Paediatric Major Trauma Research Articles

Outcomes of head trauma in children admitted to a tertiary paediatric intensive care unit in South Wales

Objective This study aimed to evaluate the demographics and outcomes of major paediatric head trauma managed in our Paediatric Intensive Care Unit (PICU) in South Wales and comparison is made with the existing published literature. Design and setting A retrospective review of medical records and imaging of patients identified from the paediatric neurosurgical trauma database at University Hospital Wales (UHW) from March 2013 to July 2021. We assessed the GCS at admission, mechanism of injury, CT scan, type of surgery required and GOS after 12 months. Patients A total of 46 children (<16 years old) who were admitted to intensive care secondary to a traumatic brain injury were identified. Mean age was 7.6 years (range 0 days–15.7 years). Results Road traffic accidents (RTA) were the predominant mechanism of injury (56.5%), followed by falls (32.6%). Neurosurgical intervention, including stand-alone ICP monitoring was required in 69.6% of patients. Post discharge outcome was defined using the Glasgow Outcome Score (GOS), with a good functional outcome (GOS ≥4) accounting for 86.4% at 12 months follow-up. Survival rate was 93.4%. Conclusion Demographics in South Wales are similar to the published literature, except falls had a higher mortality than RTA in our cohort. Head injury mechanisms, surgical interventions and outcomes show variation between patients from the pre-covid and lockdown periods. Outcomes are good for surgically and conservatively treated patients and very comparable to the published literature.

Association of Non-Transfusion-Related Admission Hypocalcaemia With Haemodynamic Instability in Paediatric Major Trauma: A Retrospective Single-Centre Pilot Study.

Background The 'lethal triad' of acidosis, hypothermia, and coagulopathy is now considered a diamond of death, with ionised hypocalcaemia (iHypoCa) contributing to cardiovascular decompensation and coagulopathy. iHypoCa may be associated with haemodynamic instability and adverse outcomes in paediatric major trauma patients. However, current data are limited. The primary aim of this pilot study was to report the association between admission iHypoCa and early hypotension on admission in a cohort of paediatric major trauma patients. Secondary aims include reporting the incidence and differential determinants of iHypoCa and the association with treatment (vasoactive agents, blood transfusion, interventional radiology (IR), or surgery) and adverse outcomes (length of stay, morbidity (Glasgow Outcome Scale), and mortality). Methods This pilot study is a retrospective analysis of paediatric major trauma patients (<16 years old) admitted to a major trauma centre (2016-2022). Patients with an admission ionised calcium level obtained before the administration of blood products were included. Multivariable logistic regression was used to assess the dichotomous endpoint of hypotension (systolic blood pressure of <80 mmHg for <1 year, <85 mmHg for one to five years, <90 mmHg for five to 12 years, <100 mmHg for >12 years) for association with hypocalcaemia and adjusted for other potential variables of interest (age, gender, Injury Severity Score, pre-hospital fluids, and acidosis). Results Admission iHypoCa was observed in 8/45 (17.8% (95% confidence interval (CI) 9.3-31.3%)) patients. Other than the adolescent age group (p < 0.05), there were no significant differences in the baseline characteristics. As a pilot study, this was not powered for statistical significance; however, point estimates of the odds of hypotension were almost three times higher for patients with iHypoCa (odds ratio (OR) 2.8 (95% CI 0.4-23.6), p = 0.33). An association between iHypoCa and the need for IR/surgery in the first 24 hours of admission was also observed (OR 10.9 (95% CI 1.4-159.4), p < 0.05). Conclusion iHypoCa was observed in approximately one in six paediatric major trauma patients at admission and may be associated with increased odds of requiring IR/surgery.Larger multicentre studies are required to clarify point estimates for treatment requirements and adverse outcomes.

The incidence of admission ionised hypocalcaemia in paediatric major trauma-A systematic review and meta-analysis.

