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Batra EK, Quinlan K, Palusci VJ, Needelman H, Collier A. Child Fatality Review. Pediatrics 2024; 153:e2023065481. [PMID: 38374813 DOI: 10.1542/peds.2023-065481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/21/2024] Open
Abstract
Understanding why children die is necessary to implement strategies to prevent future deaths and improve the health of any community. Child fatality review teams (CFRTs) have existed since the 1970s and provide a necessary framework to ensure that proper questions are asked about a child's death. CFRTs provide a vital function in a community to ensure that preventable causes of deaths are identified. Pediatricians are necessary members of CFRTs because they provide medical expertise and context around a child's death. All CFRTs should have pediatric physician representation, and results from team meetings should inform public policy at all levels of government. Pediatricians should be supported in their efforts to be present on CFRTs, and they should use data from team meetings to help advocate for implementing prevention strategies.
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Affiliation(s)
- Erich K Batra
- Departments of Pediatrics, and Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Vincent J Palusci
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
| | - Howard Needelman
- Department of Developmental Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Abby Collier
- National Center for Fatality Review and Prevention at MPHI, Okemos, Michigan
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Inci O, Altuncı YA, Can O, Akarca FK, Ersel M. The Efficiency of Focused Assessment with Sonography for Trauma in Pediatric Patients with Blunt Torso Trauma. J Emerg Trauma Shock 2024; 17:8-13. [PMID: 38681885 PMCID: PMC11044999 DOI: 10.4103/jets.jets_137_22] [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: 10/23/2022] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 05/01/2024] Open
Abstract
Introduction Focused Assessment with Sonography for Trauma (FAST) has attracted attention for its use in the detection of intra-abdominal pathology for pediatric patients. However, computed tomography (CT) remains the gold standard for the assessment of blunt torso trauma. The study examines the effectiveness of FAST both in the detection of intra-abdominal pathology in pediatric patients (<19 years) with blunt torso trauma and in the determination of the need for CT for further examination. Methods The study was designed as a retrospective observational investigation of diagnostic value. The pediatric patients who were admitted to the Emergency Department with blunt torso trauma between January 2013 and October 2016 were included in the study. The sample of the study comprised 255 patients who met the inclusion criteria. The primary outcome was the effectiveness of FAST in the detection of intra-abdominal pathology and the determination of the need for CT. The secondary outcome was to identify the agreement between CT and FAST for intra-abdominal injuries. The Chi-square test and Fisher's exact test were used for comparisons. A logistic regression model was developed to determine the variables that independently affect the agreement between FAST and CT. Results FAST was determined to have low sensitivity (20.3%) despite its high specificity (87%). However; FAST had a good negative likelihood ratio. There was a poor agreement between CT and FAST in terms of the presence of both intra-abdominal and intrathoracic injuries in pediatric patients with blunt trunk trauma. The error rate of FAST increased by five-fold, especially in the presence of concomitant thorax trauma. However, FAST had a good negative likelihood ratio. Conclusion FAST should not be regarded as an equivalent tool to CT for pediatric patients with blunt torso trauma. It is, instead, a noteworthy complementary tool that is a negative predictor.
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Affiliation(s)
- Ozlem Inci
- Department of Emergency Medicine, Batman Education and Research Hospital, Batman, Turkey
| | - Yusuf Ali Altuncı
- Department of Emergency, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ozge Can
- Department of Emergency, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | - Murat Ersel
- Department of Emergency, Faculty of Medicine, Ege University, Izmir, Turkey
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Russell RT, Esparaz JR, Beckwith MA, Abraham PJ, Bembea MM, Borgman MA, Burd RS, Gaines BA, Jafri M, Josephson CD, Leeper C, Leonard JC, Muszynski JA, Nicol KK, Nishijima DK, Stricker PA, Vogel AM, Wong TE, Spinella PC. Pediatric traumatic hemorrhagic shock consensus conference recommendations. J Trauma Acute Care Surg 2023; 94:S2-S10. [PMID: 36245074 PMCID: PMC9805499 DOI: 10.1097/ta.0000000000003805] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT Hemorrhagic shock in pediatric trauma patients remains a challenging yet preventable cause of death. There is little high-quality evidence available to guide specific aspects of hemorrhage control and specific resuscitation practices in this population. We sought to generate clinical recommendations, expert consensus, and good practice statements to aid providers in care for these difficult patients.The Pediatric Traumatic Hemorrhagic Shock Consensus Conference process included systematic reviews related to six subtopics and one consensus meeting. A panel of 16 consensus multidisciplinary committee members evaluated the literature related to 6 specific topics: (1) blood products and fluid resuscitation for hemostatic resuscitation, (2) utilization of prehospital blood products, (3) use of hemostatic adjuncts, (4) tourniquet use, (5) prehospital airway and blood pressure management, and (6) conventional coagulation tests or thromboelastography-guided resuscitation. A total of 21 recommendations are detailed in this article: 2 clinical recommendations, 14 expert consensus statements, and 5 good practice statements. The statement, the panel's voting outcome, and the rationale for each statement intend to give pediatric trauma providers the latest evidence and guidance to care for pediatric trauma patients experiencing hemorrhagic shock. With a broad multidisciplinary representation, the Pediatric Traumatic Hemorrhagic Shock Consensus Conference systematically evaluated the literature and developed clinical recommendations, expert consensus, and good practice statements concerning topics in traumatically injured pediatric patients with hemorrhagic shock.
