Epidemiology and aetiology of paediatric traumatic cardiac arrest in England and Wales

2018 ◽  
Vol 104 (5) ◽  
pp. 437-443 ◽  
Author(s):  
James Vassallo ◽  
Melanie Webster ◽  
Edward B G Barnard ◽  
Mark D Lyttle ◽  
Jason E Smith
Keyword(s):  
Cardiac Arrest ◽  
Injury Severity ◽  
Road Traffic ◽  
Population Based ◽  
Trauma Centre ◽  
Research Network ◽  
Common Mechanism ◽  
England And Wales ◽  
Traumatic Cardiac Arrest ◽  
Major Trauma Centre

ObjectiveTo describe the epidemiology and aetiology of paediatric traumatic cardiac arrest (TCA) in England and Wales.DesignPopulation-based analysis of the UK Trauma Audit and Research Network (TARN) database.Patients and settingAll paediatric and adolescent patients with TCA recorded on the TARN database for a 10-year period (2006–2015).MeasuresPatient demographics, Injury Severity Score (ISS), location of TCA (‘prehospital only’, ‘in-hospital only’ or ‘both’), interventions performed and outcome.Results21 710 paediatric patients were included in the database; 129 (0.6%) sustained TCA meeting study inclusion criteria. The majority, 103 (79.8%), had a prehospital TCA. 62.8% were male, with a median age of 11.7 (3.4–16.6) years, and a median ISS of 34 (25–45). 110 (85.3%) had blunt injuries, with road-traffic collision the most common mechanism (n=73, 56.6%). 123 (95.3%) had severe haemorrhage and/or traumatic brain injury. Overall 30-day survival was 5.4% ((95% CI 2.6 to 10.8), n=7). ‘Pre-hospital only’ TCA was associated with significantly higher survival (n=6) than those with TCA in both ‘pre-hospital and in-hospital’ (n=1)—13.0% (95% CI 6.1% to 25.7%) and 1.2% (95% CI 0.1% to 6.4%), respectively, p<0.05. The greatest survival (n=6, 10.3% (95% CI 4.8% to 20.8%)) was observed in those transported to a paediatric major trauma centre (MTC) (defined as either a paediatric-only MTC or combined adult-paediatric MTC).ConclusionsSurvival is possible from the resuscitation of children in TCA, with overall survival comparable to that reported in adults. The highest survival was observed in those with a pre-hospital only TCA, and those who were transported to an MTC. Early identification and aggressive management of paediatric TCA is advocated.

The sensitivity of pre-hospital and in-hospital tools for the identification of major trauma patients presenting to a major trauma centre.

2013 ◽  
Vol 99 (1) ◽  
pp. 16-19
Author(s):  
D Potter ◽  
A Kehoe ◽  
JE Smith
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Trauma Centre ◽  
Research Network ◽  
Trauma Network ◽  
Trauma Patients ◽  
Major Trauma Centre ◽  
Injury Assessment ◽  
Trauma Response ◽  
Retrospective Database

AbstractThe identification of major trauma patients before arrival in hospital allows the activation of an appropriate trauma response. The Wessex triage tool (WTT) uses a combination of anatomical injury assessment and physiological criteria to identify patients with major trauma suitable for triage direct to a major trauma centre (MTC), and has been adopted by the South-West Peninsula Trauma Network (PTN). A retrospective database review, using the Trauma Audit Research Network (TARN) database, was undertaken to identify a population of patients presenting to Derriford Hospital with an injury severity score (ISS) > 15. The WTT was then applied to this population to identify the sensitivity of the tool. The sensitivity of the WTT at identifying patients with an ISS>15 was 53%. One of the reasons for this finding was that elderly patients who are defined as having major trauma due to the nature of their injuries, but who did not have a mechanism to suggest they had sustained major trauma (such as a fall from standing height), were not identified by these triage tools. The implications of this are discussed.

scholarly journals Mortality in adolescent trauma: a comparison of children’s, mixed and adult major trauma centres

2021 ◽  
pp. emermed-2020-210384
Author(s):  
Jordan Evans ◽  
Hannah Murch ◽  
Roisin Begley ◽  
Damian Roland ◽  
Mark D Lyttle ◽  
...  
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Pairwise Comparison ◽  
Patient Characteristics ◽  
Mortality Rates ◽  
Trauma Centre ◽  
Research Network ◽  
Categorical Variables ◽  
Adolescent Trauma ◽  
Major Trauma Centre

