Pediatric Trauma Score Research Articles

A death calls from unsafe heights. a study of factors influencing the outcome of surgically treated pediatric head trauma patients in baghdad

Pediatric head injury accounts for a large number of admissions in emergency rooms, it is a major cause of morbidity and mortality in children over 1 year of age. The aim of this study is to assess the outcome of surgically treated pediatric patients with head trauma in Baghdad. Patients and methods : This prospective cross sectional study was conducted in neurosurgery hospital in Baghdad including fifty two patients of pediatric age group from 1 year to 14 years old with surgically operated head trauma, in the period from 1/10/2014 till 1/10/2015. All the patients were received; examined and managed properly and followed up till 6 months after surgery. The outcome was truly affected by the mechanism of injury (p=0.001), falls from heights was the most common mechanism and it was significantly related to mortality, it also increased the rate of disability, while it had no significance regarding a good functional recovery. There were associated orthopedic injuries which also affected the outcome significantly (p=0.01) increasing the mortality and disability. The outcome was truly affected by pediatric coma scale (p=0.001), functional recovery was increased with higher score and mortality increased with lower score, and disability increased in both severe and moderate scores. Pediatric trauma score had a significant effect on the outcome (p=0.001), in score (less than 0) it increased the mortality, in score(0-5) morbidity was increased. Falls from heights are the most common mechanism of pediatric head trauma and greatly affect the outcome. Concomitant orthopedic injuries are associated with poor outcome. pediatric coma scale, pediatric trauma score are significant tools in predicting outcome.

Triage in the Mass Casualties in Pre-hospital Emergency

Background: In the everyday life, a large number of pre-hospital emergency missions are including the injurers caused by traumatic events. Meanwhile, the immediate response to the injurers of the mass casualties is of particular importance due to their large number and also the distance to the medical centers. Using of a proper triage scale has a major role in prioritizing the injuries resulted from mass casualty events in order to treat and transfer them to health centers and also in the management of the scene and improving the quality of care of traumatic injuries. Therefore, the purpose of this study is to describe the various methods of triage in the scene, so that we can present a suitable triage scale for prioritizing injuries in mass casualty for pre-hospital emergency. Methods: This study is an overview one and is performed by using of databases and library resources and words including triage, pre-hospital emergency, mass casualty, crisis and emergency medical technician. Results: Based on the surveys, a variety of triage methods in the scene were found including Simple triage and rapid treatment (START), Jump start, triage sieve or Major Incident Medical Management and Support (MIMMS), Pediatric Triage Tape (PTT), Move, Assess, Sort, and Send (MASS), Care Flight, Sort, Assess, Lifesaving interventions, and Treatment and/or Transport (SALT), Revised Trauma Score (RTS), Pediatric Trauma score (PTS). Conclusion: In the literature, the use of different triage scales has been recommended in the crisis, the scene of the accident and trauma. By considering the context, structure and dispersion of mass casualty in the country, it isn’t known yet which one of these scales is operational and applicable. Therefore, for the patients in mass casualty, it is suggested that an appropriate and applicable triage scale should be designed for pre-hospital emergency operations. Key words: Triage in the scene, Pre-hospital emergency, Mass casualty

Hypothermia as an Outcome Predictor Tool in Pediatric Trauma: A Propensity-Matched Analysis.