In adult major trauma patients admission hypocalcaemia occurs in approximately half of cases and is associated with increased mortality. However, data amongst paediatric patients are limited. The objectives of this review were to determine the incidence of admission ionised hypocalcaemia in paediatric major trauma patients and to explore whether hypocalcaemia is associated with adverse outcomes. A systematic review was conducted following PRISMA guidelines. All studies including major trauma patients <18 years old, with an ionised calcium concentration obtained in the Emergency Department (ED) prior to the receipt of blood products in the ED were included. The primary outcome was incidence of ionised hypocalcaemia. Random-effects Sidik-Jonkman modelling was executed for meta-analysis of mortality and pH difference between hypo- and normocalcaemia, Odds ratio (OR) was the reporting metric for mortality. The reporting metric for the continuous variable of pH difference was Glass' D (a standardized difference). Results are reported with 95% confidence intervals (CIs) and significance was defined as p <0.05. Three retrospective cohort studies were included. Admission ionised hypocalcaemia definitions ranged from <1.00 mmol/l to <1.16 mmol/l with an overall incidence of 112/710 (15.8%). For mortality, modelling with low heterogeneity (I2 39%, Cochrane's Q p = 0.294) identified a non-significant (p = 0.122) estimate of hypocalcaemia increasing mortality (pooled OR 2.26, 95% CI 0.80-6.39). For the pH difference, meta-analysis supported generation of a pooled effect estimate (I2 57%, Cochrane's Q p = 0.100). The effect estimate of the mean pH difference was not significantly different from null (p = 0.657), with the estimated pH slightly lower in hypocalcaemia (Glass D standardized mean difference -0.08, 95% CI -0.43 to 0.27). Admission ionised hypocalcaemia was present in at least one in six paediatric major trauma patients. Ionised hypocalcaemia was not identified to have a statistically significant association with mortality or pH difference.

Epidemiology and factors associated with mortality among pediatric major trauma patients in Nova Scotia: A 17-year retrospective analysis

BackgroundMajor traumatic injury in the pediatric population requires further evaluation to improve patient outcomes. Relatively few Canadian studies have investigated pediatric trauma using population-based data. Our objectives were to describe the epidemiology of pediatric major trauma in Nova Scotia and identify factors associated with in-hospital mortality. MethodsRetrospective cohort study of pediatric major trauma patients (age <18 years) injured in Nova Scotia over a 17-year period (April 2001-March 2018). Data were collected from the Nova Scotia Trauma Registry. Characteristics were compared between patient subgroups using t-tests, chi-square analyses and Fisher's exact test. Temporal trends were evaluated using the Mann-Kendall test. Incidence and mortality rates were mapped using ArcGIS Pro. A multivariate logistic regression model was created to assess for factors associated with in-hospital mortality. ResultsA total of 1258 injuries were observed over the 17-year study period. The incidence of pediatric major trauma was 41.7 per 100,000 person-years. Most patients were male (819/1258; 65.1 %) and resided in urban areas (764/1258; 60.7 %). Blunt trauma accounted for 86.2 % (1084/1258) of injuries, and motor vehicle collisions were the most common cause (448/1258; 35.6 %). Incidence and mortality rates were highest in the 15–17 year age group, with a trend towards increasing incidence among females (p = 0.011). Mortality was 17.2 % (217/1258) of patients; 10.9 % (137/1258) died pre-hospital. No trends were detected in mortality rates. The regression model showed increased odds of in-hospital mortality for every point increase in the ISS (OR 1.05; 95 % CI 1.02 to 1.09) and for every unit decrease in scene GCS (OR 0.63; 95 % CI 0.56–0.71). Rural patients were 2 times more likely to die in-hospital versus urban patients (OR 2.40; 95 % CI 1.01–5.69), and patients injured at home were 6 times more likely to die compared to those injured in other locations (OR 6.19; 95 % CI 1.01–38.11). ConclusionPediatric trauma remains a major public health issue in Canada and beyond. Greater efforts are required to expand our understanding of trauma epidemiology and develop targeted injury prevention strategies, especially for rural inhabitants.

In paediatric major trauma patients is admission hypocalcaemia associated with adverse outcomes?

‘In [paediatric major trauma] is [admission hypocalcaemia] associated with [adverse outcomes]’.

