Experience in an Urban Level 1 Trauma Center With Tranexamic Acid in Pediatric Trauma: A Retrospective Chart Review

2020 ◽  
pp. 088506661989083
Author(s):  
Julie M. Thomson ◽  
Hanh H. Huynh ◽  
Holly M. Drone ◽  
Jessica L. Jantzer ◽  
Albert K. Tsai ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Tranexamic Acid ◽  
Trauma Center ◽  
Surgical Intervention ◽  
Statistical Significance ◽  
Pediatric Trauma ◽  
End Points ◽  
Transfusion Requirements ◽  
Level 1 ◽  
Level 1 Trauma Center

Background: Evidence for tranexamic acid (TXA) in the pharmacologic management of trauma is largely derived from data in adults. Guidance on the use of TXA in pediatric patients comes from studies evaluating its use in cardiac and orthopedic surgery. There is minimal data describing TXA safety and efficacy in pediatric trauma. The purpose of this study is to describe the use of TXA in the management of pediatric trauma and to evaluate its efficacy and safety end points. Methods: This retrospective, observational analysis of pediatric trauma admissions at Hennepin County Medical Center from August 2011 to March 2019 compares patients who did and did not receive TXA. The primary end point is survival to hospital discharge. Secondary end points include surgical intervention, transfusion requirements, length of stay, thrombosis, and TXA dose administered. Results: There were 48 patients aged ≤16 years identified for inclusion using a massive transfusion protocol order. Twenty-nine (60%) patients received TXA. Baseline characteristics and results are presented as median (interquartile range) unless otherwise specified, with statistical significance defined as P < .05. Patients receiving TXA were more likely to be older, but there was no difference in injury type or Injury Severity Score at baseline. There was no difference in survival to discharge or thrombosis. Patients who did not receive TXA had numerically more frequent surgical intervention and longer length of stay, but these did not reach significance. Conclusions: TXA was utilized in 60% of pediatric trauma admissions at a single level 1 trauma center, more commonly in older patients. Although limited by observational design, we found patients receiving TXA had no difference in mortality or thrombosis.

A Handoff Protocol for Pediatric Trauma Patients at a Rural Level One Trauma Center Reduces Length of Stay

2020 ◽  
pp. 000313482095633
Author(s):  
Evelyn Coile ◽  
Kathryn Bailey ◽  
Eric J. Clayton ◽  
Tatiana R. Eversley Kelso ◽  
Heather MacNew
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Before And After ◽  
Ancillary Staff ◽  
Trauma Triage ◽  
Level 1 ◽  
Trauma Surgeons ◽  
Level 1 Trauma Center

Background The management of the pediatric trauma patient is variable among trauma centers. In some institutions, the trauma surgeon maintains control of the patient throughout the hospital stay, while others transfer to a pediatric specialist after the initial evaluation and resuscitation period. We hypothesized that handoff to the pediatric surgeon would decrease the length of stay by more efficient coordination with pediatric subspecialists and ancillary staff. Methods A retrospective review from October 2014 to October 2018 was conducted at our rural level 1 trauma center analyzing the length of stay across all demographics and trauma triage levels before and after institution of a handoff protocol from adult specialized trauma surgeons to pediatric surgeons within a 24-hour window. Further analysis included emergency department (ED) disposition to include the effect of handoff on the length of stay in the setting of a higher post-ED acuity, that is, disposition of monitored beds. Results 1267 patient charts were analyzed and the mean length of stay was reduced by .38 days ( t = 5.92, P < .0005) across all demographics, trauma triage levels, post-ED dispositions, and mechanisms of injury after institution of our handoff protocol. Conclusion Handoff from adult specialized trauma surgeons to pediatric surgeons within a 24-hour window at a rural level 1 trauma center significantly improved the length of stay by .38 ( t = 5.92, P < .0005) among pediatric trauma patients in all demographics, trauma triage activations levels, mechanisms of injury, and post-ED dispositions acuity levels.

scholarly journals Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?

