1159: RISK FACTORS, OUTCOMES, AND TIMING OF VENTILATOR-ASSOCIATED INFECTIONS IN PEDIATRIC TRAUMA PATIENTS

AbstractTrauma-induced coagulopathy (TIC) is well documented in injured children. However, many important features of pediatric hemostasis are still in development in early childhood and may impact TIC. Certain pediatric subgroups are at a higher risk. Traumatic brain injury, which occurs with a higher rate in children, and physical child abuse are known risk factors for TIC that deserve special consideration. Resuscitation of a pediatric trauma patient follows many of the same goals as in the injured adult trauma, although some key aspects of pediatric resuscitation require ongoing investigation. Venous thromboembolism occurs with higher rates in certain high-risk groups of pediatric trauma patients, although overall it is considerably less frequent in children as compared with adults.

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Incidence and Epidemiology of Acute Kidney Injury in a Pediatric Malawian Trauma Cohort: a Prospective Observational Study

10.21203/rs.2.21800/v1 ◽

2020 ◽

Author(s):

Erica C. Bjornstad ◽

William Muronya ◽

Zachary H. Smith ◽

Keisha Gibson ◽

Amy K Mottl ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Pediatric Trauma ◽

Kidney Injury ◽

Herbal Remedies ◽

Trauma Patients ◽

Tertiary Referral Hospital ◽

Risk Of Death ◽

Relative Risks ◽

Baseline Creatinine

Abstract Introduction: Acute kidney injury (AKI) is highly associated with mortality risk in children worldwide. Trauma can lead to AKI and is a leading cause of pediatric death in Africa. However, there is no information regarding the epidemiology of pediatric, trauma-associated AKI in Africa.Methods: Prospective cohort study of pediatric trauma patients admitted to a tertiary referral hospital in Malawi. Participants enrolled at admission were followed prospectively throughout their hospitalization. AKI was defined by sequential serum creatinine measurements and Kidney Disease Improving Global Outcomes criteria. We calculated descriptive statistics and univariate relative risks (RR) for hypothesis-generation of potential risk factors associated with AKI.Results: We analyzed data from 114 participants. Depending on baseline creatinine definition, AKI incidence ranged from 4-10%. The new Schwartz equation estimated baseline creatinine values best and yielded an AKI incidence of 9.7%. Almost one in ten children died during hospitalization, but those with AKI (n=4) were at significantly higher risk of death compared to those without AKI (40.0% vs 6.2%; RR 6.5, 95% CI 2.2-19.1). Burn injuries were most commonly associated with AKI (63.6%). Other potential AKI risk factors included multiple injuries, trunk or facial injuries, and recent consumption of herbal remedies.Conclusions: AKI occurs in 10% of admitted pediatric trauma patients in Malawi and increases the risk of death 7-fold compared to those without AKI. This large unrecognized burden in trauma requires further investment by researchers, clinicians and policymakers to develop evidenced-based triage, recognition, and management approaches to prevent the associated sequelae and potential mortality from AKI.

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Ventilator Associated Pneumonia in Pediatric Trauma Patients

Proceedings of IMPRS ◽

10.18060/25738 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Dalton Sullivan ◽

Matthew P. Landman ◽

Rachel E. Gahagen Gahagen

Keyword(s):

