Benchmarking Prehospital and Emergency Department Care for Argentine Children with Traumatic Brain Injury: For the South American Guideline Adherence Group

Vavilala, Monica S.; Lujan, Silvia; Qiu, Qian; Petroni, Gustavo; Ballarini, Nicolás; Guadagnoli, Nahuel; Depetris, María Alejandra; Faguaga, Gabriela A.; Baggio, Gloria M.; Busso, Leonardo; García, Mirta E.; Carrillo, Osvaldo R. González; Medici, Paula L.; Saenz, Silvia; Vanella, Elida E.; Fabio, Anthony; Bell, Michael J.

doi:10.1371/journal.pone.0166478

Cited by 15 publications

(11 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the developed world the transport of sick/injured patients is highly organized and has reduced morbidity and mortality significantly. [ 21 ] Despite an exponential increase in the number of hospitals catering to critically ill children and adults, there has been no serious attempt to improve cost-effective and appropriate transportation of trauma victims/critically ill patients in this country. A highly organized free/subsidized emergency transport system is the need of the hour.…”

Section: Discussionmentioning

confidence: 99%

Clinico-radiologic Profile of Pediatric Traumatic Brain Injury in Western Rajasthan

Dara

Parakh

Choudhary

et al. 2018

Journal of Neurosciences in Rural Practice

View full text Add to dashboard Cite

Objective:The aim of this study was to evaluate clinico-radiological profile and outcome of pediatric traumatic brain injury (TBI).Design:Prospective observational studySetting:Intensive Care Unit, ward and OPD of Pediatrics, Dr. S. N. Medical College, Jodhpur (tertiary care hospital).Participants:A total of 188 children (1 month–18 years) were enrolled and 108 admitted.Intervention:TBI classified as mild, moderate, or severe TBI. Neuroimaging was done and managed as per protocol. Demographic profile, mode of transport, and injury were recorded.Outcome:Measured as hospital stay duration, focal deficits, mortality, and effect of early physiotherapy.Results:Males slightly outnumbered females mean age was 5.41 ± 4.20 years. Fall from height was the main cause of TBI (61.11%) followed by road traffic accident (RTA) (27.78%). Majority (56.56%) reached hospital within 6 h of injury, out of which 27% of patients were unconscious. Mild, moderate, and severe grade of TBI was seen in 50%, 27.78%, and 22.22% of cases, respectively. About 12.96% of cases required ventilator support. The average duration of hospital stay was 11.81 ± 12.9 days and was lesser when physiotherapy and rehabilitation were started early. In all children with temporal bone fracture, magnetic resonance imaging (MRI) brain revealed a temporal lobe hematoma and contusion in spite of initial computed tomography (CT) head normal. Children who have cerebrospinal fluid (CSF) rhinorrhea/otorrhea had a high chance of fracture of base of skull and contusion of the basal part of the brain.Conclusion:In India, fall from height is common setting for pediatric TBI besides RTA. Early initiation of physiotherapy results in good outcome. MRI detects basal brain contusions in children presenting with CSF rhinorrhea/otorrhea even if initial CT brain is normal.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinico-radiologic Profile of Pediatric Traumatic Brain Injury in Western Rajasthan

Dara

Parakh

Choudhary

et al. 2018

Journal of Neurosciences in Rural Practice

View full text Add to dashboard Cite

show abstract

“…However, previous work suggests that examining the care of pediatric TBI patients from Argentina is valuable and enhances our common understanding of the relationship between the quality of TBI care provided and outcomes. We recently benchmarked prehospital and emergency care of children with all TBI severities who received care at seven Argentine trauma centers and showed that many critically injured children with TBI do not receive timely or best practice prehospital care and that that longer transport time is associated with poor discharge outcomes [ 15 ]. We have also shown that there is generalizability of the five World Health Organization/Organization Mondiale de la Santé TBI prognostic predictors in both high income countries and LMICs [ 2 – 3 , 16 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Intensive care treatments associated with favorable discharge outcomes in Argentine children with severe traumatic brain injury: For the South American Guideline Adherence Group