Incidence of admission ionised hypocalcaemia in paediatric major trauma: protocol for a systematic review and meta-analysis

IntroductionHypocalcaemia forms part of the ‘diamond of death’ in major trauma, alongside hypothermia, acidosis and coagulopathy. In adults, admission hypocalcaemia prior to transfusion is associated with increased mortality, increased blood...

WTP1.7 Long-term Outcomes After Repair of Paediatric Traumatic Lower Limb Arterial Injury: Systematic Review

Abstract Aims Paediatric vascular injuries account for 1% of paediatric major trauma cases with 30% of arterial injuries located in the lower limb. Current management of paediatric lower limb arterial injuries have been extrapolated from adult injuries. The aim was to review studies specific to paediatric population due to the anatomical and physiological differences, particularly limb length discrepancy (LLD) following injury. Methods A literature review was conducted. Study PICOS - Population: Patients &amp;lt;18 years old with traumatic lower limb arterial injury. Intervention: Surgical, endovascular or no intervention. Comparison: Primary repair or Conduit repair using autologous vein or synthetic material or endovascular repair. Outcomes: Rate of success of revascularisation, amputation, graft infection, long term limb function, LLD, mortality. Results 7 studies were included for data extraction, resulting in 15 male patients, aged 4-14. The popliteal artery was most commonly injured (60%), followed by the femoral (40%). The most common repair was with reversed Great Saphenous Vein graft (GSV)(13/15) for which good long-term outcomes were reported (85% success rate). One endovascular repair was identified which was successful and one with synthetic material which resulted in a minor complication. Conclusions There is a preference for the use of autologous vein grafts in paediatric lower limb arterial repair with good outcomes. Endovascular procedures are becoming more common whereas synthetic grafts are not favoured due to their inability to lengthen as vessels grow. Further research is required to evaluate the long-term outcomes as the current reported cases are scarce.

Analgesia and Sedation of Pediatric Patients with Major Trauma in Pre-Hospital and Emergency Department Settings-A Narrative Review.

Children who sustain major injuries are at risk of receiving insufficient pain relief and sedation, which can have physical and psychological repercussions. Heightened emotional distress can increase the likelihood of developing symptoms of post-traumatic stress. Providing sufficient analgesia and sedation for children with major trauma presents specific challenges, given the potential for drug-related adverse events, particularly in non-intubated patients. The current literature suggests that a relatively low percentage of pediatric patients receive adequate analgesia in pre-hospital and emergency department settings following major trauma. There are only sparse data on the safety of the provision of analgesia and sedation in children with major trauma in the pre-hospital and ED settings. The few studies that examined sedation protocols in this context highlight the importance of physician training and competency in managing pediatric airways. There is a pressing need for prospective studies that focus upon pediatric major trauma in the pre-hospital and emergency department setting to evaluate the benefits and risks of administering analgesia and sedation to these patients. The aim of this narrative review was to offer an updated overview of analgesia and sedation management in children with major trauma in pre-hospital and ED settings.

Variability in firearm injury among major pediatric trauma centers across the USA

ObjectivesIn 2020, firearm injuries surpassed automobile collisions as the leading cause of death in US children. Annual automobile fatalities have decreased during 40 years through a multipronged approach. To develop...

Epidemiology of major paediatric trauma in a European Country – trends of a decade

ObjectivesThis study investigates causes, characteristics and temporal trends of paediatric major trauma over a 10-year period and assesses potential preventive areas.MethodsSingle-centre retrospective study of paediatric trauma patients admitted to a Paediatric Intensive Care Unit (PICU) in a tertiary university hospital in Europe with a level 1 paediatric trauma centre, from 2009 to 2019. Paediatric major trauma patients were defined as patients aged < 18 years with Injury Severity Score > 12, admitted for intensive care for more than 24 h following trauma. Demographic, social and clinical information, including place and mechanism of trauma, injury pattern, pre-hospital and in-hospital procedures, and length of stay in PICU was extracted from PICU medical records.ResultsTotal 358 patients included (age 11 ± 4,9 years; 67% male); 75% were involved in road traffic accidents: 30% motor vehicle collision, 25% pedestrian, 10% motorcycle and bicycle each. Falls from height injured 19% of children, 4% during sports activities. Main injuries were to head/neck (73%) and extremities (42%). The incidence of major trauma was highest in teenagers and did not show a decreasing trend during the study years. All fatalities (1,7%; n = 6) were related to head/neck injuries. Motor vehicle collisions resulted in higher need for blood transfusion (9 vs. 2 mL/kg, p = 0,006) and the highest ICU-mortality (83%; n = 5). Children in motorcycle accidents had longer ICU length-of-stay (6,4 vs. 4,2 days, p = 0,036). Pedestrians had 25% higher risk of head/neck injuries (RR 1,25; 1,07 − 1,46; p = 0,004), and higher incidence of severe brain injury (46% vs. 34%, p = 0,042). Most children in motor-vehicle/bicycle accidents were not using restraints/protective devices (45%) or were using them inappropriately (13%).ConclusionsOver the last decade, the absolute numbers of paediatric major trauma did not decrease. Road traffic accidents remain the leading cause of injury and death. Teenagers are at highest risk for severe trauma. Appropriate use of child restraints and protective equipment remain key for prevention.

