Pediatric Trauma Outcomes Research Articles

Trends and Outcomes of Pediatric Vascular Injuries in the United States: An Analysis of the National Trauma Data Bank

According to the Center for Disease Control and Prevention, trauma is the leading cause of death in children aged >1year in the United States (US). Although vascular injuries occur in only 0.6-1% of pediatric patients with trauma, they are a major mortality contributor. This study aims to examine epidemiology and outcomes after pediatric vascular injuries (PedVIs) in the US. The National Trauma Data Bank (2002-2012) was queried to identify children (0-16) with PedVIs. Patients were categorized based on their demographics, location, and mechanism and presenting trauma severity (injury severity score [ISS] and shock). Study was divided into two 5-year periods (P1: 2002-2006; P2: 2007-2012) to study the trends in pediatric vascular trauma presentation and outcomes (hospital death and extended length of stay [LOS >8days]) using adjusted analyses. Analyses were performed on 3,408 cases; who were male (73.7%) and Caucasian (52.8%) with a mean age of 10.5±4.5years. The Southern region of the US saw the highest increase in PedVIs (P2 versus P1: 38.3% vs. 25.0%, P<0.05). Blunt injuries constituted most of these injuries (57%). Firearm (36.9%) and motor vehicle crash (MVC) (34%) were the most common lethal mechanisms of injury. Despite the significant decrease in MVC rates (P2 versus P1: 17.4% vs. 22.6%, P<0.05), firearm rates were unchanged. Upper extremity injuries were the most common anatomically (34.9%). ISS and shock were significantly decreased during P2. Mortality occurred in 7.9% of patients, which significantly decreased (P2 versus P1: 6.3% vs. 10.9%, P<0.001) without a significant change in LOS. Odds of mortality decreased by 32% during P2 (P=0.08) and was independently associated with penetrating mechanism of injury (odds ratio [OR]: 1.97; 95% confidence interval [CI]: 1.22-3.19, P=0.006), shock at presentation (OR: 5.48; 95% CI: 3.55-8.46, P<0.001); ISS (OR: 1.08; 95% CI: 1.06-1.27, P<0.001), and Glasgow Coma Score<9 (OR: 11.21; 95% CI: 7.18-17.49, P<0.001). We observed a significant decrease in the overall severity of injury and in-hospital mortality concurrent with the observation of a significant decrease in the rates of pediatric MVC vascular injuries. Public health policies directed toward firearm safety may further decrease PedVIs and mortality among this vulnerable population.

Can the Pediatric Resuscitation and Trauma Outcomes Be Used to Predict In-Hospital Mortality in Injured Rwandese Children?

Can the Pediatric Resuscitation and Trauma Outcomes Be Used to Predict In-Hospital Mortality in Injured Rwandese Children?

A five-year retrospective study of the epidemiological characteristics and visual outcomes of pediatric ocular trauma

BackgroundPediatric trauma can lead to serious visual impairment as a result of the trauma itself or secondary to amblyopia. Precise data on epidemiological characteristics and visual outcomes of pediatric ocular injuries are valuable for the prevention of monocular blindness.MethodsA total of 268 cases of pediatric ocular trauma admitted to the Department of Ophthalmology of the Lithuanian University of Health Sciences Hospital from January 2008 to December 2013 were retrospectively reviewed. Data analysed included age, sex, cause, type and treatment of injury, initial and final visual acuity (VA) and tissues involvement. Eye injuries were classified by Birmingham Eye Trauma Terminology (BETT) and Ocular Trauma Classification System (OTCS).ResultsThe age of children ranged from 6 months to 17.5 years. Boys were more likely to suffer ocular injury than girls. Home was the leading place of eye injury (60.4%), followed by outdoors (31.7%), school (5.2%) and sporting area (2.2%). The highest percentage of eye injuries in children were caused by blunt (40.3%) and sharp objects (29.9%), followed by burns (9.3%), falls (6.7%), explosions (4.5%), fireworks (4.1%), gunshots (1.9%) and traffic accidents (0.7%). Closed globe injury (CGI) was the most common type of eye injury (53.4%). CGI were noted to be higher in children aged 13–18 years, while open globe injury (OGI) were higher in the pre-school age group. Injury of grade 4 and grade 5 were more common in OGI, while grade 1 and grade 2 predominated in cases of CGI. Hypotony, traumatic cataract, iris laceration, vitreous prolapse and uveitis were the most common presentations of OGI, while hyphema, secondary glaucoma and retinal edema were significantly related with CGI. Final diagnoses contributing to poor final visual outcome such as corneal scar corneal opacity, hypotony, aphakia, and retinal detachment were statistically significant related only with OGI. Overall, 65.63% of children regained good visual acuity (VA ≥ 0.5), but for 18.4% of them, the trauma resulted in severe visual impairment (VA ≤ 0.1).ConclusionOcular trauma in children still remains an important preventable cause of ocular morbidity. This study provides data indicating that ophthalmological injuries are a significant cause of visual impairment in children.

