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Harris MI, Adelgais KM, Linakis SW, Magill CF, Brazauskas R, Shah MI, Nishijima DK, Lowe GS, Chadha K, Chang TP, Lerner EB, Leonard JC, Schwartz HP, Gaither JB, Studnek JR, Browne LR. Impact of Prehospital Pain Management on Emergency Department Management of Injured Children. PREHOSP EMERG CARE 2023; 27:1-9. [PMID: 34734787 DOI: 10.1080/10903127.2021.2000683] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Provision of analgesia for injured children is challenging for Emergency Medical Services (EMS) clinicians. Little is known about the effect of prehospital analgesia on emergency department (ED) care. We aimed to determine the impact of prehospital pain interventions on initial ED pain scale scores, timing and dosing of ED analgesia for injured patients transported by EMS. METHODS This is a planned, secondary analysis of a prospective multicenter cohort of children with actual or suspected injuries transported to one of 11 PECARN-affiliated EDs from July 2019-April 2020. Using Wilcoxon rank sum for continuous variables and chi-square testing for categorical variables, we compared the change in EMS-to-ED pain scores and timing and dosing of ED-administered opioid analgesia in those who did and those who did not receive prehospital pain interventions. RESULTS We enrolled 474 children with complete prehospital and ED pain management data. Prehospital interventions were performed on 262/474 (55%) of injured children and a total of 88 patients (19%) received prehospital opioids. Children who received prehospital opioids with or without adjunctive non-pharmacologic pain management experienced a greater reduction in pain severity and were more likely to receive ED opioids in higher doses earlier and throughout their ED care. Non-pharmacologic pain interventions alone did not impact ED care. CONCLUSIONS We demonstrate that prehospital opioid analgesia is associated with both a significant reduction in pain severity at ED arrival and the administration of higher doses of opioid analgesia earlier and throughout ED care.
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Affiliation(s)
- M I Harris
- Department of Pediatrics, Northwell Hofstra School of Medicine, New Hyde Park, New York
| | - K M Adelgais
- Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - S W Linakis
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - C F Magill
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina
| | - R Brazauskas
- Department of Institute for Health Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - M I Shah
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | - D K Nishijima
- Department of Emergency Medicine, University of California - Davis, Sacramento, California
| | - G S Lowe
- Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
| | - K Chadha
- Department of Emergency Medicine, University at Buffalo, Buffalo, New York
| | - T P Chang
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - E B Lerner
- Department of Emergency Medicine, University at Buffalo, Buffalo, New York
| | - J C Leonard
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - H P Schwartz
- Division of Emergency Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - J B Gaither
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona
| | - J R Studnek
- Mecklenburg EMS Agency, Charlotte, North Carolina
| | - L R Browne
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Nishijima DK, Tancredi DJ, Adelgais KM, Chadha K, Chang TP, Harris MI, Leonard JC, Lerner EB, Linakis SW, Lowe GS, Magill CF, Schwartz HP, Shah MI, Browne LR. Impact of Race and Ethnicity on Emergency Medical Services Administration of Opioid Pain Medications for Injured Children. J Emerg Med 2023; 64:55-61. [PMID: 36641254 DOI: 10.1016/j.jemermed.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/04/2022] [Accepted: 10/11/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Treatment with analgesics for injured children is often not provided or delayed during prehospital transport. OBJECTIVE Our aim was to evaluate racial and ethnic disparities with the use of opioids during transport of injured children. METHODS We conducted a prospective study of injured children transported to 1 of 10 emergency departments from July 2019 to April 2020. Emergency medical services (EMS) providers were surveyed about prehospital pain interventions during transport. Our primary outcome was the use of opioids. We performed multivariate regression analyses to evaluate the association of patient demographic characteristics (race, ethnicity, age, and gender), presence of a fracture, EMS provider type (Advanced Life Support [ALS] or non-ALS) and experience (years), and study site with the use of opioids. RESULTS We enrolled 465 patients; 19% received opioids during transport. The adjusted odds ratios (AORs) for Black race and Hispanic ethnicity were 0.5 (95% CI 0.2-1.2) and 0.4 (95% CI 0.2-1.3), respectively. The presence of a fracture (AOR 17.0), ALS provider (AOR 5.6), older patient age (AOR 1.1 for each year), EMS provider experience (AOR 1.1 for each year), and site were associated with receiving opioids. CONCLUSIONS There were no statistically significant associations between race or ethnicity and use of opioids for injured children. The presence of a fracture, ALS provider, older patient age, EMS provider experience, and site were associated with receiving opioids.