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Affiliation(s)
- Robert T. Russell
- Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Children’s of Alabama, Birmingham, AL
| | - Joseph R. Esparaz
- Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Children’s of Alabama, Birmingham, AL
| | - Michael A. Beckwith
- Department of Surgery, Division of Pediatric Surgery, University of Michigan, Ann Arbor, MIS
| | - Peter J. Abraham
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Melania M. Bembea
- Division of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Matthew A. Borgman
- Department of Pediatrics, Brooke Army Medical Center, Uniformed Services University
| | - Randall S. Burd
- Division of Trauma and Burn Surgery, Children’s National Hospital, Washington, DC
| | - Barbara A. Gaines
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC Children’s Hospital, Pittsburgh, PA
| | - Mubeen Jafri
- Division of Pediatric Surgery, Doernbecher Children’s Hospital, Oregon Health and Science University, Portland, OR
| | - Cassandra D. Josephson
- Departments of Pathology and Laboratory Medicine and Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Christine Leeper
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Julie C. Leonard
- Department of Pediatrics, Division of Emergency Medicine, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH
| | - Jennifer A. Muszynski
- Division of Critical Care Medicine, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH
| | - Kathleen K. Nicol
- Department of Pathology and Laboratory Medicine, The Ohio State University College of Medicine Nationwide Children’s Hospital, Columbus, OH
| | - Daniel K. Nishijima
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA
| | - Paul A. Stricker
- Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Adam M. Vogel
- Divisions of Pediatric Surgery and Critical Care, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX
| | - Trisha E. Wong
- Division of Pediatric Hematology and Oncology and Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Philip C. Spinella
- Department of Surgery and Critical Care Medicine, University of Pittsburgh Medical Center. Pittsburgh, PA
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Mehl SC, Cunningham ME, Chance MD, Zhu H, Fallon SC, Naik-Mathuria B, Ettinger NA, Vogel AM. Variations in analgesic, sedation, and delirium management between trauma and non-trauma critically ill children. Pediatr Surg Int 2022; 38:295-305. [PMID: 34853886 DOI: 10.1007/s00383-021-05039-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Studies have shown the benefit of intensive care unit (ICU) bundled protocols; however, they are primarily derived from medical patients. We hypothesized that patients and their medication profiles are different between critically ill medical, surgical, and trauma patients. METHODS The Pediatric Health Information System 2017 dataset was used to perform a retrospective cohort study of critically ill children. The pediatric medical, surgical, and trauma cohorts were separated based on ICD-10 codes. Data collected included demographics, secondary diagnoses, outcomes, and medication data. Medications were grouped as opiates, GABA-agonists, alpha-2 agonists, anti-psychotics, paralytics, and "other" sedatives. A non-parametric Kolmogorov-Smirnov test (KS test) and odds ratios (reference group: medical cohort) were calculated to compare medication administration between the study cohorts for the first 30 ICU days. RESULTS A total of 4488 critically ill children (medical 2078, surgical 1650, and trauma 760) were identified. The trauma cohort had increased incidence of delirium (medical 10.8%, surgical 11.5%, trauma 13.8%; p < 0.01) and mortality (medical 5.4%, surgical 2.4%, trauma 11.7%; p < 0.01). For all study cohorts, > 50% received GABA-agonists on ICU days 0-30. With the KS test, there was a significant difference in administration of opiates, GABA-agonists, alpha-2 agonists, anti-psychotics, and "other" sedatives over the first 30 days in the ICU. Relative to medical patients, trauma patients had significantly higher odds of receiving anti-psychotics on ICU days 10-20 and 22-24. CONCLUSION Critically ill pediatric trauma, medical, and surgical patients are distinctly different patient populations with differing pharmacologic profiles for analgesia, sedation, and delirium. LEVEL OF EVIDENCE Level III (Retrospective Comparative Study).
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Affiliation(s)
- Steven C Mehl
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Megan E Cunningham
- Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Michael D Chance
- Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Huirong Zhu
- Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Sara C Fallon
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Bindi Naik-Mathuria
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Nicholas A Ettinger
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Suite 1210, Houston, TX, 77005, USA
| | - Adam M Vogel
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA. .,Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Suite 1210, Houston, TX, 77005, USA.
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McCarroll JE, Fisher JE, Cozza SJ, Whalen RJ. Child Maltreatment Fatality Review: Purposes, Processes, Outcomes, and Challenges. TRAUMA, VIOLENCE & ABUSE 2021; 22:1032-1041. [PMID: 31928207 DOI: 10.1177/1524838019900559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Better understanding of the causes and circumstances of maltreatment deaths of children is needed to prevent tragedy. The purpose of this article is to facilitate understanding of child maltreatment fatality review processes and their outcomes. A literature review was conducted through searches of the databases PubMed, PsycINFO, and EMBASE and through citations in publications. Over 165 publications were reviewed and 55 were selected for inclusion. Papers were from the United States, England, Ireland, Northern Ireland, Netherlands, France, Canada, Australia, South Africa, Switzerland, Saudi Arabia, Japan, and China. These were included if they described fatality review goals, authority, procedures, and outcomes. Although we searched databases on a continual basis during the preparation of this review, we could have missed publications, particularly those in newspapers and journals that are not included in large-scale databases or cited in other articles. Improvement of fatality review requires diligence by individuals and organizations that provide information to the reviewers. Among challenges to the review process are varying criteria for review, misclassifications of the manner of death, inadequate or incomplete forensic and medical investigations, lack of information about the perpetrator, diversity of the community, concealment of the cause of death by parents or other caregivers, and disagreement among reviewers about the results of their inquiries. Institutional challenges are also present, which include the need for funding, privacy issues on obtaining information, updating reviewer training, lack of follow-up by institutional authorities on the recommendations of the reviews, and research facilitating the review of maltreatment fatalities.
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Affiliation(s)
- James E McCarroll
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
- Department of Psychiatry, The Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joscelyn E Fisher
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
- Department of Psychiatry, The Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Stephen J Cozza
- Department of Psychiatry, The Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Ronald J Whalen
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
- Department of Psychiatry, The Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Burnett J, Dyer CB, Heisler CJ. Enhancing and evaluating the capacity of elder abuse fatality review teams to assist victim services. J Elder Abuse Negl 2021; 33:107-122. [PMID: 34053411 DOI: 10.1080/08946566.2021.1929640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Fatality review teams (FRTs) have been historically helpful in identifying systemic issues that may lead to child and domestic violence deaths to improve responses, guide prevention efforts, and better serve victims. More recently, these teams have formed to address similar concerns in elder abuse matters. The American Bar Association Commission on Law and Aging received an early grant to study elder abuse fatality review teams (EAFRTs) and in 2005 created its first Replication Guide. The current study reports on a subsequent national survey of EAFRTs, conducted 14 years later to identify important similarities and differences in team operations, impact and sustainability. EAFRTs are growing nationally in numbers, have positive impacts on member elder abuse and victim services knowledge, skills and confidence, but experience challenges to impact evaluability and sustainability due to low funding and membership time, turnover and commitment. Recommendations for supporting newly developing and currently functioning EAFRTs are provided.
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Affiliation(s)
- Jason Burnett
- The Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center (Uthealth), McGovern Medical School, Houston, Houston, Texas, USA.,The Texas Elder Abuse and Mistreatment Institute (TEAM), Houston, Texas, USA
| | - Carmel Bitondo Dyer
- The Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center (Uthealth), McGovern Medical School, Houston, Houston, Texas, USA.,The Texas Elder Abuse and Mistreatment Institute (TEAM), Houston, Texas, USA
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Abstract
Child death reviews are conducted with the aim of preventing child deaths however, definitions, inclusion criteria for the review of child deaths and reporting practices vary across Child Death Review Teams (CDRTs). This article aims to identify a common context and understanding of fatal neglect reporting by reviewing definitional issues of fatal neglect and comparing reporting practice across a number of CDRTs. Providing a consistent context for identifying and reporting neglect-related deaths may improve the understanding of the impact of fatal neglect and the risk factors associated with it and therefore, improve the potential of CDRT review to inform prevention programs, policies, and procedures.
