Delayed Diagnosis of Injury in Pediatric Trauma

Objective. To define the frequency and nature of delayed diagnosis of injury (DDI) in pediatric trauma. Design. Retrospective review. Setting. Tertiary pediatric trauma center. Methods. Medical records of 1175 pediatric trauma admissions from July 1, 1989, through June 30, 1992, were reviewed. Results. Fifty (4.3%) patients had 53 DDI. Fractures accounted for 38 DDI, most commonly of the extremities (total, 16). The delay until injury diagnosis ranged from 1 to 55 (median, 3) days. Patients with DDI had lower scores on the Glasgow Coma Scale, higher injury severity scores, and longer pediatric intensive care unit and hospital stays than patients without DDI. Patients with DDI more frequently required medical transport, emergent intubation, admission to the pediatric intensive care unit, and surgery. The DDI altered treatment for 68% of patients; 10 required surgery, including second operations for 6 children. Conclusions. DDI represents a failure of pediatric trauma care at all levels. The severely injured child is at the greatest risk of DDI. All pediatric patients with trauma warrant ongoing evaluation to identify initially unrecognized injuries.

Download Full-text

Multicenter mortality and morbidity associated with pulmonary hypertension in the pediatric intensive care unit

Pulmonary Circulation ◽

10.1177/2045893217745785 ◽

2017 ◽

Vol 8 (1) ◽

pp. 204589321774578 ◽

Cited By ~ 6

Author(s):

Emily Morell Balkin ◽

Martina A. Steurer ◽

Elise A. Delagnes ◽

Matt S. Zinter ◽

Satish Rajagopal ◽

...

Keyword(s):

Heart Failure ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Pulmonary Hypertension ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Clinical Decision Making ◽

Invasive Mechanical Ventilation ◽

Pediatric Intensive Care ◽

Severity Scores

Despite advances in the diagnosis and management of pediatric pulmonary hypertension (PH), children with PH represent a growing inpatient population with significant morbidity and mortality. To date, no studies have described the clinical characteristics of children with PH in the pediatric intensive care unit (PICU). A retrospective multicenter cohort study of 153 centers in the Virtual PICU Systems database who submitted data between 1 January 2009 and 31 December 2015 was performed. A total of 14,880/670,098 admissions (2.2%) with a diagnosis of PH were identified. Of these, 2190 (14.7%) had primary PH and 12,690 (85.3%) had secondary PH. Mortality for PH admissions was 6.8% compared to 2.3% in those admitted without PH (odds ratio = 3.1; 95% confidence interval = 2.9–3.4). Compared to patients admitted to the PICU without PH, those with PH were younger, had longer length of stay, higher illness severity scores, were more likely to receive invasive mechanical ventilation, cardiopulmonary resuscitation, extracorporeal membrane oxygenation, and more likely to have co-diagnoses of sepsis, heart failure, and respiratory failure. In a multivariate model, factors significantly associated with mortality for children with PH included age < 6 months or > 16 years, invasive mechanical ventilation, and co-diagnoses of heart failure, sepsis, hemoptysis, disseminated intravascular coagulation, stroke, and multi-organ dysfunction syndrome. Despite therapeutic advances, the disease burden and mortality of children with PH remains significant. Further investigation of the risk factors associated with clinical deterioration and mortality in this population could improve the ability to prognosticate and inform clinical decision-making.

Download Full-text