A National Comparison of Volume and Acuity for Adult and Pediatric Trauma: A Trauma Quality Improvement Program Cohort Study

Thornton, Steven W.; Leraas, Harold J.; Horne, Elizabeth; Cerullo, Marcelo; Chang, Doreen; Greenwald, Emily; Agarwal, Suresh; Haines, Krista; Tracy, Elisabeth T.

doi:10.1016/j.jss.2023.07.018

Cited by 3 publications

(1 citation statement)

References 38 publications

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“…In the United States, firearm-related mortalities have surpassed motor vehicle crashes (MVCs) after 60 years at the helm and are now the leading cause of death in patients between 1 and 19 years of age (Centers for Disease Control and Prevention [CDC], 2021; Goldstick et al, 2022). This increase in penetrating trauma has challenged even the most mature PTCs, whose incidence of penetrating trauma has historically been less than 20% of total trauma volume (Cotton & Nance, 2004; Thornton et al, 2023).…”

Section: Introductionmentioning

confidence: 99%

Quality Improvement Practices and Resources Targeting Firearm Injuries: A Survey of U.S. Pediatric Trauma Centers

Wurster,

Herndon,

Seastrom

et al. 2023

Journal of Trauma Nursing

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BACKGROUND: The increase in firearm injuries at U.S. pediatric trauma centers is a national public health crisis. This spike in penetrating trauma has challenged even the most mature pediatric trauma centers. OBJECTIVE: This project aims to identify U.S. pediatric trauma center best practices for the evaluation and resources dedicated to pediatric firearm injuries. METHODS: This study used an exploratory cross-sectional survey design using a study-specific questionnaire. An electronic survey was distributed to 159 verified U.S. pediatric trauma centers targeting patients younger than 15 years with firearm injuries from 2017 to 2021. Trauma approaches to injury prevention, advocacy, and common performance improvement events were surveyed. A follow-up survey provided a drill-down on the top three performance improvement events. RESULTS: A total 159 surveys were distributed, of which 63 (40%) submitted partial responses and 32 (20%) completed the initial survey in full. A 49% increase in pediatric firearm injuries occurred between 2019 and 2020. Eighty-six percent of the trauma centers identified at least one to two opportunities for improvement events related to firearm injuries, with most of these events requiring a tertiary level of review. The top three performance improvement events included the massive transfusion protocol/fluid resuscitation, emergency department procedures, and operating room resource availability. CONCLUSIONS: This study provides the first known examination of U.S. pediatric trauma center quality improvement efforts to address the crisis of pediatric firearm injuries. Our results indicate that most pediatric trauma centers are engaged in quality improvement and resource enhancement to combat firearm injuries.

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Section: Introductionmentioning

confidence: 99%

Quality Improvement Practices and Resources Targeting Firearm Injuries: A Survey of U.S. Pediatric Trauma Centers

Wurster,

Herndon,

Seastrom

et al. 2023

Journal of Trauma Nursing

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Educational Strategies in Pediatric Trauma Resuscitation Across Disciplines: A Scoping Review

Goins,

Thornton,

Horne

et al. 2024

Journal of Surgical Research

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Fluid Management in Critically Ill Children: Single-Center Retrospective Comparison of Trauma and Postoperative Patients, 2020–2022*

Wu,

Gennell,

Porigow

et al. 2024

Pediatric Critical Care Medicine

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Objective: Injury and surgery both represent well-defined starting points of a predictable inflammatory response, but the consequent response to IV fluids has not been studied. We aimed to review and compare our single-center fluid management strategies in these two populations. Design: Retrospective cohort study from January 2020 to July 2022. The primary outcome was total IV fluid volume administered. Net fluid balances and select clinical outcomes were also evaluated. Setting: Single tertiary academic center and level 1 pediatric trauma center in New York. Patients: A dataset of critically ill trauma and surgical patients aged 0–18 years who were admitted to the PICU, 2020–2022. Trauma patients had at least moderate traumatic injuries (Injury Severity Score ≥ 9) and surgical patients had at least a 1-hour operation time. Interventions: None. Measurements and Main Results: We identified 25 trauma and 115 surgical patients. During the first 5 days of hospitalization, we did not identify an association between grouping and total IV fluids administered and fluid balance in the prehospital, emergency department, and operating room (p = 0.90 and p = 0.79), even when adjusted for weight (p = 0.96). Time trend graphs of net fluid balance and IV fluid administered illustrated analogous fluid requirement and response with the transition from net positive to net negative fluid balance between 48 and 72 hours. There was an association between total IV fluid and ventilator requirement (p = 0.003). Conclusions: Critically ill pediatric trauma and postoperative patients seem to have similar fluid management and balance after injury or surgery. In our opinion, these two critically ill populations could be combined in large prospective studies on optimal fluid therapy in critically ill children.

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A National Comparison of Volume and Acuity for Adult and Pediatric Trauma: A Trauma Quality Improvement Program Cohort Study

Cited by 3 publications

References 38 publications

Quality Improvement Practices and Resources Targeting Firearm Injuries: A Survey of U.S. Pediatric Trauma Centers

Quality Improvement Practices and Resources Targeting Firearm Injuries: A Survey of U.S. Pediatric Trauma Centers

Educational Strategies in Pediatric Trauma Resuscitation Across Disciplines: A Scoping Review

Fluid Management in Critically Ill Children: Single-Center Retrospective Comparison of Trauma and Postoperative Patients, 2020–2022*

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