ObjectiveWe aimed to compare adolescent mortality rates between different types of major trauma centre (MTC or level 1; adult, children’s and mixed).MethodsData were obtained from TARN (Trauma Audit Research Network) from English sites over a 6-year period (2012–2018), with adolescence defined as 10–24.99 years. Results are presented using descriptive statistics. Patient characteristics were compared using the Kruskal-Wallis test with Dunn’s post-hoc analysis for pairwise comparison and χ2 test for categorical variables.Results21 033 cases met inclusion criteria. Trauma-related 30-day crude mortality rates by MTC type were 2.5% (children’s), 4.4% (mixed) and 4.9% (adult). Logistic regression accounting for injury severity, mechanism of injury, physiological parameters and ‘hospital ID’, resulted in adjusted odds of mortality of 2.41 (95% CI 1.31 to 4.43; p=0.005) and 1.85 (95% CI 1.03 to 3.35; p=0.041) in adult and mixed MTCs, respectively when compared with children’s MTCs. In three subgroup analyses the same trend was noted. In adolescents aged 14–17.99 years old, those managed in a children’s MTC had the lowest mortality rate at 2.5%, compared with 4.9% in adult MTCs and 4.4% in mixed MTCs (no statistical difference between children’s and mixed). In cases of major trauma (Injury Severity Score >15) the adjusted odds of mortality were also greater in the mixed and adult MTC groups when compared with the children’s MTC. Median length of stay (LoS) and intensive care unit LoS were comparable for all MTC types. Patients managed in children’s MTCs were less likely to have a CT scan (46.2% vs 62.8% mixed vs 64% adult).ConclusionsChildren’s MTC have lower crude and adjusted 30-day mortality rates for adolescent trauma. Further research is required in this field to identify the factors that may have influenced these findings.

scholarly journals The impact of ‘unofficial trauma’ on a Major Trauma Centre: A service evaluation of accident and emergency department trauma team activations

Trauma ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 278-284
Author(s):  
Alex Wright ◽  
Simon J Mercer ◽  
Ben Morton
Keyword(s):  
Road Traffic ◽  
Statistical Tests ◽  
Penetrating Trauma ◽  
Trauma Centre ◽  
Research Network ◽  
Shop Floor ◽  
Trauma Patients ◽  
Healthcare Provision ◽  
Major Trauma Centre ◽  
The Impact

Introduction Trauma remains a leading cause of death worldwide. In the UK, data for trauma patients are prospectively collected locally and collated by the Trauma Audit and Research Network. This study assesses and describes the subgroup of patients who triggered a trauma call but who subsequently did not meet criteria for Trauma Audit and Research Network. Methods A single centre, retrospective observational study of trauma calls between 1 June 2012 and 31 August 2018 was performed, determining which trauma calls had been submitted to Trauma Audit and Research Network by cross referencing with the submission database. Data were tested for normality (Shapiro–Wilk test) and appropriate statistical tests employed to determine differences between inclusion and non-inclusion groups. For categorical data, we used Chi-squared tests to examine for differences. Results There were 6529 trauma calls and over half (3837 (58.8%)) were not registered on Trauma Audit and Research Network. Patients excluded were significantly younger (mean 42.4 years SD 19.2) than those who met inclusion criteria (mean 50.3 years, SD 21.8), p < 0.001 and were significantly more likely to suffer from penetrating trauma (18.6% versus 8.2%, p < 0.001), the majority (77.8%, 553/713) caused by stabbings. Patients excluded were less likely to be involved in a road traffic accident (31.1% versus 35.3%, p < 0.001), less likely to have fallen downstairs (15.2% versus 18.7%, p < 0.001) and less likely to have fallen from a height > 2 m (8.1% versus 12.7%, p < 0.001). Discussion Patients who trigger a trauma call but who subsequently do not meet the criteria for Trauma Audit and Research Network inclusion place a significant burden on healthcare provision. To our knowledge this is the first investigation to specifically explore this group of at-risk patients. To enable medical planners a more accurate view of activity on the ‘shop floor’, particularly in reference to knife crime injuries we ask the question as to whether a separate database should now be held of trauma calls?