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Affiliation(s)
- Debbie Scott
- Eastern Health Clinical School, Monash University, Victoria, Australia
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Tekin YK. Are Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Associated with Mortality in Pediatric Trauma Patients? A Retrospective Study. Rambam Maimonides Med J 2019; 10:RMMJ.10376. [PMID: 31675303 PMCID: PMC6824831 DOI: 10.5041/rmmj.10376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There are very limited data on the prognostic capacity of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for the systemic inflammatory response in pediatric trauma (PT) patients. The purpose of this study was to evaluate the prognostic ability of NLR and PLR on mortality in pediatric trauma patients. METHODS This study looked at 358 PT patients who were admitted to the Cumhuriyet University Hospital's Emergency Department between January 2010 and June 2018. The NLR and PLR were calculated by dividing the blood neutrophil count and blood platelet count, respectively, by the lymphocyte count, at the time of admission. After performing a stepwise logistic regression analysis to determine the predictive factors on the mortality risk of post-traumatic systemic inflammatory response syndrome (SIRS), receiver operating characteristic (ROC) curve analysis was used to define the optimum cut-off values of the NLR and the PLR parameters for survival. RESULTS The NLR, and PLR values were significantly higher in survivors than in non-survivors (NLR, 6.2±5.7 versus 2.6±2.5, P<0.001; PLR, 145.3±85.0 versus 46.2±25.2, P<0.001 ). The NLR (odds ratio [OR], 3.21; P=0.048), PLR (OR, 0.90; P=0.032), blood glucose (OR, 1.02; P=0.024), and Injury Severity Score (ISS) (OR, 1.28; P=0.011) were independent predictors of the mortality risk in PT patients. The area under the curve in the ROC curve analysis was 0.764 with a cut-off of 2.77 (sensitivity 70%, specificity 77%) for the NLR; and 0.928 with a cut-off of 61.83 (sensitivity 90%, specificity 85%) for the PLR. CONCLUSION Acquiring the NLR and PLR at the time of admission could be a useful predictor for mortality in PT patients.
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Otterman G, Lahne K, Arkema EV, Lucas S, Janson S, Hellström‐Westas L. Childhood death rates declined in Sweden from 2000 to 2014 but deaths from external causes were not always investigated. Acta Paediatr 2019. [PMID: 29520820 DOI: 10.1111/apa.14309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Countries that conduct systematic child death reviews report a high proportion of modifiable characteristics among deaths from external causes, and this study examined the trends in Sweden. METHODS We analysed individual-level data on external, ill-defined and unknown causes from the Swedish cause of death register from 2000 to 2014, and mortality rates were estimated for children under the age of one and for those aged 1-14 and 15-17 years. RESULTS Child deaths from all causes were 7914, and 2006 (25%) were from external, ill-defined and unknown causes: 610 (30%) were infants, 692 (34%) were 1-14 and 704 (35%) were 15-17. The annual average was 134 cases (range 99-156) during the study period. Mortality rates from external, ill-defined and unknown causes in children under 18 fell 19%, from 7.4 to 6.0 per 100 000 population. A sizeable number of infant deaths (8.0%) were registered without a death certificate during the study period, but these counts were lower in children aged 1-14 (1.3%) and 15-17 (0.9%). CONCLUSION Childhood deaths showed a sustained decline from 2000 to 2014 in Sweden and a quarter were from external, ill-defined or unknown causes. Systematic, interagency death reviews could yield information that could prevent future deaths.
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Affiliation(s)
- Gabriel Otterman
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Klara Lahne
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Elizabeth V. Arkema
- Clinical Epidemiology Unit Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - Steven Lucas
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Staffan Janson
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
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Haas E, Truong C, Bartolomei-Hill L, Baier M, Bazron B, Rebbert-Franklin K. Local Overdose Fatality Review Team Recommendations for Overdose Death Prevention. Health Promot Pract 2018; 20:553-564. [DOI: 10.1177/1524839918797617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Erin Haas
- Maryland Department of Health, Catonsville, MD, USA
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Farrell CA, Dodington J, Lee LK. Pediatric Injury Prevention, the EMSC, and the CDC. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Russell RT, McDaniel JK, Cao W, Shroyer M, Wagener BM, Zheng XL, Pittet JF. Low Plasma ADAMTS13 Activity Is Associated with Coagulopathy, Endothelial Cell Damage and Mortality after Severe Paediatric Trauma. Thromb Haemost 2018; 118:676-687. [PMID: 29618154 DOI: 10.1055/s-0038-1636528] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Decrease of plasma activity of ADAMTS13, a metalloenzyme that cleaves von Willebrand factor (VWF) and prevents adhesion and aggregation of platelets, has been reported early after onset of systemic inflammation resulting from infections and after severe trauma. Here, we determined whether trauma-induced systemic (sterile) inflammation would be associated with a reduction of plasma ADAMTS13 activity in paediatric patients and its association with disease severity and outcome. Paediatric patients (n = 106) with severe trauma at a level 1 paediatric trauma centre between 2014 and 2016 were prospectively enrolled. Blood samples were collected upon arrival and at 24 hours and analysed for plasma levels of ADAMTS13 activity, VWF antigen, collagen binding activity, human neutrophil peptides (HNP) 1-3, coagulation abnormalities, endothelial glycocalyx damage and clinical outcome. Plasma samples were also collected for similar measurements from 52 healthy paediatric controls who underwent elective minor surgery. The median age of patients was 9 years with 81% sustaining blunt trauma. The median injury severity score was 22 and the mortality rate was 11%. Plasma levels of ADAMTS13 activity were significantly lower and plasma levels of VWF antigen and HNP 1-3 proteins were significantly higher for paediatric trauma patients on admission and at 24 hours when compared with controls. Finally, the lowest plasma ADAMTS13 activity was found in patients who died from their injuries. We conclude that relative plasma deficiency of ADAMTS13 activity may be associated with more severe traumatic injury, significant endothelial glycocalyx damage, coagulation abnormalities and mortality after severe trauma in paediatric patients.