Pattern and outcome of unintentional pediatric trauma in the emergency department of a tertiary care hospital in South India

Background: Pediatric trauma is a significant cause of morbidity, and few studies on profile and outcome have been done in the emergency departments (EDs) of India. Methodology: This prospective observational study was conducted between October 2014 and December 2014 in the adult and pediatric ED's of Christian Medical College, Vellore. All patients younger than 18 years, who presented with unintentional injury, were enrolled in this study. Results: The adult and pediatric ED's attended to a combined 24,482 patients (16,169 adults and 8313 children and adolescents) during the 3-month study with 8.2% (2022/24,482) being trauma incidents. Pediatric and adolescent ( 18 years) trauma patients made up the remainder 80% (1624). Falls are the most common mechanism of injury among infants and toddlers with decreasing frequency with age. With increasing age, the place of injury changes from the surroundings of home to playgrounds, schools, and the roads. About 80% of injuries among infants occur at home while only 12% of adolescent injuries occur at home. Road traffic injuries account for 46% of injuries sustained by adolescents. Most of the children and adolescents (63%) were managed conservatively. Minor surgical intervention was required in 20% whereas 11% required major surgical intervention. Majority (77%) was discharged stable from the ED, and 21% were admitted. The in-hospital mortality of pediatric trauma was 1.2% (5/397). Conclusions: Pediatric and adolescent trauma is a significant cause of morbidity and mortality in India, accounting for almost one-fifth of injured patients. There exists a need for injury prevention programs focusing on peridomestic safety among children 12 years and adolescents.

Visual outcome and ocular survival in pediatric ocular trauma

Purpose: Ocular injuries in children are a major under-recognized cause of ocular morbidity and can be prevented by identifying the etiology and implementing measures to prevent these injuries. This study intends to assess the visual outcome and ocular survival in paediatric ocular trauma.&#x0D; Design: A descriptive study set in a tertiary care teaching hospital in Southern India.&#x0D; Methods: A total of 56 children less than 18 years of age with ocular trauma during the period August 2010 to August 2012were studied. Injuries were classified as per modified Ocular Trauma Classification System (OTCS). Final visual outcome was assessed at the end of 1, 3, &amp; 6 months.&#x0D; Results: Of the 56 children assessed 87.5% were that of boys. About 12% were under-fives and almost 66% were in the age range of 5-14 years. And majority (47.45 %) had sustained trauma in the streets. Closed globe injury predominated (69.49%). At presentation, grade I injury noted in 28 eyes (47.45%), grade II in 1 (1.69%), grade III in 3 (5.08%) , grade IV in 8 (13.55%) , PL negative in 3 (5.08 %) and un-cooperative in 16 cases (27.11 %). At six months, good vision noted in 44 eyes (74.6%), moderate in 5 (8.47%), poor vision in 1 (1.69 %), PL negative in 4 (6.77%), un-cooperative 4 cases (6.77%). 4 eyes had phthisis (6.77%) and 1 eye (1.69%) was eviscerated.&#x0D; Conclusions: Ocular trauma in childhood was more common in the male child, mostly due to road traffic accidents. Ocular trauma being a significant cause of visual loss in childhood, awareness campaigns are necessary.

Development and validation of a new pediatric resuscitation and trauma outcome (PRESTO) model using the U.S. National Trauma Data Bank