Risk Factors ◽

Pediatric Trauma ◽

Trauma Patients ◽

Ventilator Associated Pneumonia ◽

Hospital Acquired Infection ◽

Trauma Population ◽

Hospital Acquired ◽

Cultured Bacteria ◽

The Impact ◽

Overall Mortality

Background: Ventilator associated pneumonia (VAP) is a common hospital-acquired infection found in intubated trauma patients. In previous adult studies, VAP has been associated with an increase in length of stay, cost, morbidity, mortality, and longer mechanical ventilation. There remains little examination of the risk factors, prognosis, and microbiology of VAP within the pediatric trauma population. This study aims to analyze factors associated with VAP in pediatric trauma patients. Methods: The Riley Hospital for Children Trauma Registry was utilized to identify intubated pediatric trauma patients from 2016-2020. Patients were excluded if intubated for less than 48 hours. VAP was defined as positive if patients met either Centers for Disease Control definition and or were clinically diagnosed with and treated for VAP. Univariate and multivariate modeling was performed. Results: A total of 171 patients met inclusion criteria and 43 (25%) were diagnosed with VAP. The median age was 8 years (2-13) and ISS was 26.5 (22-35). The median duration of intubation was 203.8 hours (117.3-331.3). The overall mortality was 55 (32.2%). While variables such as lower age and use of MTP resulted in a higher likelihood of mortality, VAP diagnosis was not associated with increased mortality. BAL analysis displayed that the most common cultured bacteria were H. influenzae, Staph. aureus, and Strep. Pneumoniae with most VAPs being diagnosed on day 2 of admission. When analyzing the impact of age, ISS, intubation hours, ICU days, and GI prophylaxis on VAP, only age was significantly associated with VAP: for each year the odds of VAP rose by 10%. Conclusions: A quarter of the pediatric trauma patients were diagnosed with VAP during the study period. No modifiable risk factors were found for VAP with only patient age demonstrating significance for the diagnosis. Further investigation into VAP definition and prevention in pediatric trauma patients should occur given it’s prevalence.

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Faculty Opinions recommendation of Risk factors for venous thromboembolism in pediatric trauma patients and validation of a novel scoring system: the risk of clots in kids with trauma score.

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

10.3410/f.726210414.793521259 ◽

2016 ◽

Author(s):

Saskia de Wildt ◽

Gerald Jaspers

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Scoring System ◽

Pediatric Trauma ◽

Trauma Patients ◽

Trauma Score

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Incidence and Epidemiology of Acute Kidney Injury in a Pediatric Malawian Trauma Cohort: a Prospective Observational Study

10.21203/rs.2.21800/v2 ◽

2020 ◽

Author(s):

Erica C. Bjornstad ◽

William Muronya ◽

Zachary H. Smith ◽

Keisha Gibson ◽

Amy K Mottl ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Pediatric Trauma ◽

Kidney Injury ◽

Herbal Remedies ◽

Trauma Patients ◽

Tertiary Referral Hospital ◽

Risk Of Death ◽

Relative Risks ◽

Baseline Creatinine

Abstract Introduction Acute kidney injury (AKI) is highly associated with mortality risk in children worldwide. Trauma can lead to AKI and is a leading cause of pediatric death in Africa. However, there is no information regarding the epidemiology of pediatric, trauma-associated AKI in Africa. Methods Prospective cohort study of pediatric trauma patients admitted to a tertiary referral hospital in Malawi. Participants enrolled at admission were followed prospectively throughout their hospitalization. AKI was defined by creatinine-only Kidney Disease Improving Global Outcomes criteria. We calculated descriptive statistics and univariate relative risks (RR) for hypothesis-generation of potential risk factors associated with AKI. Results We analyzed data from 114 participants. Depending on baseline creatinine definition, AKI incidence ranged from 4-10%. The new Schwartz equation estimated baseline creatinine values best and yielded an AKI incidence of 9.7%. Almost one in ten children died during hospitalization, but those with AKI (n=4) were at significantly higher risk of death compared to those without AKI (40.0% vs 6.2%; RR 6.5, 95% CI 2.2-19.1). Burn injuries were most commonly associated with AKI (63.6%). Other potential AKI risk factors included multiple injuries, trunk or facial injuries, and recent consumption of herbal remedies. Conclusions AKI occurs in up to 10% of admitted pediatric trauma patients in Malawi and increases the risk of death 7-fold compared to those without AKI. This large unrecognized burden in trauma requires further investment by researchers, clinicians and policymakers to develop evidenced-based triage, recognition, and management approaches to prevent the associated sequelae and potential mortality from AKI.

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