scholarly journals Outcomes from traumatic cardiac arrest in a single UK major trauma centre

2016 ◽  
Vol 36 ◽  
pp. S67
Author(s):  
Y.A. El Ella ◽  
S.R. Smith ◽  
E. Horwell ◽  
A.J. Brooks
Keyword(s):  
Cardiac Arrest ◽  
Major Trauma ◽  
Trauma Centre ◽  
Traumatic Cardiac Arrest ◽  
Major Trauma Centre

scholarly journals The Epidemiology of and Outcome from Pancreatoduodenal Trauma in the UK, 1989–2013

2015 ◽  
Vol 97 (2) ◽  
pp. 125-130 ◽  
Author(s):  
DA O’Reilly ◽  
O Bouamra ◽  
A Kausar ◽  
EJ Dickson ◽  
F Lecky
Keyword(s):  
Blunt Trauma ◽  
Injury Severity ◽  
Road Traffic ◽  
Penetrating Trauma ◽  
Research Network ◽  
Common Mechanism ◽  
Female Ratio ◽  
Road Traffic Collision ◽  
The Uk ◽  
Type Of Injury

IntroductionPancreatoduodenal (PD) injury is an uncommon but serious complication of blunt and penetrating trauma, associated with high mortality. The aim of this study was to assess the incidence, mechanisms of injury, initial operation rates and outcome of patients who sustained PD trauma in the UK from a large trauma registry, over the period 1989–2013.MethodsThe Trauma Audit and Research Network database was searched for details of any patient with blunt or penetrating trauma to the pancreas, duodenum or both.ResultsOf 356,534 trauma cases, 1,155 (0.32%) sustained PD trauma. The median patient age was 27 years for blunt trauma and 27.5 years for penetrating trauma. The male-to-female ratio was 2.5:1. Blunt trauma was the most common type of injury seen, with a ratio of blunt-to-penetrating PD injury ratio of 3.6:1. Road traffic collision was the most common mechanism of injury, accounting for 673 cases (58.3%). The median injury severity score (ISS) was 25 (IQR: 14–35) for blunt trauma and 14 (IQR: 9–18) for penetrating trauma. The mortality rate for blunt PD trauma was 17.6%; it was 12.2% for penetrating PD trauma. Variables predicting mortality after pancreatic trauma were increasing age, ISS, haemodynamic compromise and not having undergone an operation.ConclusionsIsolated pancreatic injuries are uncommon; most coexist with other injuries. In the UK, a high proportion of cases are due to blunt trauma, which differs from US and South African series. Mortality is high in the UK but comparison with other surgical series is difficult because of selection bias in their datasets.

scholarly journals Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management

2018 ◽  
Vol 35 (7) ◽  
pp. 434-439 ◽  
Author(s):  
Annette C Rickard ◽  
James Vassallo ◽  
Tim Nutbeam ◽  
Mark D Lyttle ◽  
Ian K Maconochie ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Delphi Study ◽  
Ventilatory Support ◽  
Trauma Centre ◽  
Paediatric Surgery ◽  
Diagnosis And Management ◽  
Traumatic Cardiac Arrest ◽  
Protocol Development ◽  
Major Trauma Centre ◽  
Poor Outcomes

AimsPaediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients.MethodsAn online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA. Participants were invited from paediatric and adult emergency medicine, paediatric anaesthetics, paediatric ICU and paediatric surgery, as well as Paediatric Major Trauma Centre leads and representatives from the Resuscitation Council UK. Statements were informed by literature reviews and were based on elements of APLS resuscitation algorithms as well as some concepts used in the management of adult TCA; they ranged from confirmation of cardiac arrest to the indications for thoracotomy.Results73 experts completed all three rounds between June and November 2016. Consensus was reached on 14 statements regarding the diagnosis and management of paediatric TCA; oxygenation and ventilatory support, along with rapid volume replacement with warmed blood, improve survival. The duration of cardiac arrest and the lack of a response to intervention, along with cardiac standstill on ultrasound, help to guide the decision to terminate resuscitation.ConclusionThis study has given a consensus-based framework to guide protocol development in the management of paediatric TCA, though further work is required in other key areas including its acceptability to clinicians.

scholarly journals 40 Cattle-Related Trauma: A 5 Year Retrospective Review in An Adult Major Trauma Centre