Hypothermia is an independent risk factor for mortality in adult trauma patients. Two small studies have shown similar results in pediatric trauma patients. Temperature is not included in any pediatric trauma assessment scores. This study sought to compare mortality and various descriptive outcomes between pediatric hypothermic and normothermic trauma patients. Data were obtained from the National Trauma Database from 2009 to 2012. Patients meeting inclusion criteria were stratified by presence of isolated head injury, head injury with multiple trauma, and absence of head injury. These groups were then subdivided into hypothermic (temperature ≤36°C) and normothermic groups. We used propensity score matching to 1:1 match hypothermic and normothermic patients. Mortality, neurosurgical interventions, endotracheal intubation, blood transfusion, length of stay, laparotomy, thoracotomy, conversion of cardiac rhythm, and time receiving mechanical ventilation were evaluated. Data from 3,011,482 patients were obtained. There were 414,562 patients who met the inclusion criteria. In all patients meeting inclusion criteria, hypothermia was a significant risk factor in all outcomes measured. Following stratification and 1:1 matching, in all groups, hypothermia was associated with increased mortality (P < 0.0001), increased rate of endotracheal intubation (P < 0.0002), increased need for blood transfusion (P < 0.0025), and conversion of cardiac rhythm (P < 0.0027). Hypothermia has been shown to be a significant prognostic indicator in the pediatric trauma patient with further potential application. Future studies are indicated to evaluate the incorporation of hypothermia into the Pediatric Trauma Score not only to help predict injury severity and mortality but also to improve appropriate and expeditious patient transfer to pediatric trauma centers and potentially facilitate earlier intervention.

Impact of Interfacility Transport Method and Specialty Teams on Outcomes of Pediatric Trauma Patients.

The aim of the study was to evaluate the impact of ground versus air transport and use of pediatric specialty versus generalist transport teams on outcomes of pediatric trauma victims requiring interfacility transport. A retrospective review of our hospital's trauma registry database was performed. Children with traumatic injuries who were transported from a referring hospital by either our pediatric specialty transport team or an outside generalist transport team were included in the analysis. Comparisons were made by mode of transport (air vs ground), team type (specialty vs generalist), and by transport mode and team type combined. Total transport time was significantly shorter for generalist air transport than other modes. Severity of injury as determined by Pediatric Trauma Score (PTS) was equivalent for all patients at the referring hospital, but there was a statistically significant greater decrease (worsening) in PTS from referral to arrival for generalist team air transports versus all other transport modes. Similarly, there was a statistically significant greater decrease (worsening) in Glasgow Coma Score from referral to arrival for generalist team air transport versus all other transport modes. Hospital discharge disposition to home was greater for all ground teams versus air teams and for specialty team air versus generalist team air. In our system, air transport by a generalist team occurred more rapidly than ground or air transport by a specialty team. However, generalist air transport is associated with significant worsening in patients' PTS and Glasgow Coma Score despite similar severity of injury at referral, and differences in hospital discharge disposition were present.

Pediatric Traumatic Retinal Detachment: Clinical Features, Prognostic Factors, and Surgical Outcomes.

Purpose We report the clinical characteristics, prognostic factors, and surgical outcomes for 23-gauge pars plana vitrectomy (23-G PPV) in pediatric cases of traumatic retinal detachment (RD). Methods Medical records of pediatric patients who underwent 23-G PPV to treat traumatic retinal detachment were retrospectively reviewed. These patients underwent a follow-up examination at least 1 year following surgery. Associations between various preoperative factors and anatomical and visual outcomes were analyzed. An Ocular Trauma Score (OTS) and a Pediatric Ocular Trauma Score (POTS) were calculated for each patient. Raw scores were converted to their corresponding OTS and POTS categories. Final visual acuities by categories were compared with those in the OTS and POTS studies. Results The mean age of the patients was 9 ± 4 years, and the male-to-female ratio was 4.7 : 1. The mean follow-up time was 23 ± 14 months. Anatomical success was achieved in 72% of the eyes, and functional success (>5/200) was achieved in 37% of the eyes. Functional success was less common among patients with visual acuities less than hand motion, macula-off retinal detachment, proliferative vitreoretinopathy at presentation, and recurrent retinal detachment during follow-up. When we compared the categorical distribution of final visual acuities in all categories, our results were significantly different than those suggested by OTS and POTS. Conclusions Visual outcomes are poorer compared to anatomical outcomes. OTS and POTS do not provide reliable prognostic information if the patient has RD. Presenting visual acuity, the presence of macula-off RD, and PVR are all important predictors of final visual acuity.

