Temporal Variations in Pediatric Trauma: Rationale for Altered Resource Utilization

Trauma is a major cause of morbidity and mortality in the pediatric population. However, temporal variations of trauma have not been well characterized and may have implications for appropriate allocation of hospital resources. Data from patients evaluated at an ACS-verified Level I pediatric trauma center between 2011 and 2015 were retrospectively analyzed. Date and time of injury, type of injury (blunt vs penetrating), and postemergency department disposition were reviewed. To assess temporal trends, heatmaps were constructed and a mixed poisson regression model was used to assess statistical significance. Pediatric trauma from blunt and penetrating injuries occurred at significantly higher rates between the hours of 1800 and 0100, on weekends compared with weekdays, and from May to August compared with November to February. These data provide useful information for hospital resource utilization. The emergency department, operating room, and intensive care unit should be prepared for increased trauma-related volume between May and August, weekends, and evening hours by appropriately increasing staff volume and resource availability.

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Epidemiology of Pediatric Trauma and Its Patterns in Western Iran: A Hospital Based Experience

Global Journal of Health Science ◽

10.5539/gjhs.v8n6p139 ◽

2015 ◽

Vol 8 (6) ◽

pp. 139 ◽

Cited By ~ 9

Author(s):

Fereshteh Jalalvandi ◽

Peyman Arasteh ◽

Roya Safari Faramani ◽

Masoumeh Esmaeilivand

Keyword(s):

Head And Neck ◽

Traffic Accidents ◽

Road Traffic ◽

Pediatric Population ◽

Care Center ◽

Pediatric Trauma ◽

Age Groups ◽

Road Traffic Accidents ◽

Orthopedic Injury ◽

The Hours

BACKGROUND & OBJECTIVE: Trauma is a major cause of mortality in children aged 1 to 14 years old and its patterns differs from country to country. In this study we investigated the epidemiology and distribution of non-intentional trauma in the pediatric population.MATERIALS & METHODS: The archives of 304 children below 10 years old who presented to Taleghani trauma care center in Kermanshah, Iran from March to September 2008, were reviewed. Patients’ demographic and injury related information were registered. The participants were categorized into three age groups of 0-2, 3-6 and 7-10 years old and the data was compared among age groups and between both sexes.FINDINGS: The most common cause for trauma was falling from heights (65.5%) and road traffic accidents (16.4%). The most common anatomical sites of injury were the upper limbs followed by the head and neck (36.8% and 31.2%, respectively). Injuries mostly occurred in homes (67.4%). The injuries were mostly related to the orthopedics and the neurosurgery division (84.1% and 13.1%, respectively). Accident rates peaked during the hours of 18-24 (41.3%). Male and female patients did display any difference regarding the variables.Children between the ages of 0-2 years old had the highest rate of injury to the head and neck area (40.3%) (p=0.024). Falls and road traffic accidents displayed increasing rates from the ages of 0-2 to 3-6 and decreasing rates to the ages of 7-10 years old (p=0.013). From the ages of 0-2 to 3-6 years old, street accidents increased and household traumas decreased. After that age household trauma rates increased and street accidents decreased (p=0.005). Children between the ages of 7-10 years old had the highest rate of orthopedic injury (p=0.029).CONCLUSION: Special planning and health policies are needed to prevent road accidents especially in children between the ages of 3-6 years old. Since homes were the place where children between the ages of 0-2 were mostly injured, parents should be educated about the correct safety measures that they need to take regarding their children's environments. The orthopedics department needs to receive the most training and resources for the management of pediatric trauma.

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Evaluation of the Pediatric Trauma Triage Checklist as a Prehospital Pediatric Trauma Triage Tool for the State of Florida

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00042308 ◽

1996 ◽

Vol 11 (1) ◽

pp. 20-26 ◽

Cited By ~ 4

Author(s):

William P. Johnson

Keyword(s):

