Lung ultrasound for detecting pneumothorax in injured children: preliminary experience at a community-based Level II pediatric trauma center

ACS-verified trauma centers show higher survival and improved mortality rates in states with ACS-verified Level I pediatric trauma centers. However, few significant changes are appreciated in the first two years after verification. Minimal research exists examining verification of ACS Level II pediatric trauma centers. We analyzed ACS Level II pediatric trauma verification at our institution. In 2014, Sanford Medical Center Fargo became the only Level II pediatric trauma center in North Dakota, as well as the only center between Spokane and Minneapolis. A retrospective review of the institution's pre-existing trauma database one year pre- and postverification was performed. Patients aged <18 years were included in the study ( P < 0.05). Patient number increased by 23 per cent, from 167 to 205 patients. A statistically significant increase occured in the three to six year old age group ( P = 0.0002); motorized recreational vehicle ( P = 0.028), violent ( P = 0.009), and other ( P = 0.0374) mechanism of injury categories; ambulance ( P = 0.0124), fixed wing ( P = 0.0028), and personal-owned vehicle ( P = 0.0112) modes of transportation. Decreased public injuries ( P = 0.0071) and advanced life support ambulance transportation ( P = 0.0397). The study showed a nonstatistically significant increase in mean Injury Severity Score (from 6.3 to 7) and Native American trauma (from 14 to 20 per cent). Whereas prolonged ACS Level I pediatric trauma center verification was found to benefit patients, minimal data exist on ACS Level II verification. Our findings are consistent with current Level I ACS pediatric trauma center data. Future benefits will require continued analysis because our Level II pediatric trauma center continues to mature and affect our rural and large Native American community.

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Development, Validation, and Implementation of a Guideline to Improve Clinical Event Debriefing at a Level-I Adult and Level-II Pediatric Trauma Center

Journal of Emergency Nursing ◽

10.1016/j.jen.2021.04.013 ◽

2021 ◽

Author(s):

Steven Phillip Tyler ◽

Jane Dixon ◽

Janet Parkosewich ◽

Paul C. Mullan ◽

Amish Aghera

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Clinical Event ◽

Level Ii ◽

Level I ◽

Pediatric Trauma Center

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Outcome in an Urban Pediatric Trauma System with Unified Prehospital Emergency Medical Services Care

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00041601 ◽

1995 ◽

Vol 10 (1) ◽

pp. 19-23 ◽

Cited By ~ 11

Author(s):

Michael J. VanRooyen ◽

Edward P. Sloan ◽

John A. Barrett ◽

Robert F. Smith ◽

Hernan M. Reyes

Keyword(s):

Head Injury ◽

Mortality Rate ◽

Trauma Center ◽

Pediatric Trauma ◽

Trauma System ◽

Age Groups ◽

Mortality Rates ◽

Trauma Centers ◽

Field Triage ◽

Pediatric Trauma Center

AbstractHypothesis:Pediatric mortality is predicted by age, presence of head trauma, head trauma with a low Glasgow Coma Scale (GCS) score, a low Pediatric Trauma Score (PTS), and transport directly to a pediatric trauma center.Population:Studied were 1,429 patients younger than 16 years old admitted to or declared dead on arrival (DOA) in a pediatric trauma center from January through October, 1988. The trauma system, which served 3-million persons, included six pediatric trauma centers.Methods:Data were obtained by a retrospective review of summary statistics provided to the Chicago Department of Health by the pediatric trauma centers.Results:Overall mortality was 4.8% (68 of 1429); 32 of the patients who died (47.1%) were DOA. The in-hospital mortality rate was 2.6%. Head injury was the principal diagnosis in 46.2% of admissions and was a factor in 72.2% of hospital deaths. The mortality rate was 20.3% in children with a GCS≤10 and 0.4% when the GCS was >10 (odds ratio [OR] = 67.0, 95% CI = 15.0–417.4). When the PTS was ≤ 5, mortality was 25.6%; with a PTS > 5, the mortality was 0.2% (OR = 420.7, 95% CI = 99.3–2,520). Although transfers to a pediatric trauma center accounted for 73.6% of admissions, direct field triage to a pediatric trauma center was associated with a 3.2 times greater mortality risk (95% CI = 1.58–6.59). Mortality rates were equal for all age groups. Pediatric trauma center volume did not influence mortality rates.Conclusions:Head injury and death occur in all age groups, suggesting the need for broad prevention strategies. Specific GCS and PTS values that predict mortality can be used in emergency medical services (EMS) triage protocols. Although the high proportion of transfers mandates systemwide transfer protocols, the lower mortality in these patients suggests appropriate EMS field triage. These factors should be considered as states develop pediatric trauma systems.