Abstract PD-009: PERFORMANCE OF TRAUMA AND CRITICAL ILLNESS SCORES TO DISCRIMINATE PEDIATRIC PATIENT’S OUTCOMES

Aims & Objectives: Trauma is the leading cause of death worldwide in children >1 year. Roughly, 10% of all pediatric intensive care units (PICU) admissions are related to this cause. Methods to benchmark PICU performance are critical for quality improvement. Whether trauma or critical illness specific scores are better to predict outcomes in this population remains controversial. Methods Retrospective review of Hospital de Niños Ricardo Gutiérrez PICU trauma registry, which collects deidentified data from all admitted trauma patients between 1995 and 2017. We tested pediatric trauma score (PTS), injury severity score (ISS), new injury severity score (NISS), revised trauma score (RTS), trauma and injury severity score (TRISS) and pediatric index of mortality 2 (PIM2) to predict risk of death in the PICU. Results We included 360 children (58% males). Median age was 60 months (IQR 30–116). 73% had intracranial injuries, 26% involved extremities,19% thorax, 14% abdomen, 6% pelvis and 5% spine. 43% had injuries in one body region, 29% in two and 28% in more than two. The most frequent combination was head and extremities (16%). Main causes of injury were falls (42%), pedestrians (20%) and car occupants (7%). Overall mortality was 5.3%. The areas under ROC curve (AUC and 95%CI) were: NISS 0.749 (0.63–0.86), ISS 0.79 (0.69–0.89), PTS 0.90 (0.84–0.96), RTS 0.912 (0.84–0.98), TRISS 0.930 (0.86–0.99) and PIM2 0.977 (0.93–1.0). Conclusions In this sample from a single institution, PIM2 had higher discrimination capability than trauma scores when using death as the outcome variable. These results need to be tested in a bigger population.

Kick Scooter Injuries in Children and Adolescents: Minor Fractures and Bruise.

Kick scooters are popular among children in both transportation and recreational activities. The aim of this retrospective study was to assess the incidence of and injury patterns associated with kick scooter accidents in school-aged children and adolescents. All 171 patients at the age of 7-15 years who were treated for kick scooter-related injuries in the metropolitan Helsinki area, Southern Finland from January 2008 to December 2013 were included. Electronic medical records were reviewed and Pediatric Trauma Scores and Injury Severity Scores were utilized to assess the injuries. The annual number of patients increased from 7 in 2008 to 55 in 2013. Almost all patients (94%, n = 161) were injured after a fall from their own height. Most patients (n = 118; 69%) were diagnosed with a fracture but only 26 patients (15%) required surgical procedures under general anesthesia. Pediatric Trauma Scores were low and only one patient had an Injury Severity Score > 15 which can be considered major trauma. Most injuries acquired from kick scooter injuries were easily treatable fractures and bruises. Considering the background population of 105,000 in the respective age group and the 6-year period of data collection from tertiary care, scooting seems a safe means of increasing the physical activity levels of school-aged children and adolescents.

Correlation of Paediatric Trauma Score, Revised Trauma Score and Injury Severity Score with Length of Hospital Stay in Paediatric Trauma Patients

Correlation of Paediatric Trauma Score, Revised Trauma Score and Injury Severity Score with Length of Hospital Stay in Paediatric Trauma Patients

