scholarly journals Changes in pediatric major trauma epidemiology, injury patterns, and outcome during COVID-19–associated lockdown

Trauma ◽  
2021 ◽  
pp. 146040862110453
Author(s):  
Naama Pines ◽  
Miklosh Bala ◽  
Itai Gross ◽  
Lea Ohana-Sarna-Cahan ◽  
Ruth Shpigel ◽  
...  
Keyword(s):  
Injury Severity ◽  
Pediatric Trauma ◽  
Admission Rate ◽  
Policy Decision ◽  
Trauma Team ◽  
Injury Patterns ◽  
Hospital Policy ◽  
Policy Makers ◽  
Trauma Team Activation ◽  
Awareness Programs

Introduction The COVID-19 pandemic and its associated preventive measures such as national and regional lockdowns have dramatically changed the epidemiology of pediatric admissions to the emergency department. Nevertheless, there are scant data on the epidemiology and injury patterns of major pediatric trauma injuries during these lockdown periods. Methods A single-center retrospective study of data obtained from a tertiary level 1 trauma hospital trauma registry. The data included demographics, injury mechanisms, injury severity and type, treatment, and resource utilization in children aged 0–18 years who required trauma team activation upon arrival. The analysis compares the data from the 5-week lockdown period from March to May 2020 in Jerusalem, Israel, to its parallel periods in 2018–2019. Results A total of 187 trauma visits that required trauma team activation (TTA) were analyzed: 48 visits during the lockdown period vs. 139 in 2018–2019, corresponding to a 40% drop in TTA. There was a significant decrease of 34% in MVA-related injuries ( p = 0.0001) but a significant increase of 14% in burns ( p = 0.01) and a 16% increase in bicycle-related injuries ( p = 0.001). No changes in ISS, injury patterns, admission rate, PICU utilization, or need for interventions were observed. Conclusion There was a significant decrease in the number of overall pediatric trauma visits during the 2020 lockdown, mainly in MVA-associated trauma, but an increase in burns and bicycle injuries. These findings can thus inform policy makers as to the need to formulate prevention awareness programs alerting the public to indoor hazards and the dangers of activities outside the home. Furthermore, it can inform hospital policy decision-making in future lockdowns. The fact that PICU admissions and the need for operating rooms stayed unchanged suggests that it is vital to maintain trauma team capabilities even during lockdowns.

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.

Family Presence During Pediatric Trauma Team Activation: An Assessment of a Structured Program

PEDIATRICS ◽  
2007 ◽  
Vol 120 (3) ◽  
pp. e565-e574 ◽  
Author(s):  
K. J. O'Connell ◽  
M. M. Farah ◽  
P. Spandorfer ◽  
J. J. Zorc
Keyword(s):  
Pediatric Trauma ◽  
Trauma Team ◽  
Family Presence ◽  
Trauma Team Activation ◽  
Structured Program

scholarly journals Maximizing the Sensitivity and Specificity of Pediatric Trauma Team Activation Criteria

2000 ◽  
Vol 7 (10) ◽  
pp. 1119-1125 ◽  
Author(s):  
M. Denise Dowd ◽  
Constance McAneney ◽  
Mary Lacher ◽  
Richard M. Ruddy
Keyword(s):  
Sensitivity And Specificity ◽  
Pediatric Trauma ◽  
Trauma Team ◽  
Trauma Team Activation ◽  
Activation Criteria

Does Patient Age and Height of Fall Alone Require Trauma Team Activation?

2011 ◽  
Vol 77 (9) ◽  
pp. 1201-1205 ◽  
Author(s):  
John M. Adams ◽  
Jaroslaw W. Bilaniuk ◽  
Brian K. Siegel ◽  
Louis T. Difazio ◽  
Robert S. Skerker ◽  
...  
Keyword(s):  
Injury Severity ◽  
Trauma Team ◽  
Positive Control ◽  
Physiological Data ◽  
Airway Compromise ◽  
Exclusion Criteria ◽  
Patient Age ◽  
Trauma Team Activation ◽  
Patient Âgé ◽  
Height Of Fall

Our American College of Surgeons Level I trauma center uses physiological data and injury patterns to identify fall patients at risk. We hypothesized that height of fall and patient age impacted injury severity and analyzed if they were significant predictors of the need for trauma team activation. Charts were reviewed from July 1, 2004, to June 30, 2007, for age; sex; Injury Severity Score (ISS); height of fall and admission to the intensive care unit, operating room, stepdown unit, floor; or death. Exclusion criteria were physiological, neurologic, or airway compromise and penetrating neck or torso injuries. ISS was used as a positive control. A total of 1865 fall patients were treated during the period of data collection, and 1348 patients were eliminated by exclusion criteria, leaving 517 patients for study. Although patient age did not correlate with the need for trauma team activation, there was a statistically significant association between age and admission to the hospital from the emergency room ( P < 0.05; area under curve [AUC] = 0.713; 95% confidence interval [CI], 0.656 to 0.770). Similarly, although the height of fall alone did not have a significant predictive value for the need of trauma team activation, there was a clear association of the height of fall with hospital admission (AUC = 0.589; 95% CI, 0.519 to 0.658). Patient age and height of fall alone are not criteria for trauma team activation in the absence of physiological, neurologic, or airway compromise.