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Affiliation(s)
- Daniel K Nishijima
- Department of Emergency Medicine, University of California, Davis, Sacramento, California.
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis, Sacramento, California
| | - Kathleen M Adelgais
- Departments of Pediatrics and Emergency Medicine, University of Colorado, Aurora, Colorado
| | - Kunal Chadha
- Department of Pediatrics, University of Buffalo, Buffalo, New York
| | - Todd P Chang
- Children's Hospital of Los Angeles and Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Matthew I Harris
- Department of Pediatrics, Cohen Children's Medical Center, Zucker School of Medicine - Hofstra University, New Hyde Park, New York
| | - Julie C Leonard
- Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - E Brooke Lerner
- Departments of Emegency Medicine and Pediatrics, University of Buffalo, Buffalo, New York
| | - Seth W Linakis
- Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Geoffrey S Lowe
- Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
| | - Christyn F Magill
- Children's Hospital of Los Angeles and Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California; Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina
| | - Hamilton P Schwartz
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Manish I Shah
- Department of Pediatrics, Division of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | - Lorin R Browne
- Departments of Pediatrics and Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Nishijima DK, VanBuren JM, Linakis SW, Hewes HA, Myers SR, Bobinski M, Tran NK, Ghetti S, Adelson PD, Roberts I, Holmes JF, Schalick WO, Dean JM, Casper TC, Kuppermann N. Traumatic injury clinical trial evaluating tranexamic acid in children (TIC-TOC): a pilot randomized trial. Acad Emerg Med 2022; 29:10.1111/acem.14481. [PMID: 35266589 PMCID: PMC9463410 DOI: 10.1111/acem.14481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The antifibrinolytic drug tranexamic acid (TXA) improves survival in adults with traumatic hemorrhage; however, the drug has not been evaluated in a trial in injured children. We evaluated the feasibility of a large-scale trial evaluating the effects of TXA in children with severe hemorrhagic injuries. METHODS Severely injured children (0 up to 18th birthday) were randomized into a double-blind randomized trial of 1) TXA 15 mg/kg bolus dose, followed by 2 mg/kg/hr infusion over 8 hours, 2) TXA 30 mg/kg bolus dose, followed by 4 mg/kg/hr infusion over 8 hours, or 3) normal saline placebo bolus and infusion. The trial was conducted at 4 pediatric Level I trauma centers in the United States between June 2018 and March 2020. We enrolled patients under federal exception from informed consent (EFIC) procedures when parents were unable to provide informed consent. Feasibility outcomes included the rate of enrollment, adherence to intervention arms, and ability to measure the primary clinical outcome. Clinical outcomes included global functioning (primary), working memory, total amount of blood products transfused, intracranial hemorrhage progression, and adverse events. The target enrollment rate was at least 1.25 patients per site per month. RESULTS A total of 31 patients were randomized with a mean age of 10.7 years (standard deviation [SD] 5.0 years) and 22 (71%) patients were male. The mean time from injury to randomization was 2.4 hours (SD 0.6 hours). Sixteen (52%) patients had isolated brain injuries and 15 (48%) patients had isolated torso injuries. The enrollment rate using EFIC was 1.34 patients per site per month. All eligible enrolled patients received study intervention (9 patients TXA 15 mg/kg bolus dose, 10 patients TXA 30 mg/kg bolus dose, and 12 patients placebo) and had the primary outcome measured. No statistically significant differences in any of the clinical outcomes were identified. CONCLUSION Based on enrollment rate, protocol adherence, and measurement of the primary outcome in this pilot trial, we confirmed the feasibility of conducting a large-scale, randomized trial evaluating the efficacy of TXA in severely injured children with hemorrhagic brain and/or torso injuries using EFIC.
