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 Endoscopic cyst gastrostomy for traumatic pancreatic pseudocysts in children: a case series

2020 ◽  
Vol 5 (1) ◽  
pp. e000456 ◽  
Author(s):  
Bethany J Farr ◽  
Victor L Fox ◽  
David P Mooney
Keyword(s):  
Trauma Center ◽  
Trauma Registry ◽  
Pediatric Trauma ◽  
Case Series ◽  
Pancreatic Pseudocysts ◽  
Pancreatic Trauma ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Pancreatic Injuries ◽  
Level 1

BackgroundPancreatic pseudocysts may develop after high-grade pancreatic injuries in children. Many resolve without intervention, and the management of symptomatic pseudocysts that persist remains controversial, with various open, percutaneous and laparoscopic approaches to intervention described. Successful endoscopic cyst gastrostomy has been reported in children with pancreatic pseudocysts of mixed etiology.MethodsThe trauma registry and electronic medical record of a level 1 pediatric trauma center were queried for children with a symptomatic pseudocyst following pancreatic trauma over a 12-year period, from 2008 to 2019.ResultsWe describe a case series of five consecutive children with persistent symptomatic pancreatic pseudocysts following blunt abdominal trauma all successfully treated with endoscopic cyst gastrostomy.DiscussionEndoscopic cyst gastrostomy appears to be safe and effective in the management of symptomatic pancreatic pseudocysts in children following pancreatic trauma.Level of evidence5 – retrospective case series.

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.

scholarly journals Descriptive Analysis Of Femur Fracture Patterns, Management And Outcome: Descriptive Observational Study From A Level 1 Trauma Center

2020 ◽  
Author(s):  
Syed Imran Ghouri ◽  
Mohammad Asim ◽  
Fuad Mustafa ◽  
Ahad Kanbar ◽  
Mohamed Ellabib ◽  
...  
Keyword(s):  
Intramedullary Nailing ◽  
Trauma Center ◽  
Descriptive Analysis ◽  
Femoral Shaft ◽  
Trauma Patients ◽  
Multicenter Studies ◽  
Severe Injuries ◽  
Duration Of Surgery ◽  
Level 1 ◽  
Level 1 Trauma Center

Abstract Background We aimed to assess the patterns, associated injuries, management and outcome of traumatic femoral fractures.Methods This retrospective study was conducted to include all trauma patients with femoral shaft fractures admitted in a level 1 trauma center between January 2012 and December 2015. Data were analyzed and compared according to the time to intramedullary nailing; mechanisms of injury and age groups.Results A total of 605 cases were analyzed, with mean age of 30.7±16.2 years.The majority of fractures were unilateral (96.7%) and 91% were closed fractures. Three-fourth of fractures were treated by reamed intramedullary nailing (rIMN); antegrade in 80%. The pyriform fossa nails were used in 71.6% while trochanteric entry nails was used in 28.4%. Forty five (8.9%) of fractures were treated with external fixator, 37 (6.1%) had conservative management. Victims of traffic-related accidents were younger, sustained severe injuries, and more likely to have rIMN and required more blood transfusion. Traffic-related injuries occured more in patients aged 14-30 years whereas; injuries related to fall were significantly higher in patients aged 31-59 years. Thirty-one patients (7.8%) had rIMN < 0-6 h, 106 (25.5%) had rIMN < 6-12 h and 267 (66.8%) had rIMN > 12 h. The implant type, duration of surgery, DVT prophylaxis, in-hospital complications and mortality were comparable among the three treatment groups.Conclusions the frequency of femoral fracture is 11% mainly in severely injured young males by traffic-related accidents and falls. Further multicenter studies are needed.

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).

scholarly journals Implementing psychosocial programming at a level 1 trauma center: results from a 5-year period

2020 ◽  
Vol 5 (1) ◽  
pp. e000363 ◽  
Author(s):  
Natasha M Simske ◽  
Trenton Rivera ◽  
Mary A Breslin ◽  
Sarah B Hendrickson ◽  
Megen Simpson ◽  
...  
Keyword(s):  
Support Groups ◽  
Trauma Center ◽  
Psychosocial Support ◽  
Trauma Patients ◽  
Post Traumatic Stress ◽  
Educational Materials ◽  
Level Of Evidence ◽  
Victims Of Crime ◽  
Level 1 ◽  
Level 1 Trauma Center

BackgroundThe primary goal of the present study is to describe the psychosocial support services provided at our institution and the evolution of such programming through time. This study will also report the demographics and injury patterns of patients using available resources.MethodsTrauma Recovery Services (TRS) is a social and psychological support program that provides services and resources to patients and families admitted to our hospital. It includes a number of different services such as emotional coaching from licensed counselors, educational materials, peer mentorship from trauma survivors, monthly support groups, post-traumatic stress disorder (PTSD) screening and programming for victims of crime. Patients using services were prospectively recorded by hired staff, volunteers and students who engaged in distributing programming. Demographics and injury characteristics were retrospectively gathered from patient’s medical records.ResultsFrom May of 2013 through December 2018, a total of 4977 discrete patients used TRS at an urban level 1 trauma center. During the study period, 31.4% of the 15 640 admitted adult trauma patients were exposed to TRS and this increased from 7.2% in 2013 to 60.1% in 2018. During the period of 5.5 years, 3317 patients had ‘direct contact’ (coaching and/or educational materials) and 1827 patients had at least one peer visit. The average number of peer visits was 2.7 per patient (range: 2–15). Of the 114 patients who attended support groups over 4 years, 55 (48%) attended more than one session, with an average of 3.9 visits (range: 2–10) per patient. After the establishment of PTSD screening and Victims of Crime Advocacy and Recovery Program (VOCARP) services in 2017, a total of 482 patients were screened for PTSD and 974 patients used VOCARP resources during the period of 2 years, with substantial growth from 2017 to 2018.ConclusionsHospital-provided resources aimed at educating patients, expanding support networks and bolstering resiliency were popular at our institution, with nearly 5000 discrete patients accessing services during a period of 5.5 years. Moving forward, greater investigation of program usage, development, and efficacy is necessary.Level of evidenceLevel II therapeutic.

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

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.

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