Quality of initial trauma care in paediatrics

Trauma care in Spain is not provided in specific centres, which means that health professionals have limited contact to trauma patients. After the setting up of a training program in paediatric trauma, the aim of this study was to evaluate the quality of the initial care provided to these patients before they were admitted to the paediatric intensive care unit (PICU) of a third level hospital (trauma centre), as an indirect measurement of the increase in the number of health professionals trained in trauma. Two cohorts of PICU admissions were reviewed, the first one during the four years immediately before the training courses started (Group 1, period 2001-2004), and the second one during the 4 years (Group 2, period 2012-2015) after nearly 500 professionals were trained. A record was made of the injury mechanism, attending professional, Glasgow coma score (GCS), and paediatric trauma score (PTS). Initial care quality was assessed using five indicators: use of cervical collar, vascular access, orotracheal intubation if GCS ≤ 8, gastric decompression if PTS≤8, and number of actions carried out from the initial four recommended (neck control, provide oxygen, get vascular access, provide IV fluids). Compliance was compared between the 2 periods. A P<.05 was considered statistically significant. A total of 218 patient records were analysed, 105 in Group 1, and 113 in Group 2. The groups showed differences both in injury mechanism and in initial care team. A shift in injury mechanism pattern was observed, with a decrease in car accidents (28% vs 6%; P<.0001). Patients attended to in low complexity hospitals increased from 29.4% to 51.9% (P=.008), and their severity decreased when assessed using the GCS ≤ 8 (29.8% vs 13.5%; P=.004), or PTS≤8 (48.5% vs 29.7%; P=.005). As regards quality indicators, only the use of neck collar improved its compliance (17.3% to 32.7%; P=.01). Patients who received no action in the initial care remained unchanged (19% vs 11%%; P=.15). Although there are limited improvements, the setting up of a training program has not translated into better initial care for trauma patients in our area of influence. Trauma training should be complemented with other support measures in order to achieve a systematic application of the trauma care principles.

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.

AGITATION IN THE SETTING OF PEDIATRIC TRAUMATIC BRAIN INJURY

BACKGROUND: Agitation following traumatic brain injury (TBI) commonly occurs during the acute phase of recovery and has been shown to hinder rehabilitation. OBJECTIVES: The current study investigated the relationships between acute agitation, injury severity, gender, disability, and functional outcomes in pediatric patients with TBI.This was done using the Agitation Behaviour Scale (ABS), which is being validated for use in children as part of this study. DESIGN/METHODS: 26 children (ages 5-17) with TBI participated in the study as part of the Attention and Outcome Following TBI study. The ABS was completed 3 times daily for 4 days and total mean agitation was calculated for analysis. Injury severity was measured by PRISM III, MRI score, Glasgow Coma Scale, Pediatric Trauma score, and length of intubation. Functional outcomes at baseline and 12 months post-TBI were measured by the Pediatric Injury Functional Outcome Scale. Relationships between injury severity, functional outcomes and agitation were analyzed with Spearman’s rank correlation coefficients. Intellectual and physical disability was measured at baseline and 12 months after TBI using the Pediatric Cerebral Performance Category and patients were categorized according to disability severity. Mean agitation was compared between gender and disability groups with one-way ANOVAs. RESULTS: There was a significant positive association between agitation and duration of ventilation, (= 0.752, P< 0.001). Higher levels of agitation were also displayed by children who had a higher risk of mortality due to their injury, (= 0.465, P= 0.017). There was a trend towards significance between agitation and trauma severity, where children that suffered more traumatic injury showed increased agitation (= -0.382, P= 0.054). In addition, a trend between agitation and long-term functional outcome was found, where more agitated children had increased functional deficits 12 months post-TBI (= 0.445, P=0.084). There were no significant differences in agitation between genders or disability groups at baseline and 12 months post-TBI. CONCLUSION: The ABS is a useful tool in the investigation of potential predictors and outcomes of agitation during TBI recovery in the pediatric population, which may facilitate development of improved management strategies in the future.

