Non-accidental Trauma Injury Patterns and Outcomes: A Single Institutional Experience

2015 ◽  
Vol 81 (9) ◽  
pp. 835-838 ◽  
Author(s):  
Austin Ward ◽  
Joseph A. Iocono ◽  
Samuel Brown ◽  
Phillip Ashley ◽  
John M. Draus
Keyword(s):  
Brain Injuries ◽  
Injury Severity ◽  
Hot Spot ◽  
Demographic Data ◽  
Pediatric Trauma ◽  
Pediatric Intensive Care ◽  
Injury Patterns ◽  
Accidental Trauma ◽  
Trauma Population ◽  
Non Accidental Trauma

Non-accidental trauma (NAT) victims account for a significant percentage of our pediatric trauma population. We sought to better understand the injury patterns and outcomes of NAT victims who were treated at our level I pediatric trauma center. Trauma registry data were used to identify NAT victims between January 2008 and December 2012. Demographic data, injury severity, hospital course, and outcomes were evaluated. One hundred and eighty-eight cases of suspected NAT were identified. Children were mostly male and white. The median age was 1.1 years; the median Injury Severity Score was 9. Traumatic brain injuries, lower extremity fractures, and skull fractures were the most common injuries. Twenty-seven per cent required medical procedures; most were performed by orthopedic surgery. Twenty-four per cent required admission to the pediatric intensive care unit. The median length of stay was two days. The mortality rate was 9.6 per cent. We generated a hot spot map of our catchment area and identified areas of our state where NAT occurs at increased rates. NAT victims sustain significant morbidity and mortality. Due to the severity of injuries, pediatric trauma surgeons should be involved in the evaluation and management of these children. Much work is needed to prevent the death and disability incurred by victims of child abuse.

Comparison of Scoring Systems for Mortality Prediction in Pediatric Multitrauma Patients

2021 ◽  
Author(s):  
Mehmet Çelegen ◽  
Kübra Çelegen
Keyword(s):  
Injury Severity ◽  
Pediatric Trauma ◽  
Pediatric Intensive Care ◽  
Scoring Systems ◽  
International Normalized Ratio ◽  
Mortality Prediction ◽  
Risk Scores ◽  
Mortality Ratio ◽  
Risk Predictors ◽  
Trauma Score

AbstractThe aim of this study was to compare scoring systems for mortality prediction and determine the threshold values of this scoring systems in pediatric multitrauma patients. A total of 57 multitrauma patients referred to the pediatric intensive care unit from January 2020 to August 2021 were included. The pediatric trauma score (PTS), injury severity score (ISS), base deficit (B), international normalized ratio (I), Glasgow coma scale (G) (BIG) score, and pediatric risk of mortality 3 (PRISM 3) score were analyzed for all patients. Of the study group, 35% were females and 65% were males with a mean age of 72 months (interquartile range: 140). All groups' mortality ratio was 12.2%. All risk scores based on mortality prediction were statistically significant. Cutoff value for PTS was 3.5 with 96% sensitivity and 62% specificity; for the ISS, it was 20.5 with 92% sensitivity and 43% specificity; threshold of the BIG score was 17.75 with 85.7% sensitivity and 34% specificity; and 12.5 for PRISM 3 score with 87.6% sensitivity and 28% specificity. PTS, ISS, BIG score, and PRISM 3 score were accurate risk predictors for mortality in pediatric multitrauma patients. ISS was superior to PTS, PRISM 3 score, and BIG score for discrimination between survivors and nonsurvivors.

scholarly journals Predictors of increasing injury severity across suspected recurrent episodes of non-accidental trauma: a retrospective cohort study

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Jonathan Thackeray ◽  
Peter C. Minneci ◽  
Jennifer N. Cooper ◽  
Jonathan I. Groner ◽  
Katherine J. Deans
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Injury Severity ◽  
Accidental Trauma ◽  
Non Accidental Trauma

scholarly journals Boarding Injuries: The Long and the Short of It

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Leslie A. Fabian ◽  
Steven M. Thygerson ◽  
Ray M. Merrill
Keyword(s):  
Brain Injuries ◽  
Injury Severity ◽  
Treatment Options ◽  
Head Injuries ◽  
Patient Treatment ◽  
Injury Patterns ◽  
Population Demographics ◽  
Icu Length Of Stay ◽  
Level Ii ◽  
Prospective Investigation