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Affiliation(s)
- Robert T Russell
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Jenny K McDaniel
- Division of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Wenjing Cao
- Division of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Michelle Shroyer
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Brant M Wagener
- Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - X Long Zheng
- Division of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Jean-François Pittet
- Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
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Histone-Complexed DNA Fragments Levels are Associated with Coagulopathy, Endothelial Cell Damage, and Increased Mortality after Severe Pediatric Trauma. Shock 2018; 49:44-52. [DOI: 10.1097/shk.0000000000000902] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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O'Malley TL, Documét PI, Burke JG, Garland R, Terry A, Slade RL, Albert SM. Preventing Violence: A Public Health Participatory Approach to Homicide Reviews. Health Promot Pract 2017; 19:427-436. [PMID: 29161927 DOI: 10.1177/1524839917697914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Death review teams are a common method for assessing preventable deaths, yet they rarely review adult homicides and do not typically include community members. Academic-community partnerships can enhance public health research by encouraging translation of research into practice and support a data-driven approach to improve community health and well-being. We describe the Pittsburgh Homicide Review Group, a community-partnered initiative to prevent future homicides through data review and community dialogue. Group members reviewed all 42 Pittsburgh 2012 homicides informed by three primary data sources: publicly available data, local service databases, and community outreach resources. Thirty-two individuals representing relevant county agencies and community groups participated in eight reviews. Data sharing among partners resulted in a comprehensive understanding of the context of homicides. Review meetings supported a collective discussion around potential contributing factors to homicides, intervention implications, and recommendations. Academic-community homicide review partnerships are a productive approach to inform homicide prevention and interventions that are relevant to communities and should be implemented widely.
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Affiliation(s)
- Teagen L O'Malley
- 1 University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Patricia I Documét
- 1 University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Jessica G Burke
- 1 University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Richard Garland
- 1 University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Art Terry
- 2 Kingsley Association, Pittsburgh, PA, USA
| | | | - Steven M Albert
- 1 University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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Alsaif DM, Almadani OM, Ali Almoghannam S, Hamdi D, Al-Farayedhi MA, Kharosha MA. Child Fatalities in Dammam: A Call for Child Fatality Reviews in Arab Countries. J Forensic Sci 2017; 63:1171-1175. [PMID: 29098711 DOI: 10.1111/1556-4029.13685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
Abstract
Identifying children's risk exposure is the first step toward mortality prevention. This retrospective study determined the causes of child fatalities in Dammam, Saudi Arabia. Death reports of children and adolescents from 1999 to 2015 (N = 157) were analyzed. Boys represented most cases (69%) and there were two age peaks (1-5 years and 16-18 years). Accidents (typically immersion) defined the main death circumstance (51%) followed by homicide (25%). Only 33% of cases underwent autopsy, and the most common cause of death was head injury (27%) followed by firearm injury. Only one immersion death underwent autopsy. This study revealed important data about the risk exposure of children in Dammam and emphasizes deficient investigative procedures. Child fatality reviews comprise systematic data collection by multidisciplinary teams to determine the true risks toward children in a community. Such teams do not exist in Arab countries; therefore, strategies should be implemented to initiate them.
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Affiliation(s)
- Dalia Mohammed Alsaif
- Center of Forensic and Legal Medicine, Ministry of health, Dammam, Eastern Province, P.O.Box 6668, Saudi Arabia 31176
| | - Osama M Almadani
- Center of Forensic and Legal Medicine, Ministry of health, Dammam, Eastern Province, P.O.Box 6668, Saudi Arabia 31176
| | - Salah Ali Almoghannam
- Center of Forensic and Legal Medicine, Ministry of health, Dammam, Eastern Province, P.O.Box 6668, Saudi Arabia 31176
| | - Dina Hamdi
- Center of Forensic and Legal Medicine, Ministry of health, Dammam, Eastern Province, P.O.Box 6668, Saudi Arabia 31176
| | - Maram A Al-Farayedhi
- Center of Forensic and Legal Medicine, Ministry of health, Dammam, Eastern Province, P.O.Box 6668, Saudi Arabia 31176
| | - Magdy A Kharosha
- Center of Forensic and Legal Medicine, Ministry of health, Dammam, Eastern Province, P.O.Box 6668, Saudi Arabia 31176
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Trends in trauma-related mortality among adolescents: A 6 year snapshot from a teaching hospital's post mortem data. J Clin Orthop Trauma 2017; 8:S1-S5. [PMID: 29339839 PMCID: PMC5761691 DOI: 10.1016/j.jcot.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/11/2016] [Accepted: 02/23/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The aim is to explore the trends in trauma mortality in children aged 0-18 years can help to co-ordinate resources toward research and programs to reduce the burden. METHODS This is a retrospective study carried out on adolescents ≤18 years of age autopsied according to the attorney request at Forensic Medicine & Toxicology department of King George's Medical University, Lucknow, India in the period from January 1st, 2009 to December 31st, 2014. RESULTS There were 9160 deaths from all causes in children ≤18 years old, 7747 of which were due to trauma related causes, with a female predominance of 1.3:1. The age distribution revealed that 65.8% of deaths occurred in the 10-18 age group. Road traffic accidents (RTA) was the most prevalent cause (3635 deaths - 46.92%), followed by asphyxia (1128 deaths - 14.56%) and sexual assault (649 deaths - 8.37%). Asphyxia/suffocation was the major cause of injury with 31.96% of deaths within group <1 year; asphyxia (28.66%) and transport-related injuries (32.27%) were more predominant in the 1-4 age group; transport-related deaths were frequent in the 5-9 age group (45.14%), 10-14 age group (55.68%) and in the group 15-18 age group (51.69%). Regarding times of death, 61% occurred at the scene, 5.6% during pre-hospital care, 26.2% occurred at the hospital within the first 24 h after admission, and the remaining 7.6% of deaths occurred after 24 h after admission to the hospital. When we analyzed the deaths according to the intent, homicides occurred in 16% of cases. Unintentional injuries occurred in 69% of deaths and self-inflicted injuries were identified in 15% cases. CONCLUSIONS Findings show that there was a predominance of deaths in children and adolescents males, between 15 and 18 years old, mainly from road traffic accidents. This study highlights the burden of trauma caused mortalities in children, which requires instant action.
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Palusci VJ. Child protection and the development of child abuse pediatrics in New York City. J Forensic Leg Med 2017; 52:159-167. [PMID: 28942263 DOI: 10.1016/j.jflm.2017.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
The history of child abuse pediatrics reflects the development of medicine as a profession influenced by social movements reacting to poverty, economic exploitation, and child maltreatment. As physicians began to specialize in caring for children, egregious cases led them to recognize children were affected by special medical problems and diseases which were compounded by poor conditions and abuse and neglect. They developed the fields of pediatrics and child abuse pediatrics to advocate for their needs in courts and communities. Using a history of prominent physicians and cases, the objectives of this article are to: (1) rediscover the founding of pediatrics in NYC in the context of the environment which served as the setting for its development; (2) highlight our early understanding of the medical issues surrounding child maltreatment, with advocacy and forensic medicine becoming a growing part of medical care for children; and (3) explore the development of child abuse pediatrics in light of prominent physicians making major contributions to child protection. Timelines show the early interplay among social problems, publicized cases, private and governmental agencies, and the development of child abuse pediatrics. The article concludes with potential lessons to be learned and further questions about this interplay of child protection systems and the development of child abuse pediatrics.