Reducing “Cry Wolf”—Changing Trauma Team Activation at a Pediatric Trauma Centre

2009 ◽  
Vol 66 (3) ◽  
pp. 698-702 ◽  
Author(s):  
Catherine Bevan ◽  
Clara Officer ◽  
Joe Crameri ◽  
Cameron Palmer ◽  
Franz E. Babl
Keyword(s):  
Pediatric Trauma ◽  
Trauma Team ◽  
Trauma Centre ◽  
Trauma Team Activation

A Review of “Prehospital Hypotension as a Valid Indicator of Trauma Team Activation” (2000)

2020 ◽  
pp. 000313482097917
Author(s):  
Glen A. Franklin
Keyword(s):  
Emergency Department ◽  
Resource Allocation ◽  
Injury Severity Score ◽  
Resource Utilization ◽  
Original Work ◽  
Injury Severity ◽  
Surrogate Marker ◽  
Trauma Team ◽  
Trauma Team Activation

Prehospital hypotension has been utilized for decades as a surrogate marker of injury severity. Several studies have discussed the correlation between injury and hypotension both in the field as well as in the emergency department. Increases have been noted in injury severity score and mortality. Resource utilization is higher in this patient population. This study revisits our original work from 2000 and reviews the current literature regarding hypotension and injury severity. We also examine the role of prehospital hypotension as an indicator of trauma team activation and resource allocation. This review serves as a part of a Literary Festschrift in honor of Dr J David Richardson’s role as the Editor-in-Chief of The American Surgeon.

scholarly journals Evaluation of a Standardized Instrument for Post Hoc Analysis of Trauma-Team-Activation-Criteria in 75,613 Injured Patients - An Analysis of the TraumaRegister DGU®

2020 ◽  
Author(s):  
Dan Bieler ◽  
Heiko Trentzsch ◽  
Axel Franke ◽  
Markus Baacke ◽  
Rolf Lefering ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Injury Severity ◽  
Trauma Team ◽  
Trauma Team Activation ◽  
Post Hoc Analysis ◽  
Field Triage ◽  
Severity Of Injury ◽  
Post Hoc ◽  
Injured Patients

Abstract IntroductionIn order to improve the quality of criteria for trauma-team-activation it is necessary to identify patients who benefited from the treatment by a trauma team. Therefore, we evaluated a post hoc criteria catalogue for trauma-team-activation which was developed in a consensus process by an expert group and published recently. The objective was to examine whether the catalogue can identify patients that died after admission to hospital and therefore can benefit of a specialized trauma team mostly.Materials and MethodThe catalogue was applied to the data of 75,613 patients from the TraumaRegister DGU® between the 01/2007 and 12/2016 with a maximum Abbreviated Injury Score (AIS) severity ≥ 2. The endpoint was hospital mortality, which was defined as death before discharge from acute care.ResultsThe TraumaRegister DGU® dataset contains 18 of the 20 proposed criteria within the catalogue which identified 99.6% of the patients who were admitted to the trauma room following an accident and who died during their hospital stay. Moreover, our analysis showed that at least one criterion was fulfilled in 59,785 cases (79.1%). The average ISS in this group was 21.2 points (SD 9.9). None of the examined criteria applied to 15,828 cases (average ISS 8.6; SD 5). The number of consensus-based criteria correlated with the severity of injury and mortality. Of all deceased patients (8,451), only 31 (0.37%) could not be identified on the basis of the 18 examined criteria. Where only one criterion was fulfilled, mortality was 1.7%; with 2 or more criteria, mortality was at least 4.6%.DiscussionThe consensus-based criteria identified nearly all patients who died as a result of their injuries. If only one criterion was fulfilled, mortality was relatively low. However, it increased to almost 5% if two criteria were fulfilled. Further studies are necessary to analyse and examine the relative weighting of the various criteria. SummaryOur instrument is capable to identify severely injured patients with increased in-hospital mortality and injury severity. However, a minimum of two criteria needs to be fulfilled. Based on these findings, we conclude that the criteria list is useful for post hoc analysis of the quality of field triage in patients with severe injury.

Trauma Team Activation at a Level I Trauma Center in Southern California: Time of Day Matters

2019 ◽  
Vol 85 (10) ◽  
pp. 1142-1145
Author(s):  
Morgan Schellenberg ◽  
Kenji Inaba ◽  
Bryan E. Love ◽  
Zachary Warriner ◽  
Matthew J. Forestiere ◽  
...  
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Trauma Team ◽  
Time Of Day ◽  
Operative Intervention ◽  
Trauma Patients ◽  
Mechanism Of Injury ◽  
Trauma Team Activation ◽  
Level I

The ACS Committee on Trauma specifies prehospital criteria that trigger trauma team activation (TTA). The study aims to define the relationship between TTA and time of day, mechanism of injury, and need for operative intervention. All trauma patients presenting to LAC1USC (January 2008–July 2018) after triggering TTA were screened. Patients were excluded if time of ED arrival was undocumented. Demographics, injury data, and outcomes were analyzed. After exclusions (<1%), 54,826 patients were enrolled. The median age was 35 [IQR 23–53]. The median Injury Severity Score was 4 [1–10]. The most common mechanisms of injury were falls (n = 14,166; 31%), auto versus pedestrian collisions (n = 11,921; 26%), and motor vehicle collisions (n = 11,024; 24%). Penetrating trauma comprised 16 per cent (n = 8,686). The busiest hour for TTAs was 19:00 to 20:00, although penetrating trauma was most common between 23:00 and 01:00. Emergent surgical intervention in absolute numbers was most frequent between 20:00 and 01:00. As a proportion of the number of TTAs per hour, emergent operative intervention was most frequent between 23:00 and 06:00. In conclusion, the volume of TTAs and the triggering mechanism of injury vary significantly by time of day. The need for operative intervention is highest overnight. This information can be used to help increase hospital preparedness and allocate resources accordingly.

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