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).

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 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.

scholarly journals Results of delayed follow-up imaging in traumatic brain injury

2016 ◽  
Vol 124 (3) ◽  
pp. 703-709 ◽  
Author(s):  
Adam Ross Befeler ◽  
William Gordon ◽  
Nickalus Khan ◽  
Julius Fernandez ◽  
Michael Scott Muhlbauer ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Trauma Center ◽  
Demographic Data ◽  
Data Types ◽  
Surgical Interventions ◽  
Imaging Results ◽  
Level 1 ◽  
Level 1 Trauma Center

OBJECT There is a paucity of scientific evidence available about the benefits of outpatient follow-up imaging for traumatic brain injury patients. In this study, 1 year of consecutive patients at a Level 1 trauma center were analyzed to determine if there is any benefit to routinely obtaining CT of the head at the outpatient follow-up visit. METHODS This single-institution retrospective review was performed on all patients with a traumatic brain injury seen at a Level 1 trauma center in 2013. Demographic data, types of injuries, surgical interventions, radiographic imaging in inpatient and outpatient settings, and outcomes were assessed through a review of the institution’s trauma registry, patient charts, and imaging. RESULTS Five hundred twenty-five patients were seen for traumatic brain injury in 2013 at Regional One Health in Memphis, Tennessee. One hundred eighty-five patients (35%) presented for outpatient follow-up, all with CT scans of the head. Seven of these patients (4%) showed worsening of their intracranial injuries on outpatient imaging studies; however, surgical intervention was recommended for only 3 of these patients (2%). All patients requiring an intervention had neurological deterioration prior to their follow-up appointment. CONCLUSIONS These experiences suggest that outpatient follow-up imaging for traumatic brain injury should be done selectively, as it was not helpful for patients who did not exhibit worsening of neurological signs or symptoms. Furthermore, routine outpatient imaging results in unnecessary resource utilization and radiation exposure.

The cervical spine can be cleared without MRI after blunt trauma:A retrospective review of a single level 1 trauma center experience over 8 years

2018 ◽  
Vol 216 (3) ◽  
pp. 427-430
Author(s):  
Daniel Novick ◽  
Raina Wallace ◽  
Jody C. DiGiacomo ◽  
Anand Kumar ◽  
Steven Lev ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Retrospective Review ◽  
Trauma Center ◽  
Single Level ◽  
Level 1 ◽  
Level 1 Trauma Center
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