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Affiliation(s)
- Daniel K Nishijima
- Department of Emergency Medicine, UC Davis School of Medicine, 4150 V. Street, PSSB 2100, Sacramento, CA, 95817, USA
| | - John M VanBuren
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Seth W Linakis
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Ohio State University School of Medicine, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, USA
| | - Hilary A Hewes
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah School of Medicine, Primary Children's Hospital, 100 N. Mario Capecchi Dr, Salt Lake City, UT, 84113, USA
| | - Sage R Myers
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, 3401 Civic Center Blvd. Philadelphia, PA, USA, 19104
| | - Matthew Bobinski
- Department of Radiology, UC Davis School of Medicine, Stockton Blvd. Sacramento, CA, 95817, USA
| | - Nam K Tran
- Department of Pathology and Laboratory Medicine, University of California, Davis, 4400 V. Street, CA, 95816, USA
| | - Simona Ghetti
- Department of Psychology, University of California, Davis, 102K Young Hall, 1 Shields Ave. Davis, CA, 95616, USA
| | - P David Adelson
- Department of Pediatric Neurosciences, Neurological Institute at Phoenix Children's Hospital, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA
| | - Ian Roberts
- Clinical Trials Unit, School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - James F Holmes
- Department of Emergency Medicine, UC Davis School of Medicine, 4150 V. Street, PSSB 2100, Sacramento, CA, 95817, USA
| | - Walton O Schalick
- Department of Orthopedics and Rehabilitation, University of Wisconsin, 317 Knutson Drive, Madison, WI, 53704, USA
| | - J Michael Dean
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - T Charles Casper
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, UC Davis School of Medicine, 4150 V. Street, PSSB 2100, Sacramento, CA, 95817, USA
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4
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Linakis SW, Kuppermann N, Stanley RM, Hewes H, Myers S, VanBuren JM, Casper TC, Bobinski M, Ghetti S, Schalick WO, Nishijima DK, Barnhard SE, Holmes JF, Tran NK, Tzimenatos LS, Zwienenberg M, Galante J, Fenton S, Brockmeyer D, Pysher T, Nance ML, Lang Chen S, Sesok‐Pizzini D, Thakkar R, Sribnik E, Nicol K, Adelson PD, Roberts I. Enrollment with and without exception from informed consent in a pilot trial of tranexamic acid in children with hemorrhagic injuries. Acad Emerg Med 2021; 28:1421-1429. [PMID: 34250690 DOI: 10.1111/acem.14343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/27/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Federal exception from informed consent (EFIC) procedures allow studies to enroll patients with time-sensitive, life-threatening conditions when written consent is not feasible. Our objective was to compare enrollment rates with and without EFIC in a trial of tranexamic acid (TXA) for children with hemorrhagic injuries. METHODS We conducted a four-center randomized controlled pilot and feasibility trial evaluating TXA in children with severe hemorrhagic brain and/or torso injuries. We initiated the trial enrolling patients without EFIC. After 3 months of enrollment, we met our a priori futility threshold and paused the trial to incorporate EFIC procedures and obtain regulatory approval. We then restarted the trial allowing EFIC if the guardian was unable to provide timely written consent. We used descriptive statistics to compare characteristics of eligible patients approached with and without EFIC procedures. We also calculated the time delay to restart the trial using EFIC. RESULTS We enrolled one of 15 (6.7%) eligible patients (0.17 per site per month) prior to using EFIC procedures. Of the 14 missed eligible patients, seven (50%) were not enrolled because guardians were not present or were injured and unable to provide written consent. After obtaining approval for EFIC, we enrolled 30 of 48 (62.5%) eligible patients (1.34 per site per month). Of these 30 patients, 22 (73.3%) were enrolled with EFIC. Of the 22, no guardians refused written consent after randomization. There were no significant differences in the eligibility rate and patient characteristics enrolled with and without EFIC procedures. Across all sites, the mean delay to restart the trial using EFIC procedures was 12 months. CONCLUSIONS In a multicenter trial of severely injured children, the use of EFIC procedures greatly increased the enrollment rate and was well accepted by guardians. Initiating the trial without EFIC procedures led to a significant delay in enrollment.
