Alerts as Coordination Mechanisms

In this study, we explore how clinical decision support features can be designed to aid teams in caring for patients during time-critical medical emergencies. We interviewed 12 clinicians with experience in leading pediatric trauma resuscitations to elicit design requirements for decision support alerts and how these alerts should be designed for teams with shared leadership. Based on the interview data, we identified three types of decision support alerts: reminders to perform tasks, alerts to changes in patient status, and suggestions for interventions. We also found that clinicians perceived alerts in this setting as coordination mechanisms and that some alert preferences were associated with leader experience levels. From these findings, we contribute three perspectives on how alerts can aid coordination and discuss implications for designing decision support alerts for shared leadership in time-critical medical processes.

Laparoscopy in the Evaluation of Blunt Abdominal Injury in Level-I and II Pediatric Trauma Centers

Introduction An American College of Surgeons (ACS) Level-I (L-I) pediatric trauma center demonstrated successful laparoscopy without conversion to laparotomy in ∼65% of trauma cases. Prior reports have demonstrated differences in outcomes based on ACS level of trauma center. We sought to compare laparoscopy use for blunt abdominal trauma at L-I compared to Level-II (L-II) centers. Methods The Pediatric Trauma Quality Improvement Program was queried (2014-2016) for patients ≤16 years old who underwent any abdominal surgery. Bivariate analyses comparing patients undergoing abdominal surgery at ACS L-I and L-II centers were performed. Results 970 patients underwent abdominal surgery with 14% using laparoscopy. Level-I centers had an increased rate of laparoscopy (15.6% vs 9.7%, P = .019 ); however they had a lower mean Injury Severity Score (16.2 vs 18.5, P = .002) compared to L-II centers. Level-I and L-II centers had similar length of stay ventilator days, and SSIs (all P > .05). Conclusion While use of laparoscopy for pediatric trauma remains low, there was increased use at L-I compared to L-II centers with no difference in LOS or SSIs. Future studies are needed to elucidate which pediatric trauma patients benefit from laparoscopic surgery.

Characteristics and Outcome of Pediatric in a Referral Trauma Center in Iran; a Cross-Sectional Study

Background Pediatric trauma is the leading cause of death from early childhood through adolescence.In this study, characteristics and associated factors of pediatric trauma cases are evaluated. Methods In this cross-sectional study, demographic and clinical characteristics of 622 patients admitted to a referral hospital in Tehran, Iran are evaluated. Reported clinical characteristics include mechanism of trauma, type of trauma, ultrasonographic (US) findings, chest and abdomino-pelvic and brain computed tomography (CT) scan findings, blood hemoglobin (Hb) level, urinalysis, type of surgery, and mortality rate. Results The average age was 7.46 ± 3.64 years and the majority (63.7%) were male and endured direct trauma (36.3%). Most of our patients (n=305; 49%) were admitted in the orthopedic ward, followed by the neurosurgery ward (n=235; 37.8%). The mortality rate was 23 cases (3.7%). the lowest mortality was in the patients 11 to 15 years old (n=3; 13%), and the highest in five years and younger group (n=14; 60.9%). Conclusions Motor vehicle accidents are the leading fatal trauma injuries in children, therefore implementation of preventive measures specific to children is quite important but long overdue.