As the popularity of longboarding increases, trauma centers are treating an increased number of high severity injuries. Current literature lacks descriptions of the types of injuries experienced by longboarders, a distinct subset of the skateboarding culture. A retrospective review of longboarding and skateboarding injury cases was conducted at a level II trauma center from January 1, 2006, through December 31, 2011. Specific injuries in addition to high injury severity factors (hospital and intensive care unit (ICU) length of stay (LOS), Injury Severity Score (ISS), patient treatment options, disposition, and outcome) were calculated to compare longboarder to skateboarder injuries. A total of 824 patients met the inclusion criteria. Skull fractures, traumatic brain injuries (TBI), and intracranial hemorrhage (ICH) were significantly more common among longboard patients than skateboarders (P<0.0001). All patients with an ISS above 15 were longboarders. Hospital and ICU LOS in days was also significantly greater for longboarders compared with skateboarders (P<0.0001). Of the three patients that died, each was a longboarder and each experienced a head injury. Longboard injuries account for a higher incidence rate of severe head injuries compared to skateboard injuries. Our data show that further, prospective investigation into the longboarding population demographics and injury patterns is necessary to contribute to effective injury prevention in this population.

scholarly journals P142: The anticoagulated trauma patient: a Canadian experience in the era of direct oral anticoagulants

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S125-S125 ◽  
Author(s):  
B. Wood ◽  
A. Ackery ◽  
S. Rizoli ◽  
B. Nascimento ◽  
M. Sholzberg ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Injury Severity ◽  
Hematological Parameters ◽  
Oral Anticoagulants ◽  
Demographic Data ◽  
Direct Oral Anticoagulants ◽  
Significant Proportion ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Trauma Population

Introduction: The anticoagulated trauma patient is a particularly vulnerable population. Our current practice is guided by experience with patients taking vitamin K dependent antagonists (VKA, like warfarin). It is currently unknown how the increasing use of direct oral anticoagulants (DOACs) will change our trauma population. We collected data about this new subset of patients to compare their clinical characteristics to patients on pre-injury VKA therapy. Methods: Retrospective review of anticoagulated trauma patients presenting to Toronto’s two adult trauma centres, Saint Michael’s Hospital and Sunnybrook Health Sciences Centre, from June 2014-June 2015 was undertaken. Patients were recruited through the institutions’ trauma registries and were eligible if they suffered a traumatic injury and taking an oral anticoagulant pre-injury. Clinical and demographic data were extracted by a trained reviewer and analysed with descriptive statistics. Results: Our study recruited 85 patients, 33% were taking DOACs and 67% VKAs. Trauma patients on DOACs & VKAs respectively had similar baseline characteristics such as age (75.9 vs 77.4), initial injury severity score (ISS (16.9 vs 20.6)) and concomitant antiplatelet use (7.1% vs 5.4%). Both groups’ most common mechanism for injury was falls and the most common indication for anticoagulation was atrial fibrillation. Patients on DOACs tended to have lower average INR (1.25 vs 2.3) and serum creatinine (94.9 vs 127.4). Conclusion: Patients on DOACs pre-injury now account for a significant proportion of orally anticoagulated trauma patients. Patients on DOACs tended to have less derangement of basic hematological parameters complicating diagnosis and management of coagulopathy.

scholarly journals Non-accidental trauma increases length of stay and mortality in pediatric trauma

2019 ◽  
Vol 35 (7) ◽  
pp. 779-784 ◽  
Author(s):  
J. K. Livingston ◽  
A. Grigorian ◽  
C. M. Kuza ◽  
M. Lekawa ◽  
N. Bernal ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Pediatric Trauma ◽  
Accidental Trauma ◽  
Non Accidental Trauma

scholarly journals Secondary overtriage of pediatric neurosurgical trauma at a Level I pediatric trauma center

2018 ◽  
Vol 22 (4) ◽  
pp. 375-383 ◽  
Author(s):  
Charles E. Mackel ◽  
Brent C. Morel ◽  
Jesse L. Winer ◽  
Hannah G. Park ◽  
Megan Sweeney ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Care Center ◽  
Tertiary Care ◽  
Pediatric Trauma ◽  
Pediatric Intensive Care ◽  
Ct Scans ◽  
Loss Of Consciousness ◽  
Skull Fractures ◽  
Level I ◽  
Neurosurgical Intervention