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Affiliation(s)
- Seth W. Linakis
- Division of Pediatric Emergency Medicine Nationwide Children’s Hospital Columbus Ohio USA
- Department of Pediatrics The Ohio State University Columbus Ohio USA
| | - Nathan Kuppermann
- Department of Emergency Medicine University of California at Davis School of Medicine Sacramento California USA
| | - Rachel M. Stanley
- Division of Pediatric Emergency Medicine Nationwide Children’s Hospital Columbus Ohio USA
- Department of Pediatrics The Ohio State University Columbus Ohio USA
| | - Hilary Hewes
- Department of Pediatrics University of Utah School of Medicine Salt Lake City Utah USA
| | - Sage Myers
- Division of Emergency Medicine Department of Pediatrics Children’s Hospital of Philadelphia Philadelphia Pennsylvania USA
| | - John M. VanBuren
- Department of Pediatrics University of Utah School of Medicine Salt Lake City Utah USA
| | - T. Charles Casper
- Department of Pediatrics University of Utah School of Medicine Salt Lake City Utah USA
| | - Matthew Bobinski
- Department of Emergency Medicine University of California at Davis School of Medicine Sacramento California USA
| | - Simona Ghetti
- Department of Psychology University of California at Davis Davis California USA
| | - Walton O. Schalick
- Department of Orthopedics and Rehabilitation University of Wisconsin Madison Wisconsin USA
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Iyer MS, Lo CB, Scherzer DJ, MacDowell D, Gupta N, McManus E, Stewart C, Linakis SW, Stanley R. The COVID-19 Elective for Pediatric Residents: Learning About Systems-Based Practice During a Pandemic. Cureus 2021; 13:e13085. [PMID: 33680625 PMCID: PMC7932829 DOI: 10.7759/cureus.13085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has prompted pediatric residency programs to adjust the delivery of educational curricula and to update content relevant to the pandemic. OBJECTIVE In this descriptive paper, we present how we rapidly developed and implemented a COVID-19 pandemic elective for pediatric residents. METHODS This curriculum was established at a single tertiary care children's hospital in June 2020. We used the ADDIE (analysis, design, development, implementation, evaluation) framework to develop a two-week elective (30 hours) consisting of six flexibly scheduled modules. We administered post-elective surveys and exit interviews to solicit feedback to improve the elective and obtain effectiveness of our educational interventions. RESULTS We developed an asynchronous online COVID-19 Elective for Pediatric Residents. The curriculum modules focus on pathophysiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the disaster management ecosystem, simulation of clinical care, mental health ramifications, and public health consequences. We also include six in-situ experiences (visits to a drive-through COVID-19 testing site, testing laboratory and local public health department, a simulation of a critically ill child, and meetings with emergency managers and social workers) to solidify learning and allow for further reflection. To date, eight participants have taken the elective. All participants strongly agreed on a five-point Likert item survey that the elective enhanced their knowledge in current evidence-based literature for COVID-19, disaster preparedness, hospital response, management of the critically ill child, and mental and public health ramifications. All participants agreed this curriculum was relevant to and will change their practice. CONCLUSIONS We demonstrate how a COVID-19 elective for pediatric residents could be quickly developed and implemented. The pilot results show that pediatric trainees value asynchronous learning, supplemented by relevant in-situ experiences. Moreover, these results suggest that this curriculum provides needed disaster response and resiliency education for pediatric residents.