BackgroundThere is a need for a pediatric trauma outcomes benchmarking model that is adapted for Low-and-Middle-Income Countries (LMICs). We used the National-Trauma-Data-Bank (NTDB) and applied constraints specific to resource-poor environments to develop and validate an LMIC-specific pediatric trauma score. MethodsWe selected a sample of pediatric trauma patients aged 0–14years in the NTDB from 2007 to 2012. Primary outcome was in-hospital death. Logistic regression was used to create the Pediatric Resuscitation and Trauma Outcome (PRESTO) score, which includes only low-tech predictor variables — those easily obtainable at point-of-care. Internal validation was performed using 10-fold cross-validation. External validation compared PRESTO to TRISS using ROC analyses. ResultsAmong 651,030 patients, there were 64% males. Median age was 7. In-hospital mortality-rate was 1.2%. Mean TRISS predicted mortality was 0.04% (range 0%–43%). Independent predictors included in PRESTO (p<0.01) were age, blood pressure, neurologic status, need for supplemental oxygen, pulse, and oxygen saturation. The sensitivity and specificity of PRESTO were 95.7% and 94.0%. The resulting model had an AUC of 0.98 compared to 0.89 for TRISS. ConclusionPRESTO satisfies the requirements of low-resource settings and is inherently adapted to children, allowing for benchmarking and eventual quality improvement initiatives. Further research is necessary for in-situ validation using prospectively collected LMIC data. Level of evidenceLevel III — Case–Control (Prognostic) Study.

Definitive airway management after prehospital supraglottic rescue airway in pediatric trauma

IntroductionSupraglottic airway (SGA) use and outcomes in pediatric trauma are poorly understood. We compared outcomes between patients receiving prehospital SGA versus bag mask ventilation (BVM). MethodsWe reviewed pediatric multisystem trauma patients (2005–2016), comparing SGA and BVM. Primary outcome was adequacy of oxygenation and ventilation. Additional measures included tracheostomy, mortality and abbreviated injury scores (AIS). ResultsNinety patients were included (SGA, n=17 and BVM, n=73). SGA patients displayed increased median head AIS (5 [4–5] vs 2 [0–4], p=0.001) and facial AIS (1 [0–2] vs 0 [0–0], p=0.03). SGA indications were multiple failed intubation attempts (n=12) and multiple failed attempts with poor visualization (n=5). Median intubation attempts were 2 [1–3] whereas BVM patients had none. Compared to BVM, SGA patients demonstrated inadequate oxygenation/ventilation (75% vs 41%), increased tracheostomy rates (31% vs 8.1%), and increased 24-h (38% vs 10.8%) and overall mortality (75% vs 14%) (all p<0.05). ConclusionsEscalating intubation attempts and severe facial AIS were associated with tracheostomy. Inadequacy of oxygenation/ventilation was more frequent in SGA compared to BVM patients. SGA patients demonstrate poor clinical outcomes; however, SGAs may be necessary in increased craniofacial injury patterns. These factors may be incorporated into a management algorithm to improve definitive airway management after SGA.

An Update Review of Epidemiology, Anatomy, Classification, Management and Outcome of pediatric Thoracolumbar Spine Trauma

An Update Review of Epidemiology, Anatomy, Classification, Management and Outcome of pediatric Thoracolumbar Spine Trauma

Characteristics and outcomes of acute pediatric blunt torso trauma based on injury intent

IntroductionBlunt trauma is a leading cause of pediatric morbidity. We compared injuries, interventions and outcomes of acute pediatric blunt torso trauma based on intent. MethodsWe analyzed de-identified data from a prospective, multi-center emergency department (ED)-based observational cohort of children under age eighteen. Injuries were classified based on intent (unintentional/inflicted). We compared demographic, physical and laboratory findings, ED disposition, hospitalization, need for surgery, 30-day mortality, and cause of death between groups using Chi-squared or Fisher's test for categorical variables, and Mann-Whitney test for non-normal continuous factors comparing median values and interquartile ranges (IQR). ResultsThere were 12,044 children who sustained blunt torso trauma: Inflicted=720 (6%); Unintentional=9563 (79.4%); Indeterminate=148 (1.2%); Missing=1613 (13.4%). Patients with unintentional torso injuries significantly differed from those with inflicted injuries in median age in years (IQR) [10 (5, 15) vs. 14 (8, 16); p-value<0.001], race, presence of pelvic fractures, hospitalization and need for non-abdominal surgery. Mortality rates did not differ based on intent. Further adjustment using binary, logistic regression revealed that the risk of pelvic fractures in the inflicted group was 96% less than the unintentional group (OR: 0.04; 95%CI: 0.01–0.26; p-value=0.001). ConclusionsChildren who sustain acute blunt torso trauma due to unintentional causes have a significantly higher risk of pelvic fractures and are more likely to be hospitalized compared to those with inflicted injuries.