OBJECTIVEThe authors reviewed the transfer requests for isolated pediatric traumatic brain injuries (TBIs) at a Level I/II facility with the goal of identifying clinical and radiographic traits associated with potentially avoidable transfers that could be safely managed in a non–tertiary care setting.METHODSThe authors conducted a retrospective study of patients < 18 years of age classified as having TBI and transferred to their Level I tertiary care center over a 12-year period. The primary outcome of interest was identifying potentially avoidable transfers, defined as transfers of patients not requiring any neurosurgical intervention and discharged 1 hospital day after admission.RESULTSOverall, 70.8% of pediatric patients with isolated TBI did not require neurosurgical intervention or monitoring, indicating an avoidable transfer. Potentially avoidable transfers were associated with outside hospital imaging that was negative (86%) or showed isolated, nondisplaced skull fractures (86%) compared to patients with cranial pathology (53.8%, p < 0.001) as well as age ≤ 6 years (81% [negative imaging/isolated, nondisplaced fractures] vs 54% [positive cranial pathology], p < 0.001). The presence of headaches, nonfocal deficits, and loss of consciousness were associated with necessary transfer (p < 0.05). Patients with potentially avoidable transfers underwent frequent repeat CT studies (19.1%) and admissions to the pediatric intensive care unit (55.9%) but at a lower rate than those whose transfers were necessary (p < 0.001). Neurosurgical interventions occurred in 11% of patients with cranial pathology, which accounted for 17.9% of necessary transfers and 5.2% of all transfers.CONCLUSIONSIn the authors’ region, potentially up to 70% of interfacility transfers for pediatric brain trauma in the absence of other systemic injuries warranting surgical intervention may not require neurosurgical intervention and could be managed locally. No patients transferred with isolated, nondisplaced skull fractures or negative CT scans required neurosurgical intervention, and 86% were discharged the day after admission. In contrast, 11% of patients with CT scans indicative of cranial pathology required neurosurgical intervention. Age > 6 years, loss of consciousness, and nonfocal deficits were associated with a greater likelihood of needing a transfer. Further studies are required to clarify which patients can be managed at local institutions, but referring centers should practice overcaution given the potential risks.

scholarly journals Comparison of Injury Patterns between Electric Bicycle, Bicycle and Motorcycle Accidents

2021 ◽  
Vol 10 (15) ◽  
pp. 3359
Author(s):  
Emilian Spörri ◽  
Sascha Halvachizadeh ◽  
Jamison G. Gamble ◽  
Till Berk ◽  
Florin Allemann ◽  
...  
Keyword(s):  
Traffic Accidents ◽  
Brain Injuries ◽  
Injury Severity ◽  
Craniocerebral Trauma ◽  
Injury Pattern ◽  
Injury Patterns ◽  
Electric Bicycle ◽  
Extremity Injuries ◽  
The Individual ◽  
Motorcycle Accidents

Background: Electric bicycles (E-bikes) are an increasingly popular means of transport, and have been designed for a higher speed comparable to that of small motorcycles. Accident statistics show that E-bikes are increasingly involved in traffic accidents. To test the hypothesis of whether accidents involving E-bikes bear more resemblance to motorcycle accidents than conventional bicyclists, this study evaluates the injury pattern and severity of E-bike injuries in direct comparison to injuries involving motorcycle and bicycle accidents. Methods: In this retrospective cohort study, the data of 1796 patients who were treated at a Level I Trauma Center between 2009 and 2018 due to traffic accident, involving bicycles, E-bikes or motorcycles, were evaluated and compared with regard to injury patterns and injury severity. Accident victims treated as inpatients at least 16 years of age or older were included in this study. Pillion passengers and outpatients were excluded. Results: The following distribution was found in the individual groups: 67 E-bike, 1141 bicycle and 588 motorcycle accidents. The injury pattern of E-bikers resembled that of bicyclists much more than that of motorcyclists. The patients with E-bike accidents were almost 14 years older and had a higher incidence of moderate traumatic brain injuries than patients with bicycle accidents, in spite of the fact that E-bike riders were nearly twice as likely to wear a helmet as compared to bicycle riders. The rate of pelvic injuries in E-bike accidents was twice as high compared with bicycle accidents, whereas the rate of upper extremity injuries was higher following bicycle accidents. Conclusion: The overall E-bike injury pattern is similar to that of cyclists. The differences in the injury pattern to motorcycle accidents could be due to the higher speeds at the time of the accident, the different protection and vehicle architecture. What is striking, however, is the higher age and the increased craniocerebral trauma of the E-bikers involved in accidents compared to the cyclists. We speculate that older and untrained people who have a slower reaction time and less control over the E-bike could benefit from head protection or practical courses similar to motorcyclists.

scholarly journals Effects of the COVID-19 pandemic on pediatric trauma in Southern California

2021 ◽  
Author(s):  
Eric O. Yeates ◽  
Areg Grigorian ◽  
Morgan Schellenberg ◽  
Natthida Owattanapanich ◽  
Galinos Barmparas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pediatric Patients ◽  
Demographic Data ◽  
Pediatric Trauma ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
Single Center ◽  
Trauma Population ◽  
Time Periods ◽  
And Control