Ultramassive Transfusion for Trauma in the Age of Hemostatic Resuscitation: A Retrospective Single-Center Cohort From a Large US Level-1 Trauma Center, 2011-2021.

Uncontrolled bleeding is a leading cause of death in trauma. In the last 40 years, ultramassive transfusion (UMT; ≥20 units of red blood cells [RBCs]/24 hours) for trauma has been associated with 50% to 80% mortality; the question remains as to whether the increasing number of units transfused in urgent resuscitation is a marker of futility. We asked whether the frequency and outcomes of UMT have changed in the era of hemostatic resuscitation. We performed a retrospective cohort study of all UMTs in the first 24 hours of care over an 11-year period at a major US level-1 adult and pediatric trauma center. UMT patients were identified, and a dataset was built by linking blood bank and trauma registry data, then reviewing individual electronic health records. Success in achieving hemostatic proportions of blood products was estimated as (units of plasma + apheresis-platelets-in-plasma + cryoprecipitate-pools + whole blood]/[all units given] ≥0.5. Demographics, injury type (blunt or penetrating), severity (Injury Severity Score [ISS]), severity pattern (Abbreviated Injury Scale score for head [AIS-Head] ≥4), admitting laboratory, transfusion, selected emergency department interventions, and discharge status were assessed using χ2 tests of categorical association, the Student t-test of means, and multivariable logistic regression. P <.05 was considered significant. Among 66,734 trauma admissions from April 6, 2011 to December 31, 2021, we identified 6288 (9.4%) who received any blood products in the first 24 hours, 159 of whom received UMT (0.23%; 154 aged 18-90 + 5 aged 9-17), 81% in hemostatic proportions. Overall mortality was 65% (n = 103); mean ISS = 40; median time to death, 6.1 hours. In univariate analyses, death was not associated with age, sex, or more RBC units transfused beyond 20 but was associated with blunt injury, increasing injury severity, severe head injury, and failure to receive hemostatic blood product ratios. Mortality was also associated with decreased pH and evidence of coagulopathy at admission, especially hypofibrinogenemia. Multivariable logistic regression showed severe head injury, admission hypofibrinogenemia and not receiving a hemostatic resuscitation proportion of blood products as independently associated with death. One in 420 acute trauma patients at our center received UMT, a historically low rate. A third of these patients lived, and UMT was not itself a marker of futility. Early identification of coagulopathy was possible, and failure to give blood components in hemostatic ratios was associated with excess mortality.

Paediatric Major Trauma: A Retrospective Observational Comparison of Mortality in Prehospital Bypass and Secondary Transfer in the East of England.