Pediatric Population ◽

Prehospital Care ◽

Statistical Significance ◽

Pediatric Trauma ◽

Outcome Data ◽

Care Providers ◽

Severity Of Injury ◽

Trauma Triage ◽

Trauma Score ◽

User Friendly

AbstractIntroduction:Triage of injured children poses a significant challenge for prehospital-care providers because there is no single trauma triage tool in use that has been developed specifically for children. The pediatric trauma score (PTS) probably is the single most studied and tested trauma triage tool developed solely for the pediatric population, and is an effective predictor of both severity of injury and potential mortality in injured children. However, the pediatric trauma score has been found to be an ineffective prehospital triage tool because it is not “user friendly” for field personnel. As such, the PTS has been modified to generate the more user-friendly ”pediatric trauma triage checklist (PTTC).”Methods:This study retrospectively reviewed 106 prehospital run reports to determine whether the patient met one or more of the criteria in the PTTC. By applying the MacKenzie algorithm to outcome data for each case, it was possible to determine whether the patient should have been sent to a trauma center.Results:The PTTC demonstrated a sensitivity of 86.2%, a specificity of 41.6%, and an accuracy of 66.0%. The PTTC demonstrate an overtriage rate of 58.3% and an under-triage rate of 13.8%. When compared with a previous study, the PTTC demonstrated a 74 % increase in overtriage. However, the 59% reduction in undertriage is more important.Conclusions:Use of the PTTC appears to have merit as a pediatric prehospital trauma triage tool but further study is recommended. The PTTC should be tested in a prospective, multiregional study involving a sample size sufficient to reach statistical significance.

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Mapping US Pediatric Hospitals and Subspecialty Critical Care for Public Health Preparedness and Disaster Response, 2008

Disaster Medicine and Public Health Preparedness ◽

10.1001/dmp.2012.28 ◽

2012 ◽

Vol 6 (2) ◽

pp. 117-125 ◽

Cited By ~ 12

Author(s):

Mary D. Brantley ◽

Hua Lu ◽

Wanda D. Barfield ◽

James B. Holt ◽

Alcia Williams

Keyword(s):

Public Health ◽

Critical Care ◽

Pediatric Population ◽

Pediatric Trauma ◽

Trauma Centers ◽

Public Health Preparedness ◽

Preparedness Planning ◽

Proximity Analysis ◽

Pediatric Hospitals ◽

Level I

ABSTRACTObjective: The objective is to describe by geographic proximity the extent to which the US pediatric population (aged 0-17 years) has access to pediatric and other specialized critical care facilities, and to highlight regional differences in population and critical resource distribution for preparedness planning and utilization during a mass public health disaster.Methods: The analysis focused on pediatric hospitals and pediatric and general medical/surgical hospitals with specialized pediatric critical care capabilities, including pediatric intensive care units (PICU), pediatric cardiac ICUs (PCICU), level I and II trauma and pediatric trauma centers, and general and pediatric burn centers. The proximity analysis uses a geographic information system overlay function: spatial buffers or zones of a defined radius are superimposed on a dasymetric map of the pediatric population. By comparing the population living within the zones to the total population, the proportion of children with access to each type of specialized unit can be estimated. The project was conducted in three steps: preparation of the geospatial layer of the pediatric population using dasymetric mapping methods; preparation of the geospatial layer for each resource zone including the identification, verification, and location of hospital facilities with the target resources; and proximity analysis of the pediatric population within these zones.Results: Nationally, 63.7% of the pediatric population lives within 50 miles of a pediatric hospital; 81.5% lives within 50 miles of a hospital with a PICU; 76.1% lives within 50 miles of a hospital with a PCICU; 80.2% lives within 50 miles of a level I or II trauma center; and 70.8% lives within 50 miles of a burn center. However, state-specific proportions vary from less than 10% to virtually 100%. Restricting the burn and trauma centers to pediatric units only decreases the national proportion to 26.3% for pediatric burn centers and 53.1% for pediatric trauma centers.Conclusions: This geospatial analysis describes the current state of pediatric critical care hospital resources and provides a visual and analytic overview of existing gaps in local pediatric hospital coverage. It also highlights the use of dasymetric mapping as a tool for public health preparedness planning.(Disaster Med Public Health Preparedness. 2012;6:117–125)

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Pediatric trauma at a single center in the Qassim region of Saudi Arabia

Annals of Saudi Medicine ◽

10.5144/0256-4947.2021.165 ◽

2021 ◽

Vol 41 (3) ◽

pp. 165-170

Author(s):

Hakem Alomani ◽

Abdulbaset Fareed ◽

Hassan Ibrahim ◽

Ahmed Shaltoot ◽

Ahmed Elhalawany ◽

...