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Affiliation(s)
- Maya S Iyer
- Division of Emergency Medicine/Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, USA
- Pediatrics, The Ohio State University College of Medicine, Columbus, USA
| | - Charmaine B Lo
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, USA
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA
| | - Daniel J Scherzer
- Division of Emergency Medicine/Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, USA
- Pediatrics, The Ohio State University College of Medicine, Columbus, USA
| | - Doug MacDowell
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, USA
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA
| | - Nita Gupta
- Division of Emergency Medicine/Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, USA
| | - Ellen McManus
- Division of Emergency Medicine/Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, USA
- Pediatrics, The Ohio State University College of Medicine, Columbus, USA
| | - Claire Stewart
- Division of Critical Care Medicine/Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, USA
- Pediatrics, The Ohio State University College of Medicine, Columbus, USA
| | - Seth W Linakis
- Division of Emergency Medicine/Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, USA
- Pediatrics, The Ohio State University College of Medicine, Columbus, USA
| | - Rachel Stanley
- Division of Emergency Medicine/Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, USA
- Pediatrics, The Ohio State University College of Medicine, Columbus, USA
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Linakis SW, Lloyd JK, Kline D, Holmes JF, Stanley RM, Leonard JC. Field triage of children with abdominal trauma. Trauma 2021. [DOI: 10.1177/1460408620933524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Identify physical findings in children with abdominal trauma to inform prehospital providers regarding appropriate hospital destinations. Methods This is a secondary analysis of the Pediatric Emergency Care Applied Research Network Abdominal Trauma Public Use Dataset. Children involved in motor vehicle collisions; struck by motor vehicles at >20 mph; involved in all-terrain vehicle, motorcycle, or scooter accidents; or who fell from >10 ft ( n = 5575) were included. Stepwise multivariable multinomial logistic regression was used to compare clinical findings at presentation between children with no intra-abdominal injury, intra-abdominal injury without intervention, and intra-abdominal injury with intervention (laparoscopy/laparotomy, embolization, red blood cell transfusion, or admission >48 h on intravenous fluids). Results Compared to children with no intra-abdominal injury, children with intra-abdominal injury (with and without intervention) were more likely to have evidence of abdominal wall trauma, abdominal tenderness, peritoneal irritation, decreased breath sounds, distracting painful injury, and evidence of thoracic trauma. Children with intra-abdominal injury requiring intervention were more likely to have evidence of abdominal wall trauma (OR 3.32, 95% CI 2.03–5.44) and be intubated (OR 4.93, 95% CI 3.17–7.65) when compared to children with intra-abdominal injury without intervention. Conclusions The findings of abdominal tenderness, peritoneal irritation, decreased breath sounds, distracting painful injury, and thoracic trauma may be used to identify children who warrant evaluation at any trauma center because of increased risk of intra-abdominal injury, whereas intubation and evidence of abdominal wall trauma help identify children with intra-abdominal injury in need of transport to a pediatric trauma center due to risk of undergoing intervention.