Background More than half of seriously injured children are not initially treated at a major trauma centre (MTC). Children may be transported by private vehicle to a trauma unit (TU). Children may also be transported by emergency medical services (EMS) to the nearest TU with approximately one in five of these undergoing secondary transfer to an MTC. Most trauma networks permit TU bypass to an MTC. However, the evidence on outcomes between transfer and bypass is limited. This study aimed to evaluate the use of the trauma network by comparing outcomes between paediatric major trauma patients by the method of presentation. Methods In this retrospective observational study, a consecutive sample of paediatric (<16 years old) major trauma patients transported to the regional MTC (Cambridge University Hospitals NHS Foundation Trust (CUH)) between 1st January 2015 and 31st December 2020 was included. Patients were excluded if they arrived at the MTC >24 hours post-injury or were transported to the MTC as the nearest hospital. Patients were divided into four groups: self-presented to MTC, MTC as nearest hospital, bypass and secondary transfer. Results A total of 315 patients (28 'self-presented', 55 'nearest', 58 'bypass' and 174 'secondary transfers') were included. The median age was 9.4 [3.7-13.6] years, and n=209 (66.3%) were male. The median Injury Severity Score (ISS) was 16.0 [9.0-25.0] and n=190 (60.3%) had an ISS >15. There was no difference in 30-day mortality between the 'bypass' and 'secondary transfer' groups.There was a significantly longer hospital and intensive care unit length of stay (LOS) in the bypass group compared to other groups, both p<0.001. The median time to definitive care was five hours greater in the secondary transfer group compared to 'bypass'(bypass 117.6 minutes [100.8-136.6], secondary transfer 418.8 minutes [315.6-529.8]). Conclusion There was no significant difference in 30-day mortality of paediatric major trauma patients who underwent secondary transfer compared to those transported directly from the scene to the MTC, despite significant time delays in reaching definitive care.

A Prospective Epidemiological Survey of Paediatric Trauma in Africa: A Cross-Sectional Study.

Trauma is a leading cause of morbidity and mortality in children worldwide. There is a need for development and provision of efficient paediatric trauma services based on adequate information and funding which are lacking in low- and middle-income countries. This study was carried out to assess the scale of the problem, identify the most common causes of trauma in Pan African Paediatric Surgical Association (PAPSA) zone and to define the limiting factors for provision of the necessary services required to reduce the potential mortality and disability. Data were collected through an electronic form sent out in PAPSA platform. Members were requested to provide prospective data on all paediatric major trauma admitted to or seen at their health facilities between the beginning of April 2019 and the end of June 2020. Hospital location, child's age, gender, type of injury, mechanism of injury, severity, initial management, method of transport, time to arrive to hospital, availability of surgical specialities, length of hospital stay and injury outcome were analysed. There were 531 entries. The mean age was 3.53 years and median age 1.34 years. Male-to-female ratio was 2:1. The leading causes for injuries were falls 194 (36.53%) and motor vehicle crashes (MVCs) 176 (33.15%) followed by obstetrical 42 (7.9%), thermal 27 (5.1%) and domestic injuries 22 (4.1%). The most common injuries were limb fractures 181 (34.1%) and traumatic brain injury 111 (20.9%). Public and private transport were used in 313 (58.9%), while ambulance service was used in only 54 (10.1%). Distances to a health facility varied between 1 and 157 km. 70.2% of cases did not receive any primary care, while definitive care was received in 95.5% of the cases. Outcome was full recovery in 90.6% of patients, morbidity in 8.1% and a mortality rate of 1.3%. Most of the injuries were in the under 5-year age group. The two main causes of trauma in children in this study were the falls from height and MVCs. Long distance travels to reach health-care facilities were noticeable in this study, together with substantial lack of adequate ambulance facilities and shortage in necessary subspecialty services such as neurosurgical, orthopaedics and rehabilitation. Implementing proposed recommendations can reduce the burden.

How much paediatric major trauma is truly paediatric? Experience from a level 1 urban Major Trauma Centre

Background: At its inception, there was no formal provision for children within the English major trauma network. There are now combined and stand-alone centres, but the scarcity of paediatric trauma facilities in some regions can result in long patient transfers and impact patient outcomes. The objective of this study was to determine the proportion of paediatric trauma patients who may benefit from input by adult services or may be safely managed within the local adult MTC, either because of patient physiology or injury patterns. Methods: All trauma presentations to our urban MTC aged ≤16 over a 3-year period were retrospectively identified and grouped, based on age and weight. ‘Young adult’ mechanisms of trauma and patient destinations (whether paediatric or adult wards) were determined. Results: There were 847 paediatric trauma cases recorded with a mean age of 9 and a male preponderance. Based on age and weight, 10–45% of cases could be considered physiologically adult-like, and 22–28% pubertal. Almost all penetrating trauma occurred in males, increasing with age. 14% of all admissions were managed on adult wards, with frequency increasing with patient age and with mechanism of actions (MOIs) relating to interpersonal violence. Conclusion: In this dataset, nearly half of paediatric trauma was ‘pubertal’ or ‘adult’ in their physiology and of these most presented with ‘young adult’ MOIs. These children likely benefit from combined paediatric and adult trauma services; where these do not exist, some older patients may be safely managed within local adult MTCs.