Keyword(s):

Saudi Arabia ◽

Traffic Accidents ◽

Road Traffic ◽

Pediatric Population ◽

Pediatric Trauma ◽

Pediatric Intensive Care ◽

Healthcare Services ◽

Road Traffic Accidents ◽

Single Center ◽

Type Of Injury

BACKGROUND: Trauma is one of the leading causes of pediatric mortality so the prevention of pediatric trauma is an important goal of any healthcare system. There are only a few studies on pediatric trauma in Saudi Arabia. The availability of data is vital for healthcare leaders in planning for healthcare services. OBJECTIVE: Assess the epidemiology, patterns, and outcome of trauma in the pediatric population in the Qassim region in Saudi Arabia. DESIGN: Descriptive medical records review. SETTING: A single-center, academic specialized pediatric referral hospital. PATIENTS AND METHODS: We reviewed all electronic and paper records for children (<14 years of age) admitted with a diagnosis of trauma to Maternity and Childrens Hospital (MCH) in Buraidah city in the two-year period between January 2017 and December 2018. MAIN OUTCOME MEASURE: Type of injury, length of stay, and mortality. SAMPLE SIZE: 133 children. RESULT: In this cohort, 77 cases (58%) were admitted to the pediatric intensive care unit (PICU) and 56 (42%) to the pediatric surgery ward. The median (interquartile range) age was 5 (1.1-8) years, and 92 (69%) were boys. The most frequent trauma was road traffic accidents, accounting for 70 cases (52%), followed by fall from a height for 40 (30%) cases. Traumatic brain injury was the most frequent type of injury, accounting for 56 cases (42%), and blunt abdominal trauma was in 11 cases (8.3%). Neurosurgery was the primary subspecialty actively involved in 62 cases (47%). Of the injured children who were admitted to PICU, 36 (46%) needed mechanical ventilation support, while 7 (9%) of those admitted to PICU required the insertion of intra-costal drainage. The mortality in our study was 3.7% (5 cases); 4 of 5 deaths were secondary to road traffic accidents. CONCLUSION: Pediatric trauma is a serious problem in our region with high mortality compared to international benchmarks. Road traffic accidents are the leading type of pediatric trauma, followed by falls from height. Further studies and perhaps national efforts are needed to identify ways to prevent road traffic accidents, and optimize the data registry and trauma services. LIMITATION: There were many missing data and incomplete files that affect accuracy and preclude generalization. CONFLICT OF INTEREST: None.

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Head injuries following television-related accidents in the pediatric population

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.7.peds1433 ◽

2014 ◽

Vol 14 (4) ◽

pp. 414-417 ◽

Cited By ~ 3

Author(s):

Adam Ross Befeler ◽

David J. Daniels ◽

Susan A. Helms ◽

Paul Klimo ◽

Frederick Boop

Keyword(s):

Pediatric Population ◽

Head Injuries ◽

Pediatric Trauma ◽

Current Data ◽

Neurological Deficits ◽

Surgical Interventions ◽

Public Education Campaign ◽

Male Head ◽

Level I ◽

The Cost

Object Current data indicate the rate of head injuries in children caused by falling televisions is increasing. The authors describe these injuries and the cost incurred by them. Methods In a single-institution retrospective review, all children treated for a television-related injury at LeBonheur Children's Hospital, a Level I pediatric trauma center, between 2009 and 2013 were identified through the institution's trauma registry. The type, mechanism, and severity of cranial injuries, surgical interventions, outcome, and costs were examined. Results Twenty-six patients were treated for a television-related injury during the study period. Most injuries (22 cases, 85%) occurred in children aged 2–4 years (mean age 3.3 years), and 19 (73%) of the 26 patients were male. Head injuries occurred in 20 patients (77%); these injuries ranged from concussion to skull fractures and subdural, subarachnoid, and intraparenchymal hemorrhages. The average Glasgow Coma Scale score on admission was 12 (range 7–15), and 3 patients (12%) had neurological deficits. Surgical intervention was required in 5 cases (19%). The majority of patients made a full recovery. There were no deaths. The total cost for television-related injuries was $1.4 million, with an average cost of $53,893 per accident. Conclusions A high occurrence of head injuries was seen following television-related accidents in young children. This injury is ideal for a public education campaign targeting parents, health care workers, and television manufacturers.

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Validation of the Surgical Intervention for Traumatic Injury scale in the pediatric population

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.2.peds19474 ◽

2020 ◽

Vol 26 (1) ◽

pp. 92-97

Author(s):

David Dornbos ◽

Christy Monson ◽

Andrew Look ◽

Kristin Huntoon ◽

Luke G. F. Smith ◽

...