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Affiliation(s)
- Vincent J Palusci
- New York University School of Medicine, Frances L. Loeb Child Protection and Development Center, 465 First Avenue, RM GC-65, New York, NY 10016, United States.
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Procedures in child deaths in The Netherlands: a comparison with child death review. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2017; 25:357-370. [PMID: 28781935 PMCID: PMC5515966 DOI: 10.1007/s10389-017-0800-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/29/2017] [Indexed: 11/12/2022]
Abstract
Aim Child Death Review (CDR) is a method in which every child death is systematically and multidisciplinary examined to (1) improve death statistics, (2) identify factors that give direction for prevention, (3) translate the results into possible interventions, and (4) support families. The aim of this study was to determine to what extent procedures of organizations involved in the (health) care for children in The Netherlands cover these four objectives of CDR. Subject and methods Organizations in the Eastern part of The Netherlands and Dutch umbrella organizations involved in child (health) care were asked to provide their protocols, guidelines or other working agreements that describe their activities and responsibilities in case of a child’s death. Eighteen documents and nine interview reports were made available. For the analyses we used scorecards for each CDR objective. Results The procedures of Perined, the National Cot Death Study Group, Dutch Cot Death Foundation and Child Protection Service cover the largest part of the objectives of CDR. Organizations pay most attention to the translation of results into possible interventions. Family support gets the least attention in protocols, guidelines and other working agreements. Conclusion Dutch organizations separately cover parts of CDR. When the procedures of organizations are combined, all CDR objectives are covered in the response to only specific groups of child deaths, i.e., perinatal deaths, Sudden Unexpected Deaths in Infants and fatal child abuse cases. Further research into the conditions that are needed for an optimal implementation of CDR in The Netherlands is necessary. This research should also evaluate the recently implemented NODOK procedure (Further Examination of the Causes of death in Children), directed to investigate unexplained deaths in minors 0–18 years old.
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Gijzen S, Hilhorst MI, L’Hoir MP, Boere-Boonekamp MM, Need A. Implementation of Child Death Review in the Netherlands: results of a pilot study. BMC Health Serv Res 2016; 16:235. [PMID: 27392027 PMCID: PMC4938929 DOI: 10.1186/s12913-016-1500-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/24/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Child mortality in the Netherlands declined gradually in the past decades. In total 1130 children and youth aged 0 to 19 years died in 2014 (i.e. 29.4 per 100,000 live births). A better understanding of the background and the circumstances surrounding the death of children as well as the manner and cause of death may lead to preventive measures. Child Death Review (CDR) is a method to systematically analyze child deaths by a multidisciplinary team to identify avoidable factors that may have contributed to the death and to give directions for prevention. CDR could be an addition to further reduce avoidable child deaths in the Netherlands. The purpose of this study is to explore the strengths, weaknesses, opportunities and threats (SWOT) of the pilot-implementation of CDR in a Dutch region. The results are translated in recommendations for future implementation of the CDR method in the Netherlands. METHODS Children who lived in the pilot region and died aged 29 days after birth until 2 years were, after parental consent, included for reviewing by a regional CDR team. Eighteen logs and seven transcribed records of CDR meetings concerning 6 deceased children were analyzed using Atlas ti. The SWOT framework was used to identify important themes. RESULTS The most important strengths identified were the expertise of and cooperation within the CDR team and the available materials. An important weakness was the poor cooperation of some professional groups. The fact that parents and professionals endorse the objective of CDR was an important opportunity. The lack of statutory basis was a threat. CONCLUSIONS Many obstacles need to be taken away before large-scale implementation of CDR in the Netherlands becomes possible. The most important precondition for implementation is the acceptance among professionals and the statutory basis of the CDR method.
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Affiliation(s)
- Sandra Gijzen
- />Department Health Technology and Services Research, University of Twente, Institute for Innovation and Governance Studies, PO Box 217, 7500 AE Enschede, The Netherlands
| | - Michaëla I. Hilhorst
- />Department of Paediatrics, BovenIJ Hospital, PO Box 37610, 1030 BD Amsterdam, The Netherlands
- />Department of Forensic Medicine, Municipal Health Service region Utrecht, P.O. Box 51, Zeist, 3700 AB The Netherlands
| | | | - Magda M. Boere-Boonekamp
- />Department Health Technology and Services Research, University of Twente, Institute for Innovation and Governance Studies, PO Box 217, 7500 AE Enschede, The Netherlands
| | - Ariana Need
- />Department Public Administration, University of Twente, Institute for Innovation and Governance Studies, PO Box 217, 7500 AE Enschede, The Netherlands
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Gijzen S, L'Hoir MP, Boere-Boonekamp MM, Need A. Stakeholders' opinions on the implementation of Child Death Review in the Netherlands. BMC Res Notes 2016; 9:228. [PMID: 27099152 PMCID: PMC4839131 DOI: 10.1186/s13104-016-1966-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The death of a child is an enormous tragedy for both the family and others involved. A child's death appeals to everyone's responsibility to take measures to prevent similar deaths in the future. Child Death Review (CDR) is an interagency approach in which a child's death is systematically analyzed by a multidisciplinary team. The aim of CDR is to identify avoidable factors that give direction to prevention and to improve death statistics. CDR is not yet implemented in the Netherlands. The purpose of this study is to determine Dutch stakeholders' opinions regarding the facilitating and impeding factors in the implementation of CDR in the Netherlands. METHODS Four focus groups were conducted: three with professionals who are involved in children's deaths and one with parents who have lost a child under the age of 2 years. The recorded discussions were transcribed and analyzed using Atlas ti. The facilitating and impeding factors were measured using the measurement instrument for determinants of innovations (MIDI). The MIDI identifies facilitating and impeding determinants associated with the innovation, user, organization and social-political context. RESULTS Improvement of the quality of (health) care and obtaining a clear explanation for the child's death (user and innovation) were identified as benefits of CDR. The emotional burden for professionals and parents and the time implications were considered to be drawbacks of CDR (user and innovation). The multidisciplinary approach (innovation), parental consent and the use of anonimyzed data (user) were considered as facilitators to implementation. Insufficient information (innovation), potential legal consequences for professionals and organizations (user), insufficient ratification by organizations (organization) and confidentiality (social-political context) were identified as impeding implementation. CONCLUSIONS The determinants identified as facilitating and the recommendations provided to overcome the barriers can be used as input for the strategy for implementation of CDR. A pilot study is necessary to determine to what extent the chosen implementation strategy is effective.