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J H Rhind ◽  
D Quinn ◽  
L Cosbey ◽  
D Mobley ◽  
I Britton ◽  
...  
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Hospital Admissions ◽  
Road Traffic ◽  
Soft Tissue Injuries ◽  
Trauma Centre ◽  
Emergency Patients ◽  
Probability Of Survival ◽  
Major Trauma Centre ◽  
Patterns Of Injury

Abstract Aim Bovine injuries are a common and significant cause of trauma, often requiring admission and operative treatment. We review all bovine related injuries over five years, both emergency and GP referrals at an adult major trauma centre in England. Method Retrospective evaluation was undertaken using keywords through radiology referrals and hospital admissions speciality databases. Demographics were collected as well as the mechanism and the situation of injury; trauma scores were calculated using: Injury Severity Score (ISS) and Probability of Survival (Ps19). Results Sixty-seven patients were identified retrospectively over 5 years, 44 emergency patients (including 23 major traumas) and 23 GP referrals. Combined (Emergency & GP) mean age 52 years old. 67% male. Mean ISS 11. Most common combined mechanism of injury, kicked (n = 23). In emergency patients, trampling injuries were most common. 86% of the trampled patients were major traumas. Indirect injuries mainly involved farm gates (92%). 73% of bull-related injuries were major traumas. In emergency patients’ fractures were the most common primary injury (n = 20), upper limb followed by spine. In GP, soft tissue injuries were the most common. 70% of the emergency referrals required admission and 50% operations. Only one GP referral required an operation. Two patients had a Ps19 score &lt;90. There were two mortalities. Conclusions Cattle related injuries are a significant cause of severe morbidity and mortality. They are under-reported. Patterns of injury are similar to high velocity road traffic collisions and bull-related injuries or trampling in particular, should alert the clinician to more significant trauma.

scholarly journals 1550 Experience from A Level-1 Major Trauma Centre in England of Trauma Epidemiology After Easing of Lockdown Restrictions

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Waseem ◽  
R Romann ◽  
J Lenihan ◽  
J Rawal ◽  
A Carrothers ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Major Trauma ◽  
Road Traffic ◽  
Trauma Centre ◽  
Research Network ◽  
Period 2 ◽  
Major Trauma Centre ◽  
Severity Of Injury ◽  
Self Harm ◽  
Allocation Decisions

Abstract Aim The COVID-19 pandemic transformed trauma care. We examined the effect of lockdown easing on trauma presentation and management. Method Data was retrospectively analysed from Trauma Audit and Research Network (TARN) on patients presenting to one Major Trauma Centre in the East of England with trauma. The first 47 days of lockdown (23rd March-9th May 2020, period 1) were compared with the next (10th May- 26th June 2020, period 2) and last 47 (27th June- 13th August 2020, period 3). Data collected included demographics, mechanism and severity of injury, management, and length of stay. Results 1,249 patients were included; 62.2% were male with a mean age of 57.73. Footfall declined in April 2020 compared with 2019 (56 vs 143) but rebounded by May (123 v 120 patients). Road traffic collisions increased over periods 1-3 (18.8% v 23% v 30.1%, p = 0.038); deliberate self-harm (DSH) increased in period 2 compared with 1 and 3 (6.3% v 3.4% v 1.4%, p = 0.03) respectively. The 2020 patient age was younger than 2019, with less trauma relating to alcohol (7.3% v 13.2%, p = 0.009). Compared with 2019 reductions in total length of stay (14.1 v 17.4 days, p = &lt;0.001), critical care length of stay (2.3 v 2.9 days, p = 0.04) and consultant driven care (54.9% v 64.9%, p &lt; 0.001) were noted in lockdown. Conclusions Our study suggests that after lockdown easing, trauma footfall rapidly rebounded to 2019 levels. This should be acknowledged in resource allocation decisions if future lockdowns are necessitated.

scholarly journals Cattle-Related Trauma: A 5 Year Retrospective Review In A Adult Major Trauma Centre

2020 ◽  
Author(s):  
John-henry Rhind ◽  
Dominic Quinn ◽  
Lucy Cosbey ◽  
Douglas Mobley ◽  
Ingrid Britton ◽  
...  
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Hospital Admissions ◽  
Road Traffic ◽  
Operative Procedure ◽  
Soft Tissue Injuries ◽  
Trauma Centre ◽  
Emergency Patients ◽  
Major Trauma Centre ◽  
Primary Injury