2015 ◽  
Vol 4 (5) ◽  
pp. 1 ◽  
Author(s):  
Erin Powers Kinney ◽  
Kamal Gursahani ◽  
Eric Armbrecht ◽  
Preeti Dalawari
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Hospital Capacity ◽  
Significant Difference ◽  
Level 1 ◽  
Level 1 Trauma Center

Objective: Previous studies looking at emergency department (ED) crowding and delays of care on outcome measures for certain medical and surgical patients excluded trauma patients. The objectives of this study were to assess the relationship of trauma patients’ ED length of stay (EDLOS) on hospital length of stay (HLOS) and on mortality; and to examine the association of ED and hospital capacity on EDLOS.Methods: This was a retrospective database review of Level 1 and 2 trauma patients at a single site Level 1 Trauma Center in the Midwest over a one year period. Out of a sample of 1,492, there were 1,207 patients in the analysis after exclusions. The main outcome was the difference in hospital mortality by EDLOS group (short was less than 4 hours vs. long, greater than 4 hours). HLOS was compared by EDLOS group, stratified by Trauma Injury Severity Score (TRISS) category (< 0.5, 0.51-0.89, > 0.9) to describe the association between ED and hospital capacity on EDLOS.Results: There was no significant difference in mortality by EDLOS (4.8% short and 4% long, p = .5). There was no significant difference in HLOS between EDLOS, when adjusted for TRISS. ED census did not affect EDLOS (p = .59), however; EDLOS was longer when the percentage of staffed hospital beds available was lower (p < .001).Conclusions: While hospital overcrowding did increase EDLOS, there was no association between EDLOS and mortality or HLOS in leveled trauma patients at this institution.

scholarly journals Management and Outcome of Traumatic Intracerebral Hemorrhage in 79 Infants and Children from a Single Level 1 Trauma Center

Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 854
Author(s):  
Harald Binder ◽  
Marek Majdan ◽  
Johannes Leitgeb ◽  
Stephan Payr ◽  
Robert Breuer ◽  
...  
Keyword(s):  
Trauma Center ◽  
Pediatric Trauma ◽  
Neurological Status ◽  
Neurological Impairment ◽  
Infants And Children ◽  
Single Level ◽  
Intracerebral Bleeding ◽  
Level 1 ◽  
Level 1 Trauma Center

Objective: Traumatic brain injury is a leading form of pediatric trauma and a frequent cause of mortality and acquired neurological impairment in children. The aim of this study was to present the severity and outcomes of traumatic intracerebral bleeding in children and adolescence. Methods: Seventy-nine infants and children with intracerebral bleedings were treated between 1992 and 2020 at a single level 1 trauma center. Data regarding accident, treatment and outcomes were collected retrospectively. The Glasgow Outcome Scale was used to classify the outcome at hospital discharge and at follow-up visits. CT scans of the brain were classified according to the Rotterdam score. Results: In total, 41 (52%) patients with intracerebral bleedings were treated surgically, and 38 (48%) patients were treated conservatively; in 15% of the included patients, delayed surgery was necessary. Patients presenting multiple trauma (p < 0.04), higher ISS (p < 0.01), poor initial neurological status (p < 0.001) and a higher Rotterdamscore (p = 0.038) were significantly more often treated surgically. Eighty-three percent of patients were able to leave the hospital, and out of these patients, about 60% showed good recovery at the latest follow-up visit. Overall, 11 patients (14%) died. Conclusion: The findings in this study verified intracerebral bleeding as a rare but serious condition. Patients presenting with multiple traumas, higher initial ISS, poor initial neurological status and a higher Rotterdamscore were more likely treated by surgery. Trial registration: (researchregistry 2686).

