Mechanism of injury predicts case fatality and functional outcomes in pediatric trauma patients: the case for its use in trauma outcomes studies

Abstract Prehospital spinal immobilization is a widely used procedure in the emergency medical service (EMS) system worldwide, while the incidence of patients with spinal injury (SI) is relatively low, and unnecessary prehospital spinal immobilization is associated with patient complications. This study aimed to determine the association between prehospital spine immobilization and favorable functional outcomes at hospital discharge among trauma patients with SI. We conducted a retrospective cohort study using the Pan-Asia Trauma Outcomes Study (PATOS) registry data from January 1, 2016, to November 30, 2018. A total of 759 patients with SI were enrolled from 43,752 trauma patients in the PATOS registry during the study period. The subjects had a median age of 58 years ( Q1−Q3,41−72), and 438 (57.7%) patients had prehospital spine immobilization. Overall, prehospital spinal immobilization was not associated with favorable functional outcomes at discharge in multivariable logistic regression (aOR, 1.06; 95%CI 0.62−1.81, p = 0.826). However, in the subgroup of cervical SI, prehospital spinal immobilization was associated with favorable functional outcomes at discharge (aOR, 3.14; 95%CI 1.04−9.50; p = 0.043). Therefore, we suggest that paramedics should be more careful when determining cervical SI and using prehospital immobilization.

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188. Mechanism of Injury Independently Predicts Mortality and Functional Outcomes in Blunt Trauma Patients

Journal of Surgical Research ◽

10.1016/j.jss.2007.12.214 ◽

2008 ◽

Vol 144 (2) ◽

pp. 260 ◽

Cited By ~ 1

Author(s):

Adil H. Haider ◽

David C. Chang ◽

Elliott R. Haut ◽

David T. Efron ◽

Edward E. Cornwell

Keyword(s):

Blunt Trauma ◽

Functional Outcomes ◽

Trauma Patients ◽

Mechanism Of Injury

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Pediatric Trauma Patients with Temporal Bone Fractures Are at Risk for Multiple Cranial CT Scans

10.1055/s-0040-1702371 ◽

2020 ◽

Author(s):

Joshua Ewy ◽

Martin Piazza ◽

Brian Thorp ◽

Michael Phillips ◽

Carolyn Quinsey

Keyword(s):

At Risk ◽

Temporal Bone ◽

Bone Fractures ◽

Pediatric Trauma ◽

Ct Scans ◽

Trauma Patients ◽

Cranial Ct

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Faculty Opinions recommendation of Ventilator-associated pneumonia in pediatric trauma patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1162712.624295 ◽

2009 ◽

Author(s):

Charles Schleien ◽

Kenneth Remy

Keyword(s):

Pediatric Trauma ◽

Trauma Patients ◽

Ventilator Associated Pneumonia

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Faculty Opinions recommendation of Diagnostic radiation exposure in pediatric trauma patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717972744.793469722 ◽

2013 ◽

Author(s):

Osvaldo Chiara ◽

Stefania Cimbanassi

Keyword(s):

Radiation Exposure ◽

Pediatric Trauma ◽

Trauma Patients ◽

Diagnostic Radiation ◽

Diagnostic Radiation Exposure

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The Frequency of Random Findings on Abdominal / Pelvis Computed Tomography in Pediatric Trauma Patients

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616666201217110021 ◽

2020 ◽

Vol 16 ◽

Author(s):

Betül Tiryaki Baştuğ

Keyword(s):

Computed Tomography ◽

Incidental Findings ◽

Pediatric Population ◽

Pediatric Trauma ◽

Trauma Patients ◽

Injured Child ◽

Level 3 ◽

Male Patients ◽

Clinically Significant ◽

Discharge Summaries

Aims: In this study, we aimed to find the percentage of random pathologies and abdominopelvic region anomalies that are not related to trauma in pediatric patients. Background: An abdominal assessment of an injured child usually involves computed tomography imaging of the abdomen and pelvis (CTAP) to determine the presence and size of injuries. Imaging may accidentally reveal irrelevant findings. Objectives: Although the literature in adults has reviewed the frequency of discovering these random findings, few studies have been identified in the pediatric population. Methods: Data on 142( 38 female, 104 male) patients who underwent CTAP during their trauma evaluation between January 2019 and January 2020 dates were obtained from our level 3 pediatric trauma center trauma records. The records and CTAP images were examined retrospectively for extra traumatic pathologies and anomalies. Results: 67 patients (47%) had 81 incidental findings. There were 17 clinically significant random findings. No potential tumors were found in this population. Conclusion: Pediatric trauma CTAP reveals random findings. For further evaluation, incidental findings should be indicated in the discharge summaries.

