accepted: 02/14/2021] [Indexed: 11/24/2022] Open
Abstract
(1) Background: Data on the effects of helicopter emergency medical service (HEMS) transport and treatment on the survival of severely injured pediatric patients in high-level trauma centers remain unclear. (2) Methods: A national dataset from the TraumaRegister DGU® was used to retrospectively compare the mortality rates among severely injured pediatric patients (1–15 years) who were transported by HEMS to those transported by ground emergency medical service (GEMS) and treated at trauma centers of different treatment levels (levels I–III). (3) Results: In total, 2755 pediatric trauma patients (age: 9.0 ± 4.8 years) were included in this study over five years. Transportation by HEMS resulted in a significant survival benefit compared to GEMS (odds ratio (OR) 0.489; 95% confidence interval (CI): 0.282–0.850). Pediatric trauma patients treated in level II or III trauma centers showed 34% and fourfold higher in-hospital mortality risk than those in level I trauma centers (level II: OR 1.34, 95% CI: 0.70–2.56; level III: OR 4.63, 95% CI: 1.33–16.09). (4) Conclusions: In our national pediatric trauma cohort, both HEMS transportation and treatment in level I trauma centers were independent factors of improved survival in pediatric trauma patients.
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Burggraf M, Polan C, Husen M, Mester B, Wegner A, Spodeck D, Dudda M, Kauther MD. Trauma induced clotting factor depletion in severely injured children: a single center observational study. World J Emerg Surg 2020; 15:31. [PMID: 32375899 PMCID: PMC7201748 DOI: 10.1186/s13017-020-00311-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/22/2020] [Indexed: 01/09/2023] Open
Abstract
Background Coagulopathy following severe trauma contributes significantly to mortality. Impaired clotting factors have been observed in adult trauma patients, but in pediatric trauma victims their activity has not yet been investigated. Methods Sixteen pediatric trauma patients were evaluated according to the ISS and assigned to two cohorts. An additional control group (CO; n = 10) was formed. Routine coagulation parameters and the soluble clotting factors (F) were tested. Nonparametric data was analyzed using the Mann-Whitney U test. Results are reported as median and interquartile range. Results The ISS of severely (SI, n = 8) and mildly (MI, n = 8) injured children differed significantly (25 [19–28] vs. 5 [4–6]; p < 0.001). INR was elevated in the SI cohort only when compared to the CO (1.21 [1.04-1.58] vs. 0.96 [0.93-1.00]; p = 0.001). Differences between SI and MI were found for FII (67 [53-90] vs. 82 [76-114] %; p = 0.028), FV (76 [47-88] vs. 92 [82-99] %; p = 0.028), and FXIII (67 [62-87] vs. 90 [77-102] %; p = 0.021). Comparison of the SI with the CO (FII 122 [112-144] %; p < 0.001; FV 123 [100-142] %; p = 0.002; and FXIII 102 [79-115] %; p = 0.006) also revealed a reduction in the activity of these factors. Furthermore, fibrinogen (198 [80-242] vs. 296 [204-324] mg/dl; p = 0.034), FVII (71 [63-97] vs. 114 [100-152] %; p = 0.009), FIX (84 [67-103] vs. 110 [90-114] %; p = 0.043), and FX (70 [61-85] vs. 122 [96-140] %; p = 0.001) were reduced in the SI in comparison with the CO. Finally, FVIII was considerably, yet not significantly, increased in both patient cohorts (235 [91-320] % and 197 [164-238] %, respectively). Conclusions This study proves that children suffer a depletion of clotting factors following severe injury which basically reflects the findings for adult trauma patients. Attempts to correct the impaired clotting factor activity could be based on a specific hemostatic therapy involving administration of coagulation factors. Nevertheless, therapeutic implications need to be investigated in future studies.
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Affiliation(s)
- Manuel Burggraf
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Christina Polan
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Martin Husen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Bastian Mester
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Alexander Wegner
- Department of Orthopedics and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Daniel Spodeck
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Marcel Dudda
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Max Daniel Kauther
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
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Govind SK, Merritt NH. A 15 year cohort review of in-hospital pediatric trauma center mortality: A catalyst for injury prevention programming. Am J Surg 2018. [DOI: 10.1016/j.amjsurg.2018.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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LaGrone L, Riggle K, Joshipura M, Quansah R, Reynolds T, Sherr K, Mock C. Uptake of the World Health Organization's trauma care guidelines: a systematic review. Bull World Health Organ 2016; 94:585-598C. [PMID: 27516636 PMCID: PMC4969985 DOI: 10.2471/blt.15.162214] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/29/2016] [Accepted: 02/15/2016] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To understand the degree to which the trauma care guidelines released by the World Health Organization (WHO) between 2004 and 2009 have been used, and to identify priorities for the future implementation and dissemination of such guidelines. METHODS We conducted a systematic review, across 19 databases, in which the titles of the three sets of guidelines - Guidelines for essential trauma care, Prehospital trauma care systems and Guidelines for trauma quality improvement programmes - were used as the search terms. Results were validated via citation analysis and expert consultation. Two authors independently reviewed each record of the guidelines' implementation. FINDINGS We identified 578 records that provided evidence of dissemination of WHO trauma care guidelines and 101 information sources that together described 140 implementation events. Implementation evidence could be found for 51 countries - 14 (40%) of the 35 low-income countries, 15 (32%) of the 47 lower-middle income, 15 (28%) of the 53 upper-middle-income and 7 (12%) of the 59 high-income. Of the 140 implementations, 63 (45%) could be categorized as needs assessments, 38 (27%) as endorsements by stakeholders, 20 (14%) as incorporations into policy and 19 (14%) as educational interventions. CONCLUSION Although WHO's trauma care guidelines have been widely implemented, no evidence was identified of their implementation in 143 countries. More serial needs assessments for the ongoing monitoring of capacity for trauma care in health systems and more incorporation of the guidelines into both the formal education of health-care providers and health policy are needed.
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Affiliation(s)
- Lacey LaGrone
- Harborview Injury Prevention and Research Center, Campus Box #356410, University of Washington, Seattle, WA 98104, United States of America (USA)
| | - Kevin Riggle
- Department of Surgery, University of Washington, Seattle, USA
| | | | - Robert Quansah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, USA
| | - Charles Mock
- Harborview Injury Prevention and Research Center, Campus Box #356410, University of Washington, Seattle, WA 98104, United States of America (USA)
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