188. Review of a regional paediatric trauma service

Sheffield Children’s NHS Foundation Trust (SCH) is a paediatric major trauma centre, covered by a regional on-call oral and maxillofacial surgery (OMFS) team. Referrals are taken from across South Yorkshire and North Derbyshire. We carried out a retrospective review of all emergency referrals to OMFS to establish indications for referral and review management.

Failure to initiate trauma team activation for patients who meet the criteria in a level 1 paediatric trauma centre: which patients are missing out?

Trauma team activation (TTA) is paramount in the early hospital management of trauma patients. This study aimed to evaluate factors which contribute to failure to activate the Trauma team for management of paediatric trauma. A retrospective cohort study of Emergency Department (ED) presentations at the paediatric major trauma hospital in Adelaide, South Australia was conducted over a 16-month period. Data from the hospital's trauma registry, individual case files and digital medical records were evaluated to determine factors that were associated with no TTA. During the study period, 617 trauma patients who met Level 1 or Level 2 TTA criteria attended the trauma centre. For 29 (4.7%) of these patients, there was no TTA. Predictors of no TTA included sustaining abdomen and/or pelvis injuries compared to limb injuries (unadjusted odds ratio [OR]=10.59, 95% confidence interval [CI] 1.98-56.69, P=0.006), sustaining non-accidental injury (NAI) versus an injury with vehicle involvement (OR=30.13, 95% CI 6.43-141.21, P < 0.001), and arriving via emergency medical retrieval service compared to private vehicle (OR=14.23, 95% CI 3.94-51.36, P < 0.001). No patients transferred directly to Paediatric Intensive Care Unit (PICU), or High Dependency Unit (HDU) received an appropriate TTA. Multiple factors were associated with no TTA in paediatric trauma patients. The results highlight that even in PICU and HDU admissions and transfer patients, vigilant clarification of mechanism of injury and potential for occult injuries should be undertaken to ensure appropriate TTA and improve patient outcome.

The Blunt Liver and Spleen Trauma (BLAST) audit: national survey and prospective audit of children with blunt liver and spleen trauma in major trauma centres

PurposeTo compare the reported and observed management of UK children with blunt liver or spleen injury (BLSI) to the American Pediatric Surgical Association (APSA) 2019 BLSI guidance.MethodsUK Paediatric Major Trauma Centres (pMTCs) undertook 1 year of prospective data collection on children admitted to or discussed with those centres with BLSI and an online questionnaire was distributed to all consultants who care for children with BLSI in those centres.ResultsAll 21/21 (100%) pMTCs participated; 131 patients were included and 100/152 (65%) consultants responded to the survey. ICU care was reported and observed to be primarily determined using haemodynamic status or concomitant injuries rather than injury grade, in accordance with APSA guidance. Bed rest was reported to be determined by grade of injury by 63% of survey respondents and observed in a similar proportion of patients. Contrary to APSA guidance, follow-up radiological assessment of the injured spleen or liver was undertaken in 44% of patients before discharge and 32% after discharge, the majority of whom were asymptomatic.ConclusionsUK management of BLSI differs from many aspects of APSA guidance. A shift towards using clinical features to determine ICU admission and readiness for discharge is demonstrated, in line with a strong evidence base. However, routine bed rest and re-imaging after BLSI is common, contrary to APSA guidance. This disparity may exist due to concern that evidence around the incidence, presentation and natural history of complications after conservatively managed BLSI, particularly bleeding from pseudoaneurysms, is weak.