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Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region

The American Surgeon ◽

10.1177/0003134820960063 ◽

2020 ◽

pp. 000313482096006

Author(s):

William Q. Duong ◽

Areg Grigorian ◽

Cyrus Farzaneh ◽

Jeffry Nahmias ◽

Theresa Chin ◽

...

Keyword(s):

United States ◽

The United States ◽

Trauma Patients ◽

Improvement Program ◽

Trauma Outcomes ◽

Risk Of Death ◽

Hospital Access ◽

Risk Of Mortality ◽

Sex Disparities ◽

Male Patients

Objectives Disparities in outcomes among trauma patients have been shown to be associated with race and sex. The purpose of this study was to analyze racial and sex mortality disparities in different regions of the United States, hypothesizing that the risk of mortality among black and Asian trauma patients, compared to white trauma patients, will be similar within all regions in the United States. Methods The Trauma Quality Improvement Program (2010-2016) was queried for adult trauma patients, separating by U.S. Census regions. Multivariable logistic regression analyses were performed for each region, controlling for known predictors of morbidity and mortality in trauma. Results Most trauma patients were treated in the South (n = 522 388, 40.7%). After risk adjustment, black trauma patients had a higher associated risk of death in all regions, except the Northeast, compared to white trauma patients. The highest associated risk of death for blacks (vs. whites) was in the Midwest (odds ratio [OR] 1.30, P < .001). Asian trauma patients only had a higher associated risk of death in the West (OR 1.39, P < .001). Male trauma patients, compared to women, had an increased associated risk of mortality in all four regions. Discussion This study found major differences in outcomes among different races within different regions of the United States. There was also both an increased rate and associated risk of mortality for male patients in all regions. Future prospective studies are needed to identify what regional differences in trauma systems including population density, transport times, hospital access, and other trauma resources explain these findings.

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National temporal variation in major trauma in England, Wales and Northern Ireland

Trauma ◽

10.1177/1460408620982264 ◽

2021 ◽

pp. 146040862098226

Author(s):

Will Kieffer ◽

Daniel Michalik ◽

Jason Bernard ◽

Omar Bouamra ◽

Benedict Rogers

Keyword(s):

Northern Ireland ◽

Temporal Variation ◽

Major Trauma ◽

Injury Severity ◽

Research Network ◽

Trauma Patients ◽

Trauma Outcomes ◽

Causes Of Mortality ◽

Injured Patients ◽

Time Of Admission

Introduction Trauma is one of the leading causes of mortality worldwide, but little is known of the temporal variation in major trauma across England, Wales and Northern Ireland. Proper workforce and infrastructure planning requires identification of the caseload burden and its temporal variation. Materials and Methods The Trauma Audit Research Network (TARN) database for admissions attending Major Trauma Centres (MTCs) between 1st April 2011 and 31st March 2018 was analysed. TARN records data on all trauma patients admitted to hospital who are alive at the time of admission to hospital. Major trauma was classified as an Injury Severity Score (ISS) >15. Results A total of 158,440 cases were analysed. Case ascertainment was over 95% for 2013 onwards. There was a statistically significant variation in caseload by year (p < 0.0001), times of admissions (p < 0.0001), caseload admitted during weekends vs weekdays, 53% vs 47% (p < 0.0001), caseload by season with most patients admitted during summer (p < 0.0001). The ISS varied by time of admission with most patients admitted between 1800 and 0559 (p < 0.0001), weekend vs weekday with more severely injured patients admitted during the weekend (p < 0.0001) and by season p < 0.0001). Discussion and Conclusion: There is a significant national temporal variation in major trauma workload. The reasons are complex and there are multiple theories and confounding factors to explain it. This is the largest dataset for hospitals submitting to TARN which can help guide workforce and resource allocation to further improve trauma outcomes.

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