RETROSPECTIVE EVALUATION OF THE BIG SCORE TO PREDICT MORTALITY IN PEDIATRIC BLUNT TRAUMA

BACKGROUND: The BIG score is a new pediatric trauma score composed of the admission Base deficit, the International Normalized Ratio and the Glasgow Coma Scale. A score < 16 identifies children with a high probability of survival following blunt trauma. OBJECTIVES: To measure the criterion validity of the BIG score to predict in-hospital mortality among children visiting an emergency department with blunt trauma requiring an admission to the intensive care unit. DESIGN/METHODS: This was a retrospective cohort study performed in a single tertiary care pediatric hospital between 2008 and 2016. Participants were all children (< 18 years) visiting the emergency department for a blunt trauma requiring intensive care unit admission or who died at the emergency department. All charts were reviewed by a member of the research team using a standardized report form. To insure quality of data abstraction, 10% of the charts were reviewed in duplicate by a second rater blinded to the first evaluation. The primary outcome was in-hospital mortality. Baseline demographics, components of the BIG score upon arrival to the emergency department, and disposition were extracted. The primary analysis was the association between the BIG score and mortality. It was calculated that the inclusion of at least 25 deaths would provide confidence intervals of +/- 0.15 for proportions. RESULTS: Twenty-eight children died among the 336 who met the inclusion criteria. The inter-rater agreement for data abstraction was excellent for the 36 charts reviewed in duplicate with kappa scores or interclass correlation coefficients > 0.8 for all data. 284 children had information on the three components of the BIG score and they were included in the primary analysis. A BIG score > 16 demonstrated a sensitivity of 0.93 (95%CI: 0.76–0.98) and specificity of 0.83 (95%CI 0.78–0.87) to identify mortality. Using ROC curves, the area under the curve was statistically better for the BIG score (0.97) in comparison to the ISS (0.70) or to the individual components of the score. CONCLUSION: The BIG score is an excellent predictor of survival for children visiting the emergency department following a blunt trauma.

Caring for critically injured children: An analysis of 56 pediatric damage control laparotomies.

Injury is the leading cause of death in children under 18 years. Damage control principles have been extensively studied in adults but remain relatively unstudied in children. Our primary study objective was to evaluate the use of damage control laparotomy (DCL) in critically injured children. An American College of Surgeons-verified Level 1 trauma center review (1996-2013) of pediatric trauma laparotomies was undertaken. Exclusion criteria included: age older than 18 years, laparotomy for abdominal compartment syndrome or delayed longer than 2 hours after admission. Demographics, mechanism, resuscitation variables, injuries, need for DCL, and outcomes were evaluated. Independent t test, Mann-Whitney U test, Fisher's exact test, and single-factor analysis of variance assessed statistical significance. Study endpoints were hospital survival and DCL complications. Of 371 children who underwent trauma laparotomy, the median age (IQR; LQ-UQ) age was 16 (5; 11-17) years. Most (73%) were male injured by blunt mechanism (65%). Fifty-six (15%) children (Injury Severity Score [ISS], 33 (25; 17-42), pediatric trauma score 5 (6; 2-8), penetrating abdominal trauma index score [PATI] 29 (32; 12-44)) underwent DCL after major solid organ (63%), vascular (36%), thoracic (38%) and pelvic (36%) injury. DCL patients were older (16.5 (4; 14-18) vs. 16 (7; 10-17)) and were more severely injured (ISS, 33 [25; 17-42] vs. 16 [16; 9-25]), requiring greater intraoperative packed red blood cell transfusion (8 [13; 3.5-16.5] vs. 1 (0; [0-1] units) than definitive laparotomy counterparts. Nonsurvivors arrived in severe physiologic compromise (base deficit, 17 [17; 8-25] vs. 7 [4; 4-8]), requiring more frequent preoperative blood product transfusion (67% vs. 10%) after comparable injury (ISS survivors, 36 [23; 18-41] vs. nonsurvivors 26 (7; 25-32), p = 0.8880). Fifty-five percent of DCL patients survived (length of stay, 26 [21; 18-39] days) requiring 3 (2; 2-4) laparotomies during 4 (6; 2-8) days until closure (fascial, 90%; vicryl/split thickness skin grafting, 10%). DCL complications (surgical site infection, 18%; dehiscence, 2%; enterocutaneous fistula, 2%) were analyzed. When stratified by age (<15 years vs. 15-18 years) and period (1996-2006 vs. 2007-2013), no differences were found in injury severity or DCL outcomes (p > 0.05). After controlling for DCL, age, and gender, multivariate analysis indicated only ISS (odds ratio, 1.10 [95% confidence interval, 1.01 - 1.19], p = 0.0218) and arrival systolic blood pressure (odds ratio, 0.96 [95% confidence interval, 0.93-0.99], p = 0.0254) predicted mortality after severe injury. DCL is a proven, lifesaving surgical technique in adults. This report is the first to analyze the use of DCL in children with critical abdominal injuries. With similar survival and morbidity rates as critically injured adults, DCL merits careful consideration in children with critical abdominal injuries. Therapeutic study, level IV.