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Affiliation(s)
- Sandra Gijzen
- Department HTSR, IGS Institute for Innovation and Governance Studies, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.
| | - Monique P L'Hoir
- TNO Child Health, P.O. Box 2215, 2301 CE, Leiden, The Netherlands
| | - Magda M Boere-Boonekamp
- Department HTSR, IGS Institute for Innovation and Governance Studies, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Ariana Need
- Department Public Administration, IGS Institute for Innovation and Governance Studies, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
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Rebbert-Franklin K, Haas E, Singal P, Cherico-Hsii S, Baier M, Collins K, Webner K, Sharfstein J. Development of Maryland Local Overdose Fatality Review Teams: A Localized, Interdisciplinary Approach to Combat the Growing Problem of Drug Overdose Deaths. Health Promot Pract 2016; 17:596-600. [PMID: 27091609 DOI: 10.1177/1524839916632549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Maryland Local Overdose Fatality Review Teams (LOFRTs) are multiagency, multidisciplinary teams that critically analyze individual cases of drug overdose in their jurisdictions to identify preventable risk factors and missed opportunities for intervention, and to make policy and programmatic recommendations to prevent future overdose deaths. Three Maryland LOFRTs were first piloted in early 2014, and became established in law in May of the same year. LOFRTs provide unique opportunities for enhanced interagency collaboration and locally driven prevention efforts. This study describes the process of establishing LOFRTs in Maryland. The experiences and information regarding LOFRTs may help counties in other states combat the growing problem of deaths by drug overdose.
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Affiliation(s)
| | - Erin Haas
- Maryland Department of Mental Health and Hygiene, Baltimore, MD, USA
| | - Pooja Singal
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sara Cherico-Hsii
- Maryland Department of Mental Health and Hygiene, Baltimore, MD, USA
| | - Michael Baier
- Maryland Department of Mental Health and Hygiene, Baltimore, MD, USA
| | | | - Karl Webner
- Cecil County Health Department, Elkton, MD, USA
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Purtle J, Rich LJ, Rich JA, Cooper J, Harris EJ, Corbin TJ. The Youth Nonfatal Violent Injury Review Panel: An Innovative Model to Inform Policy and Systems Change. Public Health Rep 2016; 130:610-5. [PMID: 26556932 DOI: 10.1177/003335491513000610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Among young people in the United States, nonfatal violent injuries outnumber fatal violent injuries by 171 to 1. The Child Fatality Review Team (CFRT) is a well-established model for informing injury prevention planning. The CFRT's restricted focus on fatal injuries, however, limits its ability to identify opportunities to prevent violent reinjury and address issues unique to nonfatal violent injuries. We adapted the CFRT model to develop and implement a Youth Nonfatal Violent Injury Review Panel. We convened representatives from 23 agencies (e.g., police, housing, and education) quarterly to share administrative information and confidentially discuss cases of nonfatal violent injury. In this article, we describe the panel model and present preliminary data on participants' perceptions of the process. Although outcomes research is needed to evaluate its impacts, the Youth Nonfatal Violent Injury Review Panel offers an innovative, promising, and replicable model for interagency collaboration to prevent youth violence and its effects.
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Affiliation(s)
- Jonathan Purtle
- Drexel University School of Public Health, Department of Health Management and Policy, Philadelphia, PA
| | - Linda J Rich
- Drexel University College of Medicine, Center for Nonviolence and Social Justice, Philadelphia, PA
| | - John A Rich
- Drexel University School of Public Health, Department of Health Management and Policy, Philadelphia, PA
| | - Jazzmin Cooper
- Drexel University College of Medicine, Center for Nonviolence and Social Justice, Philadelphia, PA
| | - Erica J Harris
- Drexel University College of Medicine, Center for Nonviolence and Social Justice, Philadelphia, PA
| | - Theodore J Corbin
- Drexel University College of Medicine, Department of Emergency Medicine, Philadelphia, PA
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Al-Amad SH, Awad MA, Al-Farsi LH, Elkhaled RH. Reporting child abuse cases by dentists working in the United Arab Emirates (UAE). J Forensic Leg Med 2016; 40:12-5. [PMID: 26950173 DOI: 10.1016/j.jflm.2016.01.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/16/2015] [Accepted: 01/01/2016] [Indexed: 11/30/2022]
Abstract
Reporting of suspicious cases of child abuse is a sensitive issue that is often hindered by uncertainty of diagnosis. This cross sectional study aimed to assess the UAE dentists' experiences in child abuse recognition, the factors that prevent them from reporting suspicious cases to authorities and their perceived training needs. A closed-ended, self-administered questionnaire was distributed to 350 dentists working in the UAE. Chi Square test was used to determine association between training needs on child abuse and its reporting rate. Logistic regression was used to determine the association between perceived training needs and other covariates. One hundred and ninety three respondents satisfied the inclusion criteria. Forty seven (25%) dentists reported encountering a suspicious child abuse case at least once in their career, but only 15 (32%) of those reported their suspicion. Fear of making the wrong diagnosis was the most frequent challenge hindering reporting and dentists who demonstrated a need for specialized training were more likely to express this fear (OR = 5.88, 95% CI: 0.07, 0.45; P = 0.00). The majority of UAE dentists do not report their suspicion to authorities and specialized training should be offered to build dentists' capacity in diagnosing and appropriately reporting suspicious child abuse cases.
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Affiliation(s)
- Suhail H Al-Amad
- College of Dental Medicine, University of Sharjah, United Arab Emirates.
| | - Manal A Awad
- College of Dental Medicine, University of Sharjah, United Arab Emirates
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Hodkinson P, Argent A, Wallis L, Reid S, Perera R, Harrison S, Thompson M, English M, Maconochie I, Ward A. Pathways to Care for Critically Ill or Injured Children: A Cohort Study from First Presentation to Healthcare Services through to Admission to Intensive Care or Death. PLoS One 2016; 11:e0145473. [PMID: 26731245 PMCID: PMC4712128 DOI: 10.1371/journal.pone.0145473] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/04/2015] [Indexed: 11/21/2022] Open
Abstract
Purpose Critically ill or injured children require prompt identification, rapid referral and quality emergency management. We undertook a study to evaluate the care pathway of critically ill or injured children to identify preventable failures in the care provided. Methods A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation to healthcare services until paediatric intensive care unit (PICU) admission or emergency department death, using expert panel review of medical records and caregiver interview. Main outcomes were expert assessment of overall quality of care; avoidability of severity of illness and PICU admission or death and the identification of modifiable factors. Results The study enrolled 282 children, 252 emergency PICU admissions, and 30 deaths. Global quality of care was graded good in 10% of cases, with half having at least one major impact modifiable factor. Key modifiable factors related to access to care and identification of the critically ill, assessment of severity, inadequate resuscitation, and delays in decision making and referral. Children were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 185 (74%) of children, and death prior to PICU admission was avoidable in 17/30 (56.7%) of children. Conclusions The study presents a novel methodology, examining quality of care across an entire system, and highlighting the complexity of the pathway and the modifiable events amenable to interventions, that could reduce mortality and morbidity, and optimize utilization of scarce critical care resources; as well as demonstrating the importance of continuity and quality of care.
