Prehospital care and transportation of pediatric trauma patients

Allen, Casey J.; Teisch, Laura F.; Meizoso, Jonathan P.; Ray, Juliet J.; Schulman, Carl I.; Namias, Nicholas; Sola, Juan E.

doi:10.1016/j.jss.2015.03.005

Cited by 17 publications

(8 citation statements)

References 26 publications

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“…Trauma anak merupakan suatu masalah global, lebih dari 900.000 anak dan remaja di dunia meninggal karena trauma (Kristiansen et al, 2011). Setiap tahun diperkirakan 1,5 juta anak mengalami trauma, 20.000 diantaranya meninggal, 300.000 lainnya harus mendapatkan perawatan di rumah sakit dan 100.000 mengalami cacat permanen (Alterman et al, 2013;Allen et al, 2015). Trauma ini menyebabkan lebih banyak kematian pada anak-anak dan remaja dari penyebab lain (American Academy of Pediatrics and Pediatric Orthopaedic Society of North America, 2008).…”

Section: Pendahuluanunclassified

Assessment Dan Manajemen Trauma Pada Anak

Rachmawati

2020

Borticalth

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Section: Pendahuluanunclassified

Assessment Dan Manajemen Trauma Pada Anak

Rachmawati

2020

Borticalth

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“…As demonstrated in prior literature, this suggests that an additional few minutes for a prehospital intervention, at the scene or in transport, to obtain intravenous access and begin the transfusion of blood products did not have a negative outcome and may provide a survival benefit. 21 This study highlights several important lessons that can aid clinicians and researchers in developing the best resuscitation strategy for pediatric trauma patients. Regardless of the state, regional, or national level, the creation of complete and accurate trauma registries with clinically relevant data, standardized definitions, and outcomes is critical.…”

mentioning

confidence: 99%

“…In addition, there were minimal differences in scene and transport times between the PHT and EDT groups for both ground and helicopter transport. As demonstrated in prior literature, this suggests that an additional few minutes for a prehospital intervention, at the scene or in transport, to obtain intravenous access and begin the transfusion of blood products did not have a negative outcome and may provide a survival benefit …”

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confidence: 99%

Prehospital Transfusion in Pediatric Trauma—The Clock Is Ticking

Russell

Koenig

2023

JAMA Pediatr

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Trauma is the leading cause of mortality and hemorrhagic shock in pediatric patients, and sustained injuries are one of the most common causes of preventable mortality in these patients. 1 An estimated 1000 to 2000 preventable traumatic deaths in children per year occur after injury in the US because of inadequate or delayed care. 2 Some of these deaths may represent pediatric patients with unrecognized hemorrhagic shock who are not promptly treated with hemorrhage control and appropriate hemostatic resuscitation. The 30-day mortality in children with traumatic hemorrhagic shock is estimated to be 36% to 50% compared with the 25% reported mortality in similar adults. 3,4 A retrospective review of the Pennsylvania statewide trauma database by Morgan et al 5 aimed to determine if the utilization of prehospital transfusion (PHT) in injured children leads to decreased mortality.Adult data have left no question as to whether prehospital blood transfusions improve mortality. Retrospective military and civilian studies in addition to randomized clinical trials have demonstrated improved 6-hour, 24-hour, and 30-day mortality rates in traumatically injured adults receiving PHT. In addition, these studies have demonstrated improvement in the patient's physiological status on arrival at the hospital, less need for crystalloid administration, and minimal blood product wastage. [6][7][8][9] The Pediatric Traumatic Hemorrhagic Shock Consensus Conference determined