Abstract Background:Bovine injuries are a common and significant cause of trauma, often requiring admission and operative treatment. We review all bovine related injuries over five years, both emergency and GP referrals at an adult major trauma centre in England.Method:Retrospective evaluation was undertaken using keywords through radiology referrals and hospital admissions speciality databases. By searching patient notes, demographics were collected as well as the mechanism and the situation of injury; trauma scores were calculated using: Injury Severity Score (ISS) and Probability of Survival (Ps19). Results were divided into emergency patients and GP referrals.Results:Sixty-seven patients were identified retrospectively over 5 years, 44 emergency patients (including 23 major traumas) and 23 GP referrals. Combined (Emergency & GP) mean age 52 years old. 67% male. Mean ISS 11. Most common combined mechanism of injury, kicked (n=23). In emergency patients, trampling injuries were most common. 86% of the trampled patients were major traumas and associated with increased ISS (mean 13). Indirect injuries mainly involved farm gates (92%). 73% of bull-related injuries were major traumas and had increased ISS scores (mean 17). Orthopaedics was the most common admitting speciality followed by cardiothoracic & neurosurgery. In emergency patients fractures were the most common primary injury (n=20), upper limb followed by spine. In GP, soft tissue injuries were the most common primary injury. 70% of the emergency referrals required admission and 50% operations. Fracture fixation was the most common operative procedure. Only one GP referral required an operation. There were significant delays in GP patients presenting. Two patients had a Ps19 score <90. There were two mortalities.Conclusion:Cattle related injuries are a significant cause of severe morbidity and mortality. They are under-reported. Patterns of injury are similar to high velocity road traffic collisions and bull-related injuries or trampling in particular, should alert the clinician to more significant trauma. Farm gates are a frequent cause of trauma associated with cattle. GP referrals with ongoing symptoms for more than two weeks seeking medical advice should alert the clinician to a more serious diagnosis.

Severe equestrian injuries: A seven-year review of admissions to a UK major trauma centre

Trauma ◽  
2021 ◽  
pp. 146040862110412
Author(s):  
Aref-Ali Gharooni ◽  
Fahim Anwar ◽  
Romann Ramdeep ◽  
Harry Mee
Keyword(s):  
United Kingdom ◽  
Major Trauma ◽  
Injury Severity ◽  
Trauma Centre ◽  
Common Mechanism ◽  
Mechanism Of Injury ◽  
The United Kingdom ◽  
Major Trauma Centre ◽  
Limb Injuries ◽  
Significant Difference

Background Equestrian sports are regaining popularity in the United Kingdom. Due to horses’ considerable weight and speed, serious injuries can occur. Riding style and equipment differ between North America and the United Kingdom with previous studies focusing on the former. Objective This study aims to assess the pattern of horse-related injury admissions to a major trauma centre in the United Kingdom. Methods A retrospective study of our hospital’s trauma registry between years 2012 and 2020 was performed. Cases included those admitted for severe horse-related injuries (irrespective of age/sex) with Injury Severity Score (ISS) of ≥ 4. Demographics, injury characteristics (ISS, Glasgow Coma Scale (GCS), injury region and operations), hospital stay and Glasgow Outcome Scale (GOS) on discharge were extracted. Four groups were formed based on mechanism of injury: fall from horse, fall and horse landing on top (FL group), kicked, and fall and kicked (FK group). Comparisons in injury and outcomes were analysed between these groups. Results 301 (2.8%) eligible cases were identified from 10,911 cases. 70.8% were female with mean (± SD) age of 42.7 (± 16.5) years. Most common mechanism of injury was fall (72.8%) then kicked (14.6%) with groups FL and FK forming < 10% each. No significant difference was found between the groups initial GCS, ISS, total or ICU length of stay and GOS ( p > 0.05). Most common regions of injury were orthopaedic (41.9%), spinal (26.2%), thoracic (20.1%) and head injuries (19.3%). 75% had good recovery on GOS though there were 3 fatalities relating to severe traumatic brain injury. Conclusion Orthopaedic limb injuries form the majority of horse-related injuries which contrasts the 1970s where head injury prevailed which is likely due to the widespread use of better head protection. Consideration should be given to enhanced limb safety equipment to prevent injury.

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