PC178 Age Associated With Mortality and Outcomes in Pediatric Vascular Trauma

PC178 Age Associated With Mortality and Outcomes in Pediatric Vascular Trauma

Optimizing the assessment of pediatric injury severity in low-resource settings: Consensus generation through a modified Delphi analysis

IntroductionAlthough a plethora of pediatric injury severity scoring systems is available, many of them present important challenges and limitations in the low resource setting. Our aim is to generate consensus among a group of experts regarding the optimal parameters, outcomes, and methods of estimating injury severity for pediatric trauma patients in low resource settings. Materials and methodsA systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients. Qualitative data was extracted from the systematic review, including scoring parameters, settings and outcomes. In order to establish consensus regarding which of these elements are most adapted to pediatric patients in low-resource settings, they were subjected to a modified Delphi survey for external validation. The Delphi process is a structured communication technique that relies on a panel of experts to develop a systematic, interactive consensus method. We invited a group of 38 experts, including adult and pediatric surgeons, emergency physicians and anesthesiologists trauma team leaders from a level 1 trauma center in Montreal, Canada, and a pediatric referral trauma hospital in Santiago, Chile to participate in two successive rounds of our survey. ResultsConsensus was reached regarding various features of an ideal pediatric trauma score. Specifically, our experts agreed pediatric trauma scoring tool should differ from its adult counterpart, that it can be derived from point of care data available at first assessment, that blood pressure is an important variable to include in a predictive model for pediatric trauma outcomes, that blood pressure is a late but specific marker of shock in pediatric patients, that pulse rate is a more sensitive marker of hemodynamic instability than blood pressure, that an assessment of airway status should be included as a predictive variable for pediatric trauma outcomes, that the AVPU classification of neurologic status is simple and reliable in the acute setting, and more so than GCS at all ages. ConclusionTherefore, we conclude that an opportunity exists to develop a new pediatric trauma score, combining the above consensus-generating ideas, that would be best adapted for use in low-resource settings.

Pediatric ocular trauma score as a prognostic tool in the management of pediatric traumatic cataracts.

To introduce and validate the pediatric ocular trauma score (POTS) - a mathematical model to predict visual outcome trauma in children with traumatic cataract METHODS: In this retrospective cohort study, medical records of consecutive children with traumatic cataracts aged 18 and below were retrieved and analysed. Data collected included age, gender, visual acuity, anterior segment and posterior segment findings, nature of surgery, treatment for amblyopia, follow-up, and final outcome was recorded on a precoded data information sheet. POTS was derived based on the ocular trauma score (OTS), adjusting for age of patient and location of the injury. Visual outcome was predicted using the OTS and the POTS and using receiver operating characteristic (ROC) curves. POTS predicted outcomes were more accurate compared to that of OTS (p = 0.014). POTS is a more sensitive and specific score with more accurate predicted outcomes compared to OTS, and is a viable tool to predict visual outcomes of pediatric ocular trauma with traumatic cataract.

Pediatric Trauma Assessment and Management Database: Leveraging Existing Data Systems to Predict Mortality and Functional Status after Pediatric Injury

Efforts to improve pediatric trauma outcomes need detailed data, optimally collected at lowest cost, to assess processes of care. We developed a novel database by merging 2 national data systems for 5 pediatric trauma centers to provide benchmarking metrics for mortality and non-mortality outcomes and to assess care provided throughout the care continuum. Trauma registry and Virtual Pediatric Systems, LLC (VPS) from 5 pediatric trauma centers were merged for children younger than 18 years discharged in 2013 from a pediatric ICU after traumatic injury. For inpatient mortality, we compared risk-adjusted models for trauma registry only, VPS only, and a combination of trauma registry and VPS variables (trauma registry+VPS). To estimate risk-adjusted functional status, we created a prediction model de novo through purposeful covariate selection using dichotomized Pediatric Overall Performance Category scale. Of 688 children included, 77.3% were discharged from the ICU with good performance or mild overall disability and 17.6% with moderate or severe overall disability or coma. Inpatient mortality was 5.1%. The combined dataset provided the best-performing risk-adjusted model for predicting mortality, as measured by the C-statistic, pseudo-R2, and Akaike Information Criterion, when compared with the trauma registry-only model. The final Pediatric Overall Performance Category model demonstrated adequate discrimination (C-statistic= 0.896) and calibration (Hosmer-Lemeshow goodness-of-fit p= 0.65). The probability of poor outcomes varied significantly by site (p < 0.0001). Merging 2 data systems allowed for improved risk-adjusted modeling for mortality and functional status. The merged database allowed for patient evaluation throughout the care continuum on a multi-institutional level. Merging existing data is feasible, innovative, and has potential to impact care with minimal new resources.