Prehospital administration of tranexamic acid in trauma patients: A 1:1 matched comparative study from a level 1 trauma center

2020 ◽  
Vol 38 (2) ◽  
pp. 266-271 ◽  
Author(s):  
Ayman El-Menyar ◽  
Brijesh Sathian ◽  
Bianca M. Wahlen ◽  
Husham Abdelrahman ◽  
Ruben Peralta ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Comparative Study ◽  
Trauma Center ◽  
Trauma Patients ◽  
Level 1 ◽  
Level 1 Trauma Center

scholarly journals Pediatric Trauma and the COVID-19 Pandemic: A 12-Year Comparison in a Level-1 Trauma Center

2020 ◽  
Vol 16 (S1) ◽  
pp. 92-96
Author(s):  
Gerard A. Sheridan ◽  
Matthew Nagle ◽  
Shane Russell ◽  
Stanly Varghese ◽  
Padhraig F. O’Loughlin ◽  
...  
Keyword(s):  
Trauma Center ◽  
Pediatric Trauma ◽  
Level 1 ◽  
Level 1 Trauma Center

scholarly journals Open Pelvic Fractures: Review of 30 Cases

2016 ◽  
Vol 10 (1) ◽  
pp. 772-778 ◽  
Author(s):  
Vincenzo Giordano ◽  
Hilton Augusto Koch ◽  
Savino Gasparini ◽  
Felipe Serrão de Souza ◽  
Pedro José Labronici ◽  
...  
Keyword(s):  
Pelvic Fracture ◽  
Significant Relationship ◽  
Trauma Center ◽  
Outpatient Visit ◽  
Statistical Significance ◽  
Pelvic Fractures ◽  
Classification Systems ◽  
Satisfactory Outcome ◽  
Level 1 ◽  
Level 1 Trauma Center

Background: Open pelvic fractures are rare but usually associated with a high incidence of complications and increased mortality rates. The aim of this study was to retrospectively evaluate all consecutive open pelvic fractures in patients treated at a single Level-1 Trauma Center during a 10-year interval. Patients and Methods: In a 10-year interval, 30 patients with a diagnosis of open pelvic fracture were admitted at a Level-1 Trauma Center. A retrospective analysis was conducted on data obtained from the medical records, which included patient’s age, sex, mechanism of injury, classification of the pelvic lesion, Injury Severity Score (ISS), emergency interventions, surgical interventions, length of hospital and Intensive Care Unit stay, and complications, including perioperative complications and death. The Jones classification was used to characterize the energy of the pelvic trauma and the Faringer classification to define the location of the open wound. Among the survivors, the results were assessed in the last outpatient visit using the EuroQol EQ-5D and the Blake questionnaires. It was established the relationship between the mortality and morbidity and these classification systems by using the Mann-Whitney non-parametric test, with a level of significance of 5%. Results: Twelve (40%) patients died either from the pelvic lesion or related injuries. All of them had an ISS superior to 35. The Jones classification showed a direct relationship to the mortality rate in those patients (p = 0.012). In the 18 (60%) other patients evaluated, the mean follow-up was 16.3 months, ranging from 24 to 112 months. Eleven (61%) patients had a satisfactory outcome. The Jones classification showed a statistically significant relationship both to the objective and subjective outcomes (p < 5%). The Faringer classification showed a statistically significant relationship to the subjective, but not to the objective outcome. In addition, among the 18 patients evaluated at the last outpatient visit, the Faringer classification showed statistical significance on the need of colostomy (p = 0.001) in the acute phase of treatment. Conclusion: We suggest the routine use of the Jones classification for the emergency room assessment and management of all open fractures of the pelvic ring. We believe the Faringer classification seems to be useful for the abdominal surgeons for the indication of gut transit derivation but not for the acute management of the bony component of an open pelvic fracture.

scholarly journals Seasonal Trends in Operative Pediatric Supracondylar Humerus and Femoral Shaft Fractures at a Pediatric Level 1 Trauma Center

2021 ◽  
Vol 4 (2) ◽  
Keyword(s):  
Trauma Center ◽  
Pediatric Trauma ◽  
Case Series ◽  
Femoral Shaft ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Temperature And Precipitation ◽  
Census Methods ◽  
Level 1 ◽  
Level 1 Trauma Center

