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Pediatric Spinal Trauma: Review of 122 Cases of Spinal Cord and Vertebral Column Injuries *
Published in Alexander R. Vaccaro, Charles G. Fisher, Jefferson R. Wilson, 50 Landmark Papers, 2018
Jetan H. Badhiwala, Peter B. Dirks
This study is limited primarily by a retrospective design, which by nature is prone to missing and inaccurate data. Despite being one of the larger series of pediatric spinal injuries, the sample size is still relatively small. Many of the statistical comparisons did not reach significance, and we suspect this is primarily a power issue. The authors do not comment on the incidence and severity of concomitant injuries, including head injuries, which can be an important source of morbidity and mortality in the pediatric trauma population. This data would be useful considering these patients often have multisystem injuries, and their care requires an interdisciplinary team of health care professionals.
Epidemiology of pediatric trauma
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
Epidemiology is the study of the distribution of diseases in groups or populations. One of its aims is to define the occurrence of disease by place and time in the general population and in specific subpopulations. The overarching goal is to reduce the incidence and severity of specific diseases. Injury epidemiology involves the collection of data on the time, place, mechanism, and victim of injury. Studies of pediatric injury epidemiology have had a major impact on our understanding of pediatric trauma. Injury epidemiology has allowed us to identify and quantify specific injury risks, develop prevention and treatment strategies, and monitor their effectiveness. The study of injury epidemiology has produced one fundamental fact: Injuries are the leading threat to the health and well-being of young people in our society today [1, 2]. This is of major importance to public health officials and health care providers alike.
Prehospital Trauma Airway Management: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Sabina Braithwaite, Christopher Stephens, Kyle Remick, Whitney Barrett, Francis X. Guyette, Michael Levy, Christopher Colwell
Evidence suggests that the location (i.e., prehospital vs. shortly following hospital arrival) of advanced airway management may be associated with patient outcomes. While some studies found that in-hospital intubation is associated with better outcomes compared with prehospital intubation (22, 23), others found that location of intubation was not associated with mortality or early ventilator-acquired pneumonia in spite of increased intensive care unit, mechanical ventilation, and hospital length of stay (24). A military study noted lower survival for prehospital as compared to emergency department intubation (22). Hawkins et al. evaluated 288 intubated pediatric trauma patients and noted that overall mortality was highest in the more severely injured scene intubation group (29.7%) as compared with those intubated at the referring hospital or pediatric trauma center, but age, injury severity, and neurologic status were more associated with mortality than the intubation location (25).
Regionalization Patterns for Children with Serious Trauma in California (2005–2015): A Retrospective Cohort Study
Published in Prehospital Emergency Care, 2021
N. Ewen Wang, Clifton Ewbank, Christopher R. Newton, David A. Spain, Elizabeth Pirrotta, Monika Thomas-Uribe
Among seriously injured children (ISS > 9), 6,383/29,194 (21.9%) were initially triaged to an adult non-trauma hospital. Table 3 describes the characteristics of these children and the definitive facility where they received care. Notably, the majority of children stayed at the non-trauma hospital (N = 3,401; 53.3%). Approximately 20% of children were transferred to a pediatric trauma center and 12.0% were transferred to an adult trauma center. The median age of children who stayed at a non-trauma hospital was 15.1 (9.2–16.9) years, while the median age of those transferred to a pediatric trauma center was 8.7 (2.4–13.8) years, the median of those transferred to an adult trauma center was 15.1 (9.4–16.8) years, and the median age of those transferred to another adult non-trauma hospital was 12.5 (5.3–16.0) years. Greater than one half of children with private non-HMO insurance with primary triage to a non-trauma hospital remained at a non-trauma hospital (N = 1,225/2,168; 56.5%), while 20.3% (N = 441/2,168) were transferred to a pediatric trauma center and 14.5% (N = 314/2,168) to an adult trauma center level I/II. Among children with public insurance, 41.3% (N = 1,050/2,541) remained at a non-trauma hospital, while 30.4% (N = 772/2,541) were transferred to a pediatric trauma center and 14.7% (373/2,541) to an adult trauma center level I/II. Children with private HMO insurance made up nearly half of the transfers to another adult non-trauma hospital (N = 213/435; 49.0%).
U.S. Military Medical Evacuation and Prehospital Care of Pediatric Trauma Casualties in Iraq and Afghanistan
Published in Prehospital Emergency Care, 2020
Jason F. Naylor, Michael D. April, Erick E. Thronson, Guyon J. Hill, Steven G. Schauer
Conflict-related traumatic injuries were the most common reason for pediatric admission to military hospitals during the recent wars in Afghanistan and Iraq (1, 2). Pediatric trauma patients present many unique challenges (3, 4). Patient assessment and resuscitative interventions may require smaller sized supplies and equipment (e.g., blood pressure cuffs, intravascular access catheters, chest tubes). Developing airway anatomy poses additional challenges to endotracheal intubation and restrictions for surgical cricothyrotomy (5). Weight-based calculations determine medication doses and resuscitation fluid volumes. Provider training, experience, and skill sustainment for pediatric trauma management factors substantially (6–8). These and other challenges specific to pediatric trauma patients may have contributed to the higher in-hospital mortality observed within deployed military treatment facilities among children in comparison to adult military services members: 7.8–8.5% vs. 1.0–3.4% (2, 9).