Three-Wheel and Four-Wheel All-Terrain Vehicle Injuries in Children

In January 1988, sales of new three-wheel all-terrain vehicles (ATVs) were banned in the United States because of the high incidence of injury associated with their use, especially by children. Four-wheel ATVs remain on the market. A retrospective review of all ATV injuries seen in a level I pediatric trauma center was conducted to compare the nature and severity of injuries in three-wheel vehicles with those associated with four-wheelers. A total of 36 ATV injuries were seen from April 1986 to August 1988. All patients were < 16 years of age; 72% were ≤12 years of age. Of the patients, 56% were boys; 44% were girls. Although 56% of incidents involved three-wheelers, a larger number of more serious injuries, defined as the presence of indicators of injury severity (eg, death, Injury Severity Score ≥10, intensive care unit admission, or need for surgery), involved four-wheel vehicles. A total of 15 injuries occurred in 1987; 12 injuries, including the first death involving an ATV at the pediatric trauma center, occurred in the 7 months since the sales ban. Immature judgment and/or motor skills were the most common factors contributing to injury. Existing information regarding injuries involving three-wheel ATVs is supported by our data, according to which it is suggested that four-wheel vehicles may be dangerous in the hands of immature or unskilled operators < 16 years of age. Injury prevention efforts should be directed at prohibiting any ATV use by persons < 16 years of age.

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Toward a Comprehensive Emergency Medical System for Children

PEDIATRICS ◽

10.1542/peds.86.1.120 ◽

1990 ◽

Vol 86 (1) ◽

pp. 120-122

Author(s):

J. Alex Haller

Keyword(s):

Trauma Center ◽

Injury Severity ◽

Pediatric Trauma ◽

Trauma System ◽

Objective Evaluation ◽

The United States ◽

The State ◽

Levels Of Care ◽

Emergency Medical ◽

Pediatric Trauma Center

Systems management of life-threatening injuries in children and adults is now accepted as state-of-the-art by those who care for trauma victims in the United States and Canada. A few regional trauma systems for adults have had several decades of experience and have recently served as models for inclusion of pediatric trauma.1 In certain instances, notably the state of Pennsylvania, an emergency medical services (EMS) system has come into being with fully integrated adult and children's components. That the National Pediatric Trauma Registry includes more than 12 000 children is indicative of the significant problem of trauma in childhood; the Registry has provided a necessary base for statistical analysis of injury severity and long-term rehabilitation needs.2 Since 1985, several federally funded state demonstration grants for EMS for children (EMSC) have attempted to establish guidelines for patient care and to suggest methods of ongoing monitoring of the effectiveness of these systems, surveillance of quality, and review of patient outcome. A statewide designated pediatric trauma center for Maryland located in The Johns Hopkins Children's Center has been functional for 12 years.3 Data are now available for objective evaluation of the effectiveness and impact of this regional pediatric trauma program. The level of compliance within Maryland's regionalized pediatric trauma system from 1979 through 1986 was recently examined using hospital discharge abstract data routinely recorded for all discharges from 58 acute care hospitals in the state of Maryland.4 Compliance with regionalization was measured by examining (1) the proportion of patients with injuries of varying injury severity scores5,6 who were treated at each of three levels of care (statewide pediatric trauma center, regional trauma center, and community hospital) and (2) the proportion of in-hospital deaths occurring at each level of care.

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Pediatric Trauma System Evaluation before and after Level II Verification

The American Surgeon ◽

10.1177/000313481908501137 ◽

2019 ◽

Vol 85 (11) ◽

pp. 1281-1287

Author(s):

Michael D. Dixon ◽

Scott Engum

Keyword(s):

Native American ◽

Trauma Center ◽

Injury Severity ◽

Life Support ◽

Pediatric Trauma ◽

Trauma System ◽

Trauma Centers ◽

Level Ii ◽

Level I ◽

Pediatric Trauma Center

ACS-verified trauma centers show higher survival and improved mortality rates in states with ACS-verified Level I pediatric trauma centers. However, few significant changes are appreciated in the first two years after verification. Minimal research exists examining verification of ACS Level II pediatric trauma centers. We analyzed ACS Level II pediatric trauma verification at our institution. In 2014, Sanford Medical Center Fargo became the only Level II pediatric trauma center in North Dakota, as well as the only center between Spokane and Minneapolis. A retrospective review of the institution's pre-existing trauma database one year pre- and postverification was performed. Patients aged <18 years were included in the study ( P < 0.05). Patient number increased by 23 per cent, from 167 to 205 patients. A statistically significant increase occured in the three to six year old age group ( P = 0.0002); motorized recreational vehicle ( P = 0.028), violent ( P = 0.009), and other ( P = 0.0374) mechanism of injury categories; ambulance ( P = 0.0124), fixed wing ( P = 0.0028), and personal-owned vehicle ( P = 0.0112) modes of transportation. Decreased public injuries ( P = 0.0071) and advanced life support ambulance transportation ( P = 0.0397). The study showed a nonstatistically significant increase in mean Injury Severity Score (from 6.3 to 7) and Native American trauma (from 14 to 20 per cent). Whereas prolonged ACS Level I pediatric trauma center verification was found to benefit patients, minimal data exist on ACS Level II verification. Our findings are consistent with current Level I ACS pediatric trauma center data. Future benefits will require continued analysis because our Level II pediatric trauma center continues to mature and affect our rural and large Native American community.