et al. 2017

Self Cite

View full text Add to dashboard Cite

ObjectiveLittle is known about the critical care management of children with traumatic brain injury (TBI) in low middle income countries. We aimed to identify indicators of intensive care unit (ICU) treatments associated with favorable outcomes in Argentine children with severe TBI.MethodsWe conducted a secondary analysis of data from patients previously enrolled in a prospective seven center study of children with severe TBI who were admitted to an ICU in one of the seven study centers. Severe TBI was defined by head AIS ≥ 3, head CT with traumatic lesion, and admission GCS < 9. Seven indicators of best practice TBI care were examined. The primary outcome was discharge Pediatric Cerebral Performance Category Scale [PCPC] and Pediatric Overall Performance category Scale [POPC]. We also examined variation in ICU care and in-patient mortality.ResultsOf the 117 children, 67% were male and 7.5 (4.3) years on average, 92% had isolated TBI. Hypotension (54%) was more common than hypoxia (28%) and clinical or radiographic signs of high intracranial pressure (ICP) were observed in 92%. Yet, ICP monitoring occurred in 60% and hyperosmolar therapy was used in only 36%. Adherence to indicators of best TBI practice ranged from 55.6% to 83.7% across the seven centers and adherence was associated with favorable discharge PCPC (aRR 0.98; 95% CI [0.96, 0.99]), and POPC (aRR 0.98; 95% CI [0.96, 0.99]). Compared to patients whose adherence rates were below 65%, patients whose adherence rates were higher between 75%-100% had better discharge PCPC (aRR 0.28; 95% CI [0.10, 0.83]) and POPC (aRR 0.32; 95% CI [0.15, 0.73]. Two indicators were associated with favorable discharge PCPC: Avoidance of hypoxia (aRR 0.46; 95% CI [0.23, 0.93]), and Nutrition started in 72 hours (aRR 0.45; 95% CI [0.21, 0.99]). Avoiding hypoxia was also associated with favorable discharge POPC (aRR 0.47; 95% CI [0.22, 0.99]).ConclusionThere is variation in Argentine ICU practice in the care of children with severe TBI. Second insults are common and hyperosmolar therapy use is uncommon. Adherence to best practice TBI care by avoiding hypoxia and providing timely nutrition were associated with significantly favorable discharge outcomes. Implementing strategies that prevent hypoxia and facilitate early nutrition in the ICUs are urgently needed to improve pediatric TBI outcomes.

show abstract

“…Public road accident is the circumstance of occurrence of cranial trauma. This is the finding throughout the literature review[3] [4][5]. The young male subject is the first victim of road accidents[3].…”

mentioning

confidence: 79%

Pre-Hospital Management of Craniocerebral Trauma in South Saharan Africa: Cotonou Experience

Moumouni¹,

Kpelao²,

Fadigba³

et al. 2019

OJMN

View full text Add to dashboard Cite

The management of craniocerebral trauma begins at the site of the accident. This is one of the diseases for which pre-hospital care is well codified. The objective of this study is to report the experience of the Emergency Aid Medical Service (EMAS) of BENIN in the pre-hospital management of craniocerebral trauma. 146 head injuries were cared for. 116 were male. The mean age was 32 years with extremes ranging from 2 to 77 years. Etiology in 68% of patients was a public road accident. And the request for the use of the EMAS was made by highway users for 41% of the injuries. About 5.5% were severe cranio-brain injuries, more than 75% of which had died in intensive care. In 77% of the EMAS interventions, there was an intensive care physician in the team. 34 wounded had been transported in a vacuum mattress. The rigid cervical collar was used in 8 major traumas. All the wounded were transported by ambulance. The duration of hospitalization varied from a few hours in the emergency department to 90 days in the hospital ward. 9 patients died. One of them, who died in an ambulance, was a woman. The prehospital medical care of head trauma in BENIN is still progressing.

show abstract

Benchmarking Prehospital and Emergency Department Care for Argentine Children with Traumatic Brain Injury: For the South American Guideline Adherence Group

Cited by 15 publications

References 22 publications

Clinico-radiologic Profile of Pediatric Traumatic Brain Injury in Western Rajasthan

Clinico-radiologic Profile of Pediatric Traumatic Brain Injury in Western Rajasthan

Intensive care treatments associated with favorable discharge outcomes in Argentine children with severe traumatic brain injury: For the South American Guideline Adherence Group

Pre-Hospital Management of Craniocerebral Trauma in South Saharan Africa: Cotonou Experience

Contact Info

Product

Resources

About