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Affiliation(s)
- Peter Hodkinson
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Andrew Argent
- Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Steve Reid
- Directorate of Primary Health Care, University of Cape Town, Cape Town, South Africa
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sian Harrison
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, United States of America
| | - Mike English
- Nuffield Department of Medicine, Oxford University, Oxford, UK and KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College, London, UK and NIHR BRC funded researcher Imperial College, London
| | - Alison Ward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Abstract
The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association have collaborated to identify practices and principles to guide the care of children, families, and staff in the challenging and uncommon event of the death of a child in the emergency department in this policy statement and in an accompanying technical report.
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Abstract
The death of a child in the emergency department (ED) is one of the most challenging problems facing ED clinicians. This revised technical report and accompanying policy statement reaffirm principles of patient- and family-centered care. Recent literature is examined regarding family presence, termination of resuscitation, bereavement responsibilities of ED clinicians, support of child fatality review efforts, and other issues inherent in caring for the patient, family, and staff when a child dies in the ED. Appendices are provided that offer an approach to bereavement activities in the ED, carrying out forensic responsibilities while providing compassionate care, communicating the news of the death of a child in the acute setting, providing a closing ritual at the time of terminating resuscitation efforts, and managing the child with a terminal condition who presents near death in the ED.
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O'Malley PJ, Barata IA, Snow SK, Shook JE, Ackerman AD, Chun TH, Conners GP, Dudley NC, Fuchs SM, Gorelick MH, Lane NE, Moore BR, Wright JL, Benjamin LS, Barata IA, Alade K, Arms J, Avarello JT, Baldwin S, Brown K, Cantor RM, Cohen A, Dietrich AM, Eakin PJ, Gausche-Hill M, Gerardi M, Graham CJ, Holtzman DK, Hom J, Ishimine P, Jinivizian H, Joseph M, Mehta S, Ojo A, Paul AZ, Pauze DR, Pearson NM, Rosen B, Russell WS, Saidinejad M, Sloas HA, Schwartz GR, Swenson O, Valente JH, Waseem M, Whiteman PJ, Woolridge D, Snow SK, Vicioso M, Herrin SA, Nagle JT, Cadwell SM, Goodman RL, Johnson ML, Frankenberger WD, Renaker AM, Tomoyasu FS. Death of a Child in the Emergency Department. Ann Emerg Med 2014; 64:102-5. [PMID: 24951421 DOI: 10.1016/j.annemergmed.2014.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
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Shook JE, Ackerman AD, Chun TH, Conners GP, Dudley NC, Fuchs SM, Gorelick MH, Lane NE, Moore BR, Wright JL, Benjamin LS, Barata IA, Alade K, Arms J, Avarello JT, Baldwin S, Brown K, Cantor RM, Cohen A, Dietrich AM, Eakin PJ, Gausche-Hill M, Gerardi M, Graham CJ, Holtzman DK, Hom J, Ishimine P, Jinivizian H, Joseph M, Mehta S, Ojo A, Paul AZ, Pauze DR, Pearson NM, Rosen B, Russell WS, Saidinejad M, Sloas HA, Schwartz GR, Swenson O, Valente JH, Waseem M, Whiteman PJ, Woolridge D, Snow SK, Vicioso M, Herrin SA, Nagle JT, Cadwell SM, Goodman RL, Johnson ML, Frankenberger WD, Renaker AM, Tomoyasu FS. Death of a Child in the Emergency Department. J Emerg Nurs 2014; 40:301-4. [DOI: 10.1016/j.jen.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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O'Malley PJ, Barata IA, Snow SK, Shook JE, Ackerman AD, Chun TH, Conners GP, Dudley NC, Fuchs SM, Gorelick MH, Lane NE, Moore BR, Wright JL, Benjamin LS, Barata IA, Alade K, Arms J, Avarello JT, Baldwin S, Brown K, Cantor RM, Cohen A, Dietrich AM, Eakin PJ, Gausche-Hill M, Gerardi M, Graham CJ, Holtzman DK, Hom J, Ishimine P, Jinivizian H, Joseph M, Mehta S, Ojo A, Paul AZ, Pauze DR, Pearson NM, Rosen B, Russell WS, Saidinejad M, Sloas HA, Schwartz GR, Swenson O, Valente JH, Waseem M, Whiteman PJ, Woolridge D, Snow SK, Vicioso M, Herrin SA, Nagle JT, Cadwell SM, Goodman RL, Johnson ML, Frankenberger WD, Renaker AM, Tomoyasu FS. Death of a Child in the Emergency Department. Ann Emerg Med 2014; 64:e1-17. [DOI: 10.1016/j.annemergmed.2014.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Palusci VJ, Covington TM. Child maltreatment deaths in the U.S. National Child Death Review Case Reporting System. CHILD ABUSE & NEGLECT 2014; 38:25-36. [PMID: 24094272 DOI: 10.1016/j.chiabu.2013.08.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 08/02/2013] [Accepted: 08/23/2013] [Indexed: 06/02/2023]
Abstract
Comprehensive reviews of child death are increasingly conducted throughout the world, although limited information is available about how this information is systematically used to prevent future deaths. To address this need, we used cases from 2005 to 2009 in the U.S. National Child Death Review Case Reporting System to compare child and offender characteristics and to link that information with actions taken or recommended by review teams. Child, caretaker, and offender characteristics, and outcomes were compared to team responses, and findings were compared to published case series. Among 49,947 child deaths from 23 states entered into the Case Reporting System during the study period, there were 2,285 cases in which child maltreatment caused or contributed to fatality. Over one-half had neglect identified as the maltreatment, and 30% had abusive head trauma. Several child and offender characteristics were associated with specific maltreatment subtypes, and child death review teams recommended and/or planned several activities in their communities. Case characteristics were similar to those published in other reports of child maltreatment deaths. Teams implemented 109 actions or strategies after their review, and we found that aggregating information from child death reviews offers important insights into understanding and preventing future deaths. The National Child Death Review Case Reporting System contains information about a large population which confirms and expands our knowledge about child maltreatment deaths and which can be used by communities for future action.