Comparison of outcomes in severe pediatric trauma at adult trauma centers with different trauma case volumes

BackgroundIn addition to trauma center levels and types, trauma volume may be an important factor impacting outcomes in severe pediatric trauma. MethodsAll severely injured pediatric patients treated at adult trauma centers were identified from the National Trauma Data Bank. All qualifying centers were stratified into four groups based on the cumulative pediatric trauma case volumes with ISS >15: lowest (group 1), lower (group 2), higher (group 3), and highest (group 4) volume centers. Mortality rates among the groups were compared. ResultsA total of 3747 patients were stratified into group 1 (n=2122, median annual pediatric trauma volume 3 cases/year), group 2 (n=842, 15 cases/year), group 3 (n=494, 24 cases/year), and group 4 (n=289, 43 cases/year). In the hierarchical logistic regression analysis, the highest volume centers (group 4) were shown to have improved mortality (odds ratio 0.474, 95% confidence interval [CI] 0.301–0.747) compared to the lowest volume centers (group 1). Odds ratios of group 4 against group 1 for subgroups were 0.634 (age<10, 95% CI 0.335–1.198), 0.491 (blunt injury, 95% CI 0.310–0.777), and 0.495 (level 1 center, 95% CI 0.312–0.785). ConclusionsIn severe pediatric trauma treated at adult trauma centers, higher volume centers were associated with improved mortality in comparison to the lower volume centers. Level of evidenceLevel III, therapeutic/care management, retrospective comparative study without negative criteria.

The UK Paediatric Ocular Trauma Study 1 (POTS1): development of a global standardized protocol for prospective data collection in pediatric ocular trauma.

BackgroundOcular trauma is an important cause of visual morbidity in children worldwide. Pediatric ocular trauma accounts for up to one third of all ocular trauma admissions, with significant economic implications for health care providers. It is estimated that 90% of all ocular trauma is preventable. Development of strategies to reduce the incidence and severity of pediatric ocular trauma requires an understanding of the epidemiology of these injuries and their characteristics. This will enable appropriate targeting of resources toward prevention and allow effective service planning. At present, there is no standardized methodology for the collection of global cross-sectional data in pediatric ocular trauma, and the ability to undertake detailed epidemiological and health-economic analyses is limited. Furthermore, it is difficult to draw international comparisons in incidence, etiology, and outcomes of pediatric ocular trauma due to the range of published reporting criteria. This study describes two novel questionnaires for standardized data collection in pediatric ocular trauma, which can be adopted across a range of health care settings internationally.MethodsTwo standardized data collection questionnaires have been developed from previously reported templates. The first enables collection of demographic and incident data on serious pediatric ocular trauma requiring hospitalization, and the second enables follow-up outcome data collection. Both the questionnaires are designed to collect primarily categorical data in order to increase ease of completion and facilitate quantitative analysis. These questionnaires enable acquisition of standardized data on the incidence, etiology, and outcomes of pediatric ocular trauma.DiscussionThese questionnaires enable collection of standardized data and are designed for global use across all health care settings. Through prospective data collection, epidemiological trends can be determined, allowing health care providers to develop collaborative global preventive strategies. Furthermore, the same questionnaires may be used in future studies to draw comparisons with baseline data, allowing assessment of the efficacy of targeted preventative interventions.

Epidemiology, clinical profile and factors, predicting final visual outcome of pediatric ocular trauma in a tertiary eye care center of Central India.

Purpose:Ocular trauma constitutes an important cause of preventable visual morbidity worldwide. This study was done to study the incidence, sociodemographic pattern, and clinical profile of ocular trauma in pediatric age group. Also to evaluate the factors influencing final visual outcome in these patients.Methods:This was a prospective interventional study concerning ocular trauma in pediatric patients up to 16 years of age of either sex. Various variables having an impact on final visual outcome were studied, and results were analyzed using statistical indices – relative risk, Chi-square test, P value, and linear regression analysis.Results:A total of 220 cases of trauma were evaluated with the mean age being 8.74 ± 3.93 years, males were predominantly affected and open globe injuries outnumbered blunt injuries. Penetrating injuries accounted for 67.79% cases of open globe injury, rupture being the least (2.54%). Stepwise multiple linear regression analysis executed, showed the best predictors in the descending order for final visual outcome were presenting visual acuity, size of corneal tear, type of injury, zone of injury, time period between injury and treatment with a variance of 35.9%, 6.3%, 5.3%, 3.7%, and 2.7%, respectively. All above variables were also found to be statistically significant (P < 0.05) on Chi-square test.Conclusion:We report the first study on the epidemiology and clinical outcomes of pediatric ocular trauma in central India. Poor initial Visual Acuity and posterior segment involvement adversely affect the visual outcome. Early medical treatment and globe-salvaging repair should be done in all eyes suffering from trauma.