Abstract Purpose The COVID-19 pandemic resulted in increased penetrating trauma and decreased length of stay (LOS) amongst the adult trauma population, findings important for resource allocation. Studies regarding the pediatric trauma population are sparse and mostly single-center. This multicenter study examined pediatric trauma patients, hypothesizing increased penetrating trauma and decreased LOS after the 3/19/2020 stay-at-home (SAH) orders. Methods A multicenter retrospective analysis of trauma patients ≤ 17 years old presenting to 11 centers in California was performed. Demographic data, injury characteristics, and outcomes were collected. Patients were divided into three groups based on injury date: 3/19/2019–6/30/2019 (CONTROL), 1/1/2020–3/18/2020 (PRE), 3/19/2020–6/30/2020 (POST). POST was compared to PRE and CONTROL in separate analyses. Results 1677 patients were identified across all time periods (CONTROL: 631, PRE: 479, POST: 567). POST penetrating trauma rates were not significantly different compared to both PRE (11.3 vs. 9.0%, p = 0.219) and CONTROL (11.3 vs. 8.2%, p = 0.075), respectively. POST had a shorter mean LOS compared to PRE (2.4 vs. 3.3 days, p = 0.002) and CONTROL (2.4 vs. 3.4 days, p = 0.002). POST was also not significantly different than either group regarding intensive care unit (ICU) LOS, ventilator days, and mortality (all p > 0.05). Conclusions This multicenter retrospective study demonstrated no difference in penetrating trauma rates among pediatric patients after SAH orders but did identify a shorter LOS.

scholarly journals Undertriage of Pediatric Major Trauma Patients in the United States

2017 ◽  
Vol 56 (9) ◽  
pp. 845-853 ◽  
Author(s):  
Jin Peng ◽  
Krista Wheeler ◽  
Jonathan I. Groner ◽  
Kathryn J. Haley ◽  
Henry Xiang
Keyword(s):  
Rural Areas ◽  
Chronic Conditions ◽  
Major Trauma ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
The United States ◽  
Trauma Patients ◽  
Trauma Population ◽  
Life Threatening ◽  
Delivery Models

Although trauma undertriage has been widely discussed in the literature, undertriage in the pediatric trauma population remains understudied. Using the 2009-2013 Nationwide Emergency Department Sample, we assessed the national undertriage rate in pediatric major trauma patients (age ≤16 years and injury severity score [ISS] >15), and identified factors associated with pediatric trauma undertriage. Nationally, 21.7% of pediatric major trauma patients were undertriaged. Children living in rural areas were more likely to be undertriaged ( P = .02), as were those without insurance ( P = .00). Children with life-threatening injuries were less likely to be undertriaged ( P < .0001), as were those with chronic conditions ( P < .0001). Improving access to specialized pediatric trauma care through innovative service delivery models may reduce undertriage and improve outcomes for pediatric major trauma patients.

Percutaneous versus Open Tracheostomy in the Pediatric Trauma Population

2010 ◽  
Vol 76 (3) ◽  
pp. 276-278 ◽  
Author(s):  
Ashish Raju ◽  
D'Andrea K. Joseph ◽  
Cheickna Diarra ◽  
Steven E. Ross
Keyword(s):  
Injury Severity ◽  
Percutaneous Tracheostomy ◽  
Pediatric Trauma ◽  
Retrospective Chart Review ◽  
Feeding Tube ◽  
Tube Placement ◽  
Trauma Patients ◽  
Complication Rates ◽  
Trauma Population ◽  
Significant Difference

The purpose of this study was to determine the safety and efficacy of percutaneous versus open tracheostomy in the pediatric trauma population. A retrospective chart review was conducted of all tracheostomies performed on trauma patients younger than 18 years for an 8-year period. There was no difference in the incidence of brain, chest, or facial injury between the open and percutaneous tracheostomy groups. However, the open group had a significantly lower age (14.2 vs. 15.5 years; P < 0.01) and higher injury severity score (26 vs. 21; P = 0.015). Mean time from injury to tracheostomy was 9.1 days (range, 0 to 16 days) and was not different between the two methods. The majority of open tracheostomies were performed in the operating room and, of percutaneous tracheostomies, at the bedside. Concomitant feeding tube placement did not affect complication rates. There was not a significant difference between complication rates between the two methods of tracheostomy (percutaneous one of 29; open three of 20). Percutaneous tracheostomy can be safely performed in the injured older child.

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