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Affiliation(s)
- Seth W Linakis
- Division of Pediatric Emergency Medicine, Nationwide Children's Hospital and The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julia K Lloyd
- Division of Pediatric Emergency Medicine, Nationwide Children's Hospital and The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David Kline
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - James F Holmes
- Department of Emergency Medicine, UC Davis Health, Sacramento, CA, USA
| | - Rachel M Stanley
- Division of Pediatric Emergency Medicine, Nationwide Children's Hospital and The Ohio State University Wexner Medical Center, Columbus, OH, USA
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Julie C Leonard
- Division of Pediatric Emergency Medicine, Nationwide Children's Hospital and The Ohio State University Wexner Medical Center, Columbus, OH, USA
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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Stoner MJ, Mahajan P, Bressan S, Lam SH, Chumpitazi CE, Kornblith AE, Linakis SW, Roland D, Freedman SB, Nigrovic LE, Denninghoff K, Ishimine P, Kuppermann N. Pediatric Emergency Care Research Networks: A Research Agenda. Acad Emerg Med 2018; 25:1336-1344. [PMID: 30393902 DOI: 10.1111/acem.13656] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/26/2018] [Accepted: 10/31/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pediatric emergency care research networks have evolved substantially over the past two decades. Some networks are specialized in specific areas (e.g., sedation, simulation) while others study a variety of medical and traumatic conditions. Given the increased collaboration between pediatric emergency research networks, the logical next step is the development of a research priorities agenda to guide global research in emergency medical services for children (EMSC). OBJECTIVES An international group of pediatric emergency network research leaders was assembled to develop a list of research priorities for future collaborative endeavors within and between pediatric emergency research networks. METHODS Before an in-person meeting, we used a modified Delphi approach to achieve consensus around pediatric emergency research network topic priorities. Further discussions took place on May 15, 2018, in Indianapolis, Indiana, at the Academic Emergency Medicine (AEM) consensus conference "Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps." Here, a group of 40 organizers and participants met in a 90-minute "breakout" session to review and further develop the initial priorities. RESULTS We reached consensus on five clinical research priorities that would benefit from collaboration among the existing and future emergency networks focused on EMSC: sepsis, trauma, respiratory conditions, pharmacology of emergency conditions, and mental health emergencies. Furthermore, we identified nonclinical research priorities categorized under the domains of technology, knowledge translation, and organization/administration of pediatric emergency care. CONCLUSION The identification of pediatric emergency care network research priorities within the domains of clinical care, technology, knowledge translation and organization/administration of EMSC will facilitate and help focus collaborative research within and among research networks globally. Engagement of essential stakeholders including EMSC researchers, policy makers, patients, and their caregivers will stimulate advances in the delivery of emergency care to children around the globe.
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Affiliation(s)
- Michael J. Stoner
- Division of Emergency Medicine Department of Pediatrics Nationwide Children's Hospital The Ohio State University College of Medicine Columbus OH
| | - Prashant Mahajan
- Department of Emergency Medicine C.S. Mott Children's Hospital of Michigan University of Michigan Medical School Ann Arbor MI
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine Department of Women's and Children's Health University of Padova Padova Italy
| | - Samuel H. F. Lam
- Department of Emergency Medicine Sutter Medical Center Sacramento Sacramento CA
| | | | - Aaron E. Kornblith
- Department of Emergency Medicine and Pediatrics University of California at San Francisco San Francisco CA
| | - Seth W. Linakis
- Division of Emergency Medicine Department of Pediatrics Nationwide Children's Hospital The Ohio State University College of Medicine Columbus OH
| | - Damian Roland
- SAPPHIRE Group Health Sciences Leicester University Leicester UK & Paediatric Emergency Medicine Leicester Academic (PEMLA) group Children's Emergency Department Leicester Hospitals Leicester UK
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology Department of Pediatrics Alberta Children's Hospital and Alberta Children's Hospital Research Institute Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Lise E. Nigrovic
- Division of Emergency Medicine Boston Children's Hospital Boston MA
| | - Kurt Denninghoff
- Department of Emergency Medicine University of Arizona College of Medicine Tucson AZ
| | - Paul Ishimine
- Departments of Emergency Medicine University of California at San Diego School of Medicine San Diego CA
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics University of California at Davis School of Medicine, and UC Davis Health Sacramento CA
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Amanullah S, Schlichting LE, Linakis SW, Steele DW, Linakis JG. Emergency Department Visits Owing to Intentional and Unintentional Traumatic Brain Injury among Infants in the United States: A Population-Based Assessment. J Pediatr 2018; 203:259-265.e1. [PMID: 30266505 DOI: 10.1016/j.jpeds.2018.08.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/24/2018] [Accepted: 08/09/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine national trends of emergency department (ED) visits owing to traumatic brain injury (TBI) among infants (age <12 months), specifically in the context of intentional and unintentional mechanisms. STUDY DESIGN National Electronic Injury Surveillance System-All Injury Program data documenting nonfatal ED visits from 2003 to 2012 were analyzed. TBI was defined as ED visits resulting in a diagnosis of concussion, or fracture, or internal injury of the head. Intentional and unintentional injury mechanisms were compared using multivariable models. Joinpoint regression was used to identify significant time trends. RESULTS TBI-related ED visits (estimated n = 713 124) accounted for 28% of all injury-related ED visits by infants in the US, yielding an average annual rate of 1722 TBI-related ED visits per 100 000 infants. Trend analysis showed an annual increase of 9.48% in the rate of TBI-related ED visits over 10 years (P < .05). For these visits, an estimated 701 757 (98.4%) were attributed to unintentional mechanisms and 11 367 (1.6%) to intentional mechanisms. Unintentional TBI-related ED visit rates increased by 9.52% annually (P < .05) and the rates of intentional TBI were relatively stable from 2003 to 2012. Infants with intentional TBI were more likely to be admitted (aOR, 11.44; 95% CI, 3.02-21.75) compared with those with unintentional TBI. CONCLUSIONS The rate of TBI-related ED visits in infants increased primarily owing to unintentional mechanisms and intentional TBI-related ED visits remained stable over the decade. Improved strategies to reduce both intentional and unintentional injuries in infants are required.