LO63: External validation of the BIG score to predict mortality in pediatric blunt trauma

Introduction: The BIG score is a new pediatric trauma score composed of the admission base deficit (BD), the international normalized ratio (INR) and the Glasgow Coma Scale (GCS). A score&amp;lt;16 identifies children with a high probability of survival following blunt trauma.The objective of this study was to measure the criterion validity of the BIG score to predict in-hospital mortality among children visiting an emergency department with blunt trauma requiring an admission to the intensive care unit. Methods: This was a retrospective cohort study performed in a single tertiary care pediatric hospital between 2008 and 2016. Participants were all children (&amp;lt;18 years) visiting the emergency department for a blunt trauma requiring intensive care unit admission or who died at the emergency department. All charts were reviewed by a member of the research team using a standardized report form. To insure quality of data abstraction, 10% of the charts were reviewed in duplicate by a second rater blinded to the first evaluation. The primary outcome was in-hospital mortality. Baseline demographics, initial components of the BIG score, Injury Severity Score (ISS) and disposition were extracted. The primary analysis was the association between a BIG score ≥16 and in-hospital mortality. It was calculated that the inclusion of at least 25 deaths would provide confidence intervals of +/- 0.20 for proportions in the worst-case scenario. Results: Twenty-eight children died among the 336 who met the inclusion criteria. The inter-rater agreement for data abstraction was excellent with kappa scores or intraclass correlation coefficients higher than 0.8 for all variables. Two hundred eighty-four children had information on the three components of the BIG score and they were included in the primary analysis. A BIG score ≥16 demonstrated a sensitivity of 0.93 (95%CI: 0.76-0.98) and specificity of 0.83 (95%CI 0.78-0.87) to identify mortality. Using ROC curves, the area under the curve was higher for the BIG score (0.97; 95%IC: 0.95-0.99) in comparison to the ISS (0.78; 95%IC: 0.71-0.85). Conclusion: The BIG score is an excellent predictor of survival for children visiting the emergency department following a blunt trauma.

Analysis of clinical features and risk factors of death in children with trauma

Objective To analyze the clinical features and risk factors of death in pediatric trauma, in order to provide preventing strategies and reduce mortality. Methods A retrospective study of 7 936 traumatic children admitted to the emergency department of our hospital from April 2014 to March 2016 was conducted.We retrospectively summarized the clinical features and Logistic regression analysis was used to analyze the risk factors of death in children with trauma. Results Compared to females, male patients contributed higher percentages(1.73∶1). There were more migrant children(5 535 cases) than local ones(2 401 cases)(χ2=14.314, P<0.05). Children in infancy stage(2 024 cases)and toddler period(3 097 cases) were more than in the other periods.Limb[41.9%(3 324/7 936)] and skin injuries[38.5%(3 058 324/7 936)] were the most common.Children trauma causes varied with age, fall, tumble and traffic accidents were common causes of children trauma.Pediatric trauma score of surviving group(n=1933), death group(n=5), general ward group(n=1852) and ICU group(n=86) were 8.53± 2.17, 3.17± 1.29, 9.72± 1.25, 5.23± 1.84, respectively.Shock decompensation, mechanical ventilation, Glasgow coma scale ≤7 and pediatric trauma score<8 were the risk factors which caused the death of trauma. Conclusion Parents should improve the security sense, strengthen the care of children and obey the traffic rules to reduce the rate of children trauma.Clinicians should pay attention to shock decompensation, mechanical ventilation, Glasgow coma scale and pediatric trauma score in order to identify critically ill patients in early stage and improve the success rate of rescue. Key words: Children; Trauma; Risk factor,

The Performance of the Pediatric Trauma Score in a Pediatric Emergency Department: A Prospective Study

The Performance of the Pediatric Trauma Score in a Pediatric Emergency Department: A Prospective Study

Improving the prognostic value of blunt abdominal trauma scoring systems in children