Background: Supracondylar humerus (SCHF) and femoral shaft (FSF) fractures are two common injuries at pediatric trauma centers. While anecdotally we see an increase in injuries with warmer weather, the purpose of this study was to objectively describe the seasonal variation in these operative fractures, and their relative burden on hospital census. Methods: We performed an IRB-approved, retrospective review of 1626 SCHF and 601 FSF treated operatively from 2013-2018 at a single level 1 pediatric trauma center. Dates of injury were categorized with hospital census information, and temperature and precipitation data were obtained through the National Weather Service. Results: For every 10º F increase in temperature, there was a 5% increased likelihood of FSF (p=0.048) and a 26% increased likelihood of SCHF (p=<0.0001). FSF were less likely to occur on weekdays than weekends (OR 0.59, p<0.0001) and less likely to occur on days with precipitation (OR 0.41, p= 0.03). SCHF demonstrated no significant weekly or precipitation-related trends. SCHF represent a significantly larger burden on orthopedic volume during summer months. The ratio of operative FSF relative to the total orthopedic volume per month did not correlate with season. Conclusions: As often anecdotally reported, SCHF volumes mirror temperature variations annually. FSF appear to have more complex trends, with increased incidence on weekends regardless of season. Geographic variation in weather contributes strongly to pediatric trauma volume, and the ability to forecast a hospital system’s operative fracture volume allows for responsible resource allocation during key periods. Level of Evidence: Retrospective case series, Level IV

scholarly journals Pediatric Nonaccidental Trauma: Experience at a Level 1 Trauma Center

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Taylor Goldman ◽  
Sathyaprasad Burjonrappa
Keyword(s):  
Trauma Center ◽  
Pediatric Trauma ◽  
High Index ◽  
Organ Injury ◽  
Fisher Exact Test ◽  
Injury Patterns ◽  
Nonaccidental Trauma ◽  
Level 1 ◽  
High Index Of Suspicion ◽  
Level 1 Trauma Center

Introduction. Pediatric nonaccidental trauma (NAT) is difficult to diagnose. Several isolated injuries in NAT could happen in the setting of accidental trauma (AT), and having a high index of suspicion is important to correctly identify abuse. NAT has a significant mortality rate if the sentinel event is not adequately diagnosed, and the infant is not separated from the perpetrator. Level 1 pediatric trauma centers (PTC) see a significant number of NAT. We evaluated the injury patterns of NAT admissions at our level 1 PTC. Methods. Retrospective analysis of all cases of NAT for children under the age of two admitted at an ACS level 1 pediatric trauma center between the years of 2016 and 2018. Charts were queried for demographic data, injury patterns, mortality, and disposition. Correlation between disposition status and injury patterns was performed. The Fisher Exact test and student t -test were used to study the significance of differences in categorical and continuous data, respectively. Results. 32/91 (35%) trauma patients under the age of two years were diagnosed as NAT in the three-year study period. 21/32 (39%) male and 11/26 (42%) female admissions were confirmed NAT ( p = NS ). 20 were under 1 year of age, and 12 were aged between 1 and 2 years ( p = NS ). 13 (41%) were Caucasian, 6 (19%) were Hispanic/Latino, 11 (34%) were Black, and 2(6%) were of unknown ethnicity ( p = NS ). Facial, torso, lower extremity, retinal, and internal organ injury were significantly more common with NAT. Medicaid coverage was noted in 31/32 (97%) NAT patients. 20/32 (62.5%) patients were legally displaced as a result of the NAT. Conclusion. 1/3rd of all admissions at a pediatric level 1 trauma center were identified as NAT. A high index of suspicion is necessary to not miss NAT, as injury patterns are variable. Nearly 1/3rd of all victims go back to the same environment where they sustained NAT increasing their susceptibility to future NAT.

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