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Affiliation(s)
- Siraj Amanullah
- Department of Emergency Medicine; Department of Pediatrics, Alpert Medical School of Brown University; Department of Health Services, Policy and Practice; Hassenfeld Child Health Innovation Institute, Brown School of Public Health; Injury Prevention Center, Rhode Island Hospital, Providence, RI.
| | | | - Seth W Linakis
- Division of Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Dale W Steele
- Department of Emergency Medicine; Department of Pediatrics, Alpert Medical School of Brown University; Department of Health Services, Policy and Practice; Center for Evidence Synthesis in Health, Brown School of Public Health, Providence, RI
| | - James G Linakis
- Department of Emergency Medicine; Department of Pediatrics, Alpert Medical School of Brown University; Hassenfeld Child Health Innovation Institute, Brown School of Public Health; Injury Prevention Center, Rhode Island Hospital, Providence, RI
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Myers RJ, Linakis SW, Mello MJ, Linakis JG. Competitive Wrestling-related Injuries in School Aged Athletes in U.S. Emergency Departments. West J Emerg Med 2010; 11:442-9. [PMID: 21293763 PMCID: PMC3027436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 01/12/2010] [Accepted: 01/18/2010] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe the characteristics of wrestling injuries occurring in male athletes aged 7-17 treated in United States (U.S.) emergency departments (ED) from 2000-2006, and to compare injury patterns between younger & older youth wrestlers. METHODS A stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System was used for 2000-2006. ED visits for injuries sustained in organized wrestling were analyzed for male patients ages 7-17 years old (subdivided into 7-11 years old [youth group] and 12-17 years old [scholastic group]). RESULTS During the study period, there were an estimated 167,606 ED visits for wrestling injuries in 7-17 years old U.S. males, with 152,710 (91.1%) occurring in the older (12-17 years old) group. The annual injury incidence was 6.49 injuries/1,000 wrestlers in the youth group and 29.57 injuries/1,000 wrestlers in the scholastic group. The distribution of diagnoses was similar in both age groups, with sprain/strain as the most common diagnosis, followed by fracture and contusion/abrasion. Distributions of injury by location were significantly different between groups (p=0.02), although both groups exhibited approximately 75% of all injuries from the waist up. Overexertion and struck by/against were the most common precipitating and direct mechanisms in both groups, respectively. Over 97% of all injured wrestlers were treated and released. CONCLUSION The types of injury in youth (7-11 years old) wrestlers are similar to those of scholastic (12-17 years old) wrestlers, although the distribution of body parts injured differs between the age groups. The majority of injuries occurs above the waist and may be a target for prevention strategies.
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Affiliation(s)
| | | | - Michael J. Mello
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - James G. Linakis
- The Warren Alpert Medical School of Brown University, Providence, RI,Address for Correspondence: James G. Linakis, PhD, MD, Department of Emergency Medicine, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903. Email
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