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An Analysis of Pediatric Gunshot Wounds Treated at a Level I Pediatric Trauma Center

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000063479.92520.2e ◽

2003 ◽

Vol 54 (6) ◽

pp. 1102-1106 ◽

Cited By ~ 8

Author(s):

Alison K. Snyder ◽

Li Ern Chen ◽

Robert P. Foglia ◽

Patrick A. Dillon ◽

Robert K. Minkes

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Gunshot Wounds ◽

Level I ◽

Pediatric Trauma Center

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Detection of Missed Injuries in a Pediatric Trauma Center With the Addition of Acute Care Pediatric Nurse Practitioners

Journal of Trauma Nursing ◽

10.1097/jtn.0000000000000093 ◽

2014 ◽

Vol 21 (6) ◽

pp. 276-277

Author(s):

&NA;

Keyword(s):

Acute Care ◽

Nurse Practitioners ◽

Trauma Center ◽

Pediatric Trauma ◽

Pediatric Nurse ◽

Missed Injuries ◽

Pediatric Nurse Practitioners ◽

Pediatric Trauma Center

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Recreational All-Terrain Vehicle Injuries Among Children: An 11-Year Review of a Central Kentucky Level I Pediatric Trauma Center Database

Yearbook of Pediatrics ◽

10.1016/s0084-3954(08)79230-3 ◽

2009 ◽

Vol 2009 ◽

pp. 350-352

Author(s):

J.A. Stockman

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Level I ◽

Pediatric Trauma Center

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Computed tomography before transfer to a level I pediatric trauma center risks duplication with associated increased radiation exposure

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2008.08.061 ◽

2008 ◽

Vol 43 (12) ◽

pp. 2268-2272 ◽

Cited By ~ 46

Author(s):

Walter J. Chwals ◽

Ann V. Robinson ◽

Carlos J. Sivit ◽

Diya Alaedeen ◽

Ellen Fitzenrider ◽

...

Keyword(s):

Computed Tomography ◽

Radiation Exposure ◽

Trauma Center ◽

Pediatric Trauma ◽

Level I ◽

Pediatric Trauma Center

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Usefulness of Pelvic Radiographs in the Initial Trauma Evaluation with Concurrent CT: Is Additional Radiation Exposure Necessary?

International Journal of Pediatrics ◽

10.1155/2018/6260954 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Anne K. Misiura ◽

Autumn D. Nanassy ◽

Jacqueline Urbine

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Trauma Patients ◽

Additional Information ◽

Pelvic Radiographs ◽

Pelvic Radiograph ◽

Digital Radiograph ◽

Urban Level ◽

Level I ◽

Pediatric Trauma Center

Trauma patients in a Level I Pediatric Trauma Center may undergo CT of the abdomen and pelvis with concurrent radiograph during initial evaluation in an attempt to diagnose injury. To determine if plain digital radiograph of the pelvis adds additional information in the initial trauma evaluation when CT of the abdomen and pelvis is also performed, trauma patients who presented to an urban Level I Pediatric Trauma Center between 1 January 2010 and 7 February 2017 in whom pelvic radiograph and CT of the abdomen and pelvis were performed within 24 hours of each other were analyzed. A total of 172 trauma patients had pelvic radiograph and CT exams performed within 24 hours of each other. There were 12 cases in which the radiograph missed pelvic fractures seen on CT and 2 cases in which the radiograph suspected a fracture that was not present on subsequent CT. Furthermore, fractures in the pelvis were missed on pelvic radiographs in 12 of 35 cases identified on CT. Sensitivity of pelvic radiograph in detecting fractures seen on CT was 65.7% with a 95% confidence interval of 47.79-80.87%. Results suggest that there is no added diagnostic information gained from a pelvic radiograph when concurrent CT is also obtained, a practice which exposes the pediatric trauma patient to unnecessary radiation.

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