Keyword(s):

Surgical Intervention ◽

Pediatric Population ◽

Traumatic Injury ◽

Pediatric Trauma ◽

Current Method ◽

Clinical Findings ◽

Surgical Decompression ◽

Operative Intervention ◽

Admission Diagnosis ◽

Communication Tool

OBJECTIVEWhile the Glasgow Coma Scale (GCS) has been effective in describing severity in traumatic brain injury (TBI), there is no current method for communicating the possible need for surgical intervention. This study utilizes a recently developed scoring system, the Surgical Intervention for Traumatic Injury (SITI) scale, which was developed to efficiently communicate the potential need for surgical decompression in adult patients with TBI. The objective of this study was to apply the SITI scale to a pediatric population to provide a tool to increase communication of possible surgical urgency.METHODSThe SITI scale uses both radiographic and clinical findings, including the GCS score on presentation, pupillary examination, and CT findings. To examine the scale in pediatric TBI, a neurotrauma database at a level 1 pediatric trauma center was retrospectively evaluated, and the SITI score for all patients with an admission diagnosis of TBI between 2010 and 2015 was calculated. The primary endpoint was operative intervention, defined as a craniotomy or craniectomy for decompression, performed within the first 24 hours of admission.RESULTSA total of 1524 patients met inclusion criteria for the study during the 5-year span: 1469 (96.4%) were managed nonoperatively and 55 (3.6%) patients underwent emergent operative intervention. The mean SITI score was 4.98 ± 0.31 for patients undergoing surgical intervention and 0.41 ± 0.02 for patients treated nonoperatively (p < 0.0001). The area under the receiver operating characteristic (AUROC) curve was used to examine the diagnostic accuracy of the SITI scale in this pediatric population and was found to be 0.98. Further evaluation of patients presenting with moderate to severe TBI revealed a mean SITI score of 5.51 ± 0.31 in 40 (15.3%) operative patients and 1.55 ± 0.02 in 221 (84.7%) nonoperative patients, with an AUROC curve of 0.95.CONCLUSIONSThe SITI scale was designed to be a simple, objective communication tool regarding the potential need for surgical decompression after TBI. Application of this scale to a pediatric population reveals that the score correlated with the perceived need for emergent surgical intervention, further suggesting its potential utility in clinical practice.

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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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Evolution of Gaseous and Particulate Pollutants in the Air: What Changed after Five Lockdown Weeks at a Southwest Atlantic European Region (Northwest of Spain) Due to the SARS-CoV-2 Pandemic?

Atmosphere ◽

10.3390/atmos12050562 ◽

2021 ◽

Vol 12 (5) ◽

pp. 562

Author(s):

Jorge Moreda-Piñeiro ◽

Joel Sánchez-Piñero ◽

María Fernández-Amado ◽

Paula Costa-Tomé ◽

Nuria Gallego-Fernández ◽

...

Keyword(s):

Air Quality ◽

Road Traffic ◽

Statistical Significance ◽

Temporal Trends ◽

Air Pollutant ◽

Concentration Data ◽

Southwest Atlantic ◽

Pollutant Concentrations ◽

Air Quality Monitoring Stations ◽

Almost All

Due to the exponential growth of the SARS-CoV-2 pandemic in Spain (2020), the Spanish Government adopted lockdown measures as mitigating strategies to reduce the spread of the pandemic from 14 March. In this paper, we report the results of the change in air quality at two Atlantic Coastal European cities (Northwest Spain) during five lockdown weeks. The temporal evolution of gaseous (nitrogen oxides, comprising NOx, NO, and NO2; sulfur dioxide, SO2; carbon monoxide, CO; and ozone, O3) and particulate matter (PM10; PM2.5; and equivalent black carbon, eBC) pollutants were recorded before (7 February to 13 March 2020) and during the first five lockdown weeks (14 March to 20 April 2020) at seven air quality monitoring stations (urban background, traffic, and industrial) in the cities of A Coruña and Vigo. The influences of the backward trajectories and meteorological parameters on air pollutant concentrations were considered during the studied period. The temporal trends indicate that the concentrations of almost all species steadily decreased during the lockdown period with statistical significance, with respect to the pre-lockdown period. In this context, great reductions were observed for pollutants related mainly to fossil fuel combustion, road traffic, and shipping emissions (−38 to −78% for NO, −22 to −69% for NO2, −26 to −75% for NOx, −3 to −77% for SO2, −21% for CO, −25 to −49% for PM10, −10 to −38% for PM2.5, and −29 to −51% for eBC). Conversely, O3 concentrations increased from +5 to +16%. Finally, pollutant concentration data for 14 March to 20 April of 2020 were compared with those of the previous two years. The results show that the overall air pollutants levels were higher during 2018–2019 than during the lockdown period.

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