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An Analysis of Pediatric Gunshot Wounds Treated at a Level I Pediatric Trauma Center

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000063479.92520.2e ◽

2003 ◽

Vol 54 (6) ◽

pp. 1102-1106 ◽

Cited By ~ 8

Author(s):

Alison K. Snyder ◽

Li Ern Chen ◽

Robert P. Foglia ◽

Patrick A. Dillon ◽

Robert K. Minkes

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Gunshot Wounds ◽

Level I ◽

Pediatric Trauma Center

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Recreational All-Terrain Vehicle Injuries Among Children: An 11-Year Review of a Central Kentucky Level I Pediatric Trauma Center Database

Yearbook of Pediatrics ◽

10.1016/s0084-3954(08)79230-3 ◽

2009 ◽

Vol 2009 ◽

pp. 350-352

Author(s):

J.A. Stockman

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Level I ◽

Pediatric Trauma Center

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Computed tomography before transfer to a level I pediatric trauma center risks duplication with associated increased radiation exposure

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2008.08.061 ◽

2008 ◽

Vol 43 (12) ◽

pp. 2268-2272 ◽

Cited By ~ 46

Author(s):

Walter J. Chwals ◽

Ann V. Robinson ◽

Carlos J. Sivit ◽

Diya Alaedeen ◽

Ellen Fitzenrider ◽

...

Keyword(s):

Computed Tomography ◽

Radiation Exposure ◽

Trauma Center ◽

Pediatric Trauma ◽

Level I ◽

Pediatric Trauma Center

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Usefulness of Pelvic Radiographs in the Initial Trauma Evaluation with Concurrent CT: Is Additional Radiation Exposure Necessary?

International Journal of Pediatrics ◽

10.1155/2018/6260954 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Anne K. Misiura ◽

Autumn D. Nanassy ◽

Jacqueline Urbine

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Trauma Patients ◽

Additional Information ◽

Pelvic Radiographs ◽

Pelvic Radiograph ◽

Digital Radiograph ◽

Urban Level ◽

Level I ◽

Pediatric Trauma Center

Trauma patients in a Level I Pediatric Trauma Center may undergo CT of the abdomen and pelvis with concurrent radiograph during initial evaluation in an attempt to diagnose injury. To determine if plain digital radiograph of the pelvis adds additional information in the initial trauma evaluation when CT of the abdomen and pelvis is also performed, trauma patients who presented to an urban Level I Pediatric Trauma Center between 1 January 2010 and 7 February 2017 in whom pelvic radiograph and CT of the abdomen and pelvis were performed within 24 hours of each other were analyzed. A total of 172 trauma patients had pelvic radiograph and CT exams performed within 24 hours of each other. There were 12 cases in which the radiograph missed pelvic fractures seen on CT and 2 cases in which the radiograph suspected a fracture that was not present on subsequent CT. Furthermore, fractures in the pelvis were missed on pelvic radiographs in 12 of 35 cases identified on CT. Sensitivity of pelvic radiograph in detecting fractures seen on CT was 65.7% with a 95% confidence interval of 47.79-80.87%. Results suggest that there is no added diagnostic information gained from a pelvic radiograph when concurrent CT is also obtained, a practice which exposes the pediatric trauma patient to unnecessary radiation.

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Preventable transfers in pediatric trauma: A 10-year experience at a level I pediatric trauma center

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2015.09.020 ◽

2016 ◽

Vol 51 (4) ◽

pp. 645-648 ◽

Cited By ~ 14

Author(s):

Stephen J. Fenton ◽

Justin H. Lee ◽

Austin M. Stevens ◽

Kyle C. Kimbal ◽

Chong Zhang ◽

...

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Level I ◽

Pediatric Trauma Center

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Initial Approach to the Management of Multisystem Trauma

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0062 ◽

2019 ◽

pp. 397-401

Author(s):

David S. Morris

Keyword(s):

Trauma Center ◽

Injury Severity ◽

Hospital Admissions ◽

The United States ◽

Emergency Department Visits ◽

Severely Injured ◽

Level Ii ◽

Level I ◽

Nonfatal Injuries ◽

Injured Patients

Nearly 200,000 people die of injury-related causes in the United States each year, and injury is the leading cause of death for all patients aged 1 to 44 years. Approximately 30 million people sustain nonfatal injuries each year, which results in about 29 million emergency department visits and 3 million hospital admissions. Management of severely injured patients, typically defined as having an Injury Severity Score greater than 15 is best managed in a level I or level II trauma center. Any physician who provides care for critically ill patients should have a basic familiarity with the fundamentals of trauma care.

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