Obesity in pediatric trauma

Background/purposeThe implications of childhood obesity on pediatric trauma outcomes are not clearly established. Anthropomorphic data were recently added to the National Trauma Data Bank (NTDB) Research Datasets, enabling a large, multicenter evaluation of the effect of obesity on pediatric trauma patients. MethodsChildren ages 2 to 19years who required hospitalization for traumatic injury were identified in the 2013–2014 NTDB Research Datasets. Age and gender-specific body mass indices (BMI) were calculated. Outcomes included injury patterns, operative procedures, complications, and hospital utilization parameters. ResultsData from 149,817 pediatric patients were analyzed; higher BMI percentiles were associated with significantly more extremity injuries, and fewer injuries to the head, abdomen, thorax and spine (p values <0.001). On multivariable analysis, higher BMI percentiles were associated with significantly increased likelihood of death, deep venous thrombosis, pulmonary embolus and pneumonia; although there was no difference in risk of overall complications. Obese children also had significantly longer lengths of stay and more frequent ventilator requirement. ConclusionsAmong children admitted after trauma, increased BMI percentile is associated with increased risk of death and potentially preventable complications. These findings suggest that obese children may require different management than nonobese counterparts to prevent complications. Level of evidenceLevel III; prognosis study.

Systematic review and need assessment of pediatric trauma outcome benchmarking tools for low-resource settings.

Trauma is a leading cause of mortality and disability in children worldwide. The World Health Organization reports that 95% of all childhood injury deaths occur in Low-Middle-Income Countries (LMIC). Injury scores have been developed to facilitate risk stratification, clinical decision making, and research. Trauma registries in LMIC depend on adapted trauma scores that do not rely on investigations that require unavailable material or human resources. We sought to review and assess the existing trauma scores used in pediatric patients. Our objective is to determine their wideness of use, validity, setting of use, outcome measures, and criticisms. We believe that there is a need for an adapted trauma score developed specifically for pediatric patients in low-resource settings. A systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients. We constructed a search strategy in collaboration with a senior hospital librarian. Multiple databases were searched, including Embase, Medline, and the Cochrane Central Register of Controlled Trials. Articles were selected based on predefined inclusion criteria by two reviewers and underwent qualitative analysis. The scores identified are suboptimal for use in pediatric patients in low-resource settings due to various factors, including reliance on precise anatomic diagnosis, physiologic parameters maladapted to pediatric patients, or laboratory data with inconsistent accessibility in LMIC. An important gap exists in our ability to simply and reliably estimate injury severity in pediatric patients and predict their associated probability of outcomes in settings, where resources are limited. An ideal score should be easy to calculate using point-of-care data that are readily available in LMIC, and can be easily adapted to the specific physiologic variations of different age groups.

The impact of transfer on pediatric trauma outcomes

BackgroundRecently, concerns have been raised over delays that result from transferring patients to designated trauma centers. This study aimed to assess whether transfer status had an impact on pediatric trauma outcomes. MethodsUsing a local 1996–2014 pediatric trauma database containing 1541 patients, the following outcomes were tested: death, major complication, time to definitive treatment (TDT), hospital length of stay (LOS), and ICU length of stay (ICU LOS). Logistic, generalized linear, and Poisson regression models were used. ResultsMortality and complication rates did not differ significantly between direct (mortality=52/1000, complications=54/1000) and transferred (mortality=59/1000; complications=67/1000) patients (mortality aRR: 1.17, 95% CI: 0.76–1.80, p=0.48; complication aRR: 1.13, 95% CI: 0.75–1.70, p=0.57). Transfer status was not a significant predictor of ICU LOS (p=0.72). Transfer status was a significant predictor of time to definitive treatment (transfer x-=17.4h vs. direct x-=2.6h, p=0.0035) and of LOS for severely injured patients (p=0.005). The significant predictors of pediatric trauma mortality were: ISS, transport mode, age, and TDT, and of major complication were ISS and TDT. ConclusionsAlthough transferred patients had longer time to specialized care, there were no significant differences in the mortality or complication rates between transferred and direct patients after adjusting for injury severity.

Management and Outcomes of Pediatric High Grade Blunt Renal Trauma

Management and Outcomes of Pediatric High Grade Blunt Renal Trauma