Pediatric electric scooter injuries in the UK: Case series and review of literature

Objective Electric scooters are being used worldwide as a new means of transport and e-scooter shared schemes are currently being piloted in cities across the UK. At present, there is no data published looking at pediatric e-scooter injuries within the UK. We aim to assess if e-scooters pose a risk to children and the patterns and severity of orthopedic injuries related to their use. Methods We performed a retrospective review of all orthopedic pediatric referrals relating to e-scooter use from January 1 to December 31, 2020 at two hospitals, including one pediatric Major Trauma Center in central London. Data including patient demographics, mechanism of injury, diagnosis, and treatment were collected. Results Ten patients were identified in this series, of which 5 required orthopedic surgery. Four patients required admission to hospital from the emergency department. The median age was 15 (range 13–17 years) and all were male. All e-scooters were privately owned and all sustained a fall whilst riding the e-scooter. No patient was wearing a helmet. Six sustained lower limb injuries and four upper limb injuries. Two patients were trauma called and one patient sustained an open fracture. There were no mortalities at 30 days. Conclusion E-scooters pose a significant risk to children and can be associated with severe musculoskeletal injury. The risk they pose to the pediatric population should not be overlooked and these findings may inform public policy regarding the restriction of electric scooter use in children.

Admission hypocalcemia in pediatric major trauma patients-An uncommon phenomenon associated with an increased need for urgent blood transfusion.

Hemorrhage is a leading cause of death among children. Recent data from adult trauma suggests that early, transfusion-unrelated, hypocalcemia is common and that it is associated with an increased need for blood transfusion, mortality, and coagulopathy. The objectives of this study are to evaluate the prevalence of admission hypocalcemia in severely injured children and its correlation with urgent blood transfusion. This is a retrospective cohort study of all severely injured (Injury Severity Score [ISS] > 15) pediatric (<18 years) trauma patients admitted to Rambam Health Care Campus, Israel between 2012 and 2020. We excluded patients transferred from other facilities and those who received blood before determining calcium levels. Severe hypocalcemia was defined as ionized calcium (Ca++ ) < 1.0 mmol/L and mild hypocalcemia as 1.0 mmol/L ≤ Ca++ < 1.1 mmol/L. The primary outcome was urgent blood transfusion (transfusion in the emergency department [ED]). Six hundred seventy-three severely injured children were admitted from the field. Ca++ levels were determined before blood transfusion in 457 patients. Severe hypocalcemia was found in three patients (0.7%) and mild hypocalcemia in additional 21 patients (4.6%). Hypocalcemic patients required more urgent blood transfusion (29.2% vs. 6.5%, p< .001) and had higher ISS (29 [interquartile range, IQR: 22-35] vs. 25 [IQR: 19-34], p= .05). Multivariable logistic regression analysis identified Ca++ < 1.1 mmol/L as an independent predictor of the need for blood transfusion, odds ratio 5.44 (95% confidence interval 1.44-20.58), p= .01. Contrary to adults, admission hypocalcemia is uncommon in severely injured children. However, it may be associated with an increased risk of blood transfusion in the ED.

Optimising whole body computed tomography doses for paediatric trauma patients: a Swiss retrospective analysis

We aimed to evaluate the impact of a low-dose whole-body computed tomography (WBCT) protocol on radiation doses in paediatric major trauma patients. Retrospective cohort study of paediatric trauma patients (<16 years) at a national level 1 paediatric trauma centre (PTC) over a 6 year period prior and post introduction of a low-dose WBCT protocol (2014–2019). Demographic data, patient characteristics, CT device, and exposure information including scan range, dose-length product, and volume CT dose index were collected. Effective dose (ED) and exposure parameters were compared before and after protocol introduction. Forty-eight patients underwent WBCT during the study period. Prior to introduction of the low-dose protocol (n = 18), the ED was 20.6 mSv (median 20.1 ± 5.3 mSv [range 12.5–30.7]). After introduction of the low-dose WBCT protocol (n = 30), mean ED was 4.8 mSv (median 2.6 ± 5.0 [range: 0.8–19.1]). This resulted in a reduction of 77% in mean ED (p value <0.001). Significant radiation dose reduction of 77% can be achieved with low-dose WBCT protocols in PTCs.