Purpose Blunt abdominal trauma (BAT) is a frequent reason for hospital admission and a significant cause of death in children older than 2 years of age. Mechanisms causing abdominal injuries are predominantly motor vehicle accidents, falls, and intentional injuries. Blunt trauma accounts for 90% of pediatric injuries. There are many scoring systems that are designed to monitor victims of BAT and to predict victims who may require conservative management and those who may require surgical intervention. None of these scoring systems is perfect and fulfill the data for accurate prediction of the prognosis of these victims. We assessed three different clinical scoring systems and their prognostic properties alone and after their modification by adding a plain, erect, abdominal radiographic film to improve their prognostic values. Patients and methods We included all patients presenting with BAT older than 2 years and younger than 18 years. All children were subjected to three different trauma scoring systems. We evaluated all children using Pediatric Trauma Score, Clinical Abdominal Score System, and Blunt Abdominal Trauma in Children. We then added plain, erect, abdominal radiographic films to these systems. Results A total of 250 children with BAT were subjected to three different scoring systems. Among them, 58% were boys and 42% were girls. The cause for BAT in two hundred and two cases was car accidents, falling from heights in seven, and kicks and abuse in 41 cases. The mean time until hospital arrival was 2 h. The mean age was 15 years. The mean time for every scoring system was 5 min. Radiographic imaging showed positive signs of trauma (air under diaphragm, elevated copula of diaphragm) in 45 patients. Conclusion Adding a simple radiographic film in the erect position of the abdomen and lower chest markedly improved the prognostic value of the different scoring systems included. Keywords : children, scoring systems, 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.

The changes of serum cortisol and its influence on prognosis in children with traumatic brain injury

Objective To explore the changes of serum cortisol and its influence on prognosis in children with traumatic brain injury(TBI). Methods A total of 52 children suffering from TBI hospitalized in SICU of Nanjing Children′s Hospital from June 2014 to December 2015 were analyzed.According to the glasgow coma scale(GCS), they were divided into three groups: mild injury group(19 cases, GCS≥13), moderate injury group(16 cases, 8<GCS <13), and severe injury group(17 cases, GCS≤8). We collected the data of the following clinical parameters on the 1st, 3rd, 7th day after hospitalization: the levels of serum adrenocorticotropic hormone (ACTH) and cortisol, general vital signs, pediatric critical illness score, paediatric trauma score, cycle index(mean arterial pressure), metabolic index (total protein, albumin, blood sugar), respiratory index(pH, PaO2, PaO2/FiO2), ICU length of hospital stay, the total length of hospital stay, 28 days case fatality rate. Results (1)There were significant differences in the scores of GCS, pediatric critical illness score, pediatric trauma score, heart rate, blood glucose and white blood cell count among three groups (P 0.05, respectively). (2)The levels of cortisol in children with TBI increased (24 hours) at early stage, and then gradually dropped to normal within one week.The levels of ACTH were also elevated after injury.The levels of serum ACTH and cortisol in severe and moderate injury group were significantly higher than those in the mild group[ACTH: (44.19±9.41)pg/ml, (29.91±5.49)pg/ml, (9.47±2.32)pg/ml; cortisol: (48.57±3.63) mg/dl, (40.94±2.95) mg/dl, (25.14±1.76) mg/dl], the differences were statistically significant (P 0.05). (3)There were significant differences in the duration of mechanical ventilation, duration of shock, the ICU length of hospital stay and the total length of hospital stay among the three groups(P<0.05). All of the three groups had good prognosis, and 28 d mortality was 0. Conclusion The changes of serum cortisol and ACTH will happen to children after TBI.In the acute phase, the more severe the brain injury is, the higher the serum ACTH and cortisol level shows, and the longer of the total length of hospital stay, ICU length of hospital stay, the duration of mechanical ventilation time and shock.The serum cortisol and ACTH will decrease in some children after TBI due to the organic lesion of hypothalamic-pituitary-adrenal axis. Key words: Children; Trauma; Traumatic brain injury; Cortisol,