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Affiliation(s)
- Vincent J Palusci
- New York University School of Medicine, Frances L. Loeb Child Protection and Development Center, Bellevue Hospital Center, 462 First Avenue, Room GC-65, New York, NY 10016, USA
| | - Theresa M Covington
- National Center for Review and Prevention of Child Deaths, Michigan Public Health Institute, 2436 Woodlake Cir # 300, Okemos, MI 48864, USA
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Fraga AMA, Bustorff-Silva JM, Fernandez TM, Fraga GP, Reis MC, Baracat ECE, Coimbra R. Children and adolescents deaths from trauma-related causes in a Brazilian City. World J Emerg Surg 2013; 8:52. [PMID: 24305495 PMCID: PMC3867624 DOI: 10.1186/1749-7922-8-52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 11/25/2013] [Indexed: 11/15/2022] Open
Abstract
Introduction Injury is the first cause of death worldwide in the population aged 1 to 44. In developed countries, the most common trauma-related injuries resulting in death during childhood are traffic accidents, followed by drowning. Methods This retrospective study based on autopsy examinations describes the epidemiology profile of deaths by trauma-related causes in individuals younger than 18 years from 2001 to 2008 in the city of Campinas. The aim is to identify epidemiology changes throughout the years in order to develop strategies of prevention. Results There were 2,170 deaths from all causes in children < 18 years old, 530 of which were due to trauma-related causes, with a male predominance of 3.4:1. The age distribution revealed that 76% of deaths occurred in the 10-17 age group. The most predominant trauma cause was firearm injury (47%). Other frequent causes were transport-related injuries (138 cases-26%; pedestrians were struck in 57.2% of these cases) and drowning (55 cases-10.4%). Asphyxia/suffocation was the cause of death in 72% of cases in children < 1 year old; drowning (30.8%) was predominant in the 1-4 age group; transport-related deaths were frequent in the 5-9 age group (56%) and the 10-14 age group (40.4%). Gun-related deaths were predominant (68%) in the 14-17 age group. 51% of deaths occurred at the scene. Conclusions There was a predominance of deaths in children and adolescents males, between 15-17 years old, mainly from gun-related homicides, and the frequency has decreased since 2004 after the disarmament statute and the combating of violence.
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Bergren MD. Child mortality in the school Setting. Position statement. NASN Sch Nurse 2013; 28:312-313. [PMID: 24386697 DOI: 10.1177/1942602x13503805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
It is the position of the National Association of School Nurses that data on children's deaths in school should be recorded, analyzed, and reported at the local, state, and national levels. The systematic review of data on child deaths is necessary to drive interventions and policies that will decrease mortality from injuries, violence, acute illness, and chronic disease in the school setting (Bergren, 2010; Christian & Sege, 2010).
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Child mortality in the Netherlands in the past decades: an overview of external causes and the role of public health policy. J Public Health Policy 2013; 35:43-59. [PMID: 24107788 DOI: 10.1057/jphp.2013.41] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Among European countries, the Netherlands has the second lowest child mortality rate from external causes. We present an overview, discuss possible explanations, and suggest prevention measures. We analyzed mortality data from all deceased children aged 0-19 years for the period 1969-2011. Child mortality declined in the past decades, largely from decreases in road traffic accidents that followed government action on traffic safety. Accidental drowning also showed a downward trend. Although intentional self-harm showed a significant increase, other external causes of mortality, including assault and fatal child abuse, remained constant. Securing existing preventive measures and analyzing the circumstances of each child's death systematically through Child Death Review may guide further reduction in child mortality.
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Mejdoubi J, van den Heijkant S, Struijf E, van Leerdam F, HiraSing R, Crijnen A. Addressing risk factors for child abuse among high risk pregnant women: design of a randomised controlled trial of the nurse family partnership in Dutch preventive health care. BMC Public Health 2011; 11:823. [PMID: 22017924 PMCID: PMC3231980 DOI: 10.1186/1471-2458-11-823] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 10/21/2011] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Low socio-economic status combined with other risk factors affects a person's physical and psychosocial health from childhood to adulthood. The societal impact of these problems is huge, and the consequences carry on into the next generation(s). Although several studies show these consequences, only a few actually intervene on these issues. In the United States, the Nurse Family Partnership focuses on high risk pregnant women and their children. The main goal of this program is primary prevention of child abuse. The Netherlands is the first country outside the United States allowed to translate and culturally adapt the Nurse Family Partnership into VoorZorg. The aim of the present study is to assess whether VoorZorg is as effective in the Netherland as in the United States. METHODS The study consists of three partly overlapping phases. Phase 1 was the translation and cultural adaptation of Nurse Family Partnership and the design of a two-stage selection procedure. Phase 2 was a pilot study to examine the conditions for implementation. Phase 3 is the randomized controlled trial of VoorZorg compared to the care as usual. Primary outcome measures were smoking cessation during pregnancy and after birth, birth outcomes, child development, child abuse and domestic violence. The secondary outcome measure was the number of risk factors present. DISCUSSION This study shows that the Nurse Family Partnership was successfully translated and culturally adapted into the Dutch health care system and that this program fulfills the needs of high-risk pregnant women. We hypothesize that this program will be effective in addressing risk factors that operate during pregnancy and childhood and compromise fetal and child development. TRIAL REGISTRATION Current Controlled Trials ISRCTN16131117.
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Affiliation(s)
- Jamila Mejdoubi
- EMGO+ Institute for Health and Care Research, VU University Medical Center, Department of Public and Occupational Health, Amsterdam, The Netherlands
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Preventive youth health care in 11 European countries: an exploratory analysis. Int J Public Health 2011; 57:637-41. [PMID: 21956621 PMCID: PMC3359454 DOI: 10.1007/s00038-011-0305-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 09/06/2011] [Accepted: 09/12/2011] [Indexed: 12/02/2022] Open
Abstract
Objective To systematically identify similarities and differences in the way preventive youth health care (YHC) is organized in 11 European countries. Method Questionnaire survey to EUSUHM (European Union for School and University Health and Medicine) representatives. Results The greatest similarities were found in the age range of the YHC target group and the separation of curative and preventive services. Croatia, Germany and Switzerland show the greatest differences when compared to other European countries, for example, in the access to medical records, YHC professional input and the number of examinations, immunizations and screenings. In eight countries YHC is financed by national insurances or taxation. In Germany, FYR Macedonia, the Netherlands, Russia and Switzerland, different forms of financing exist in parallel. Conclusion The results should be interpreted as a preliminary step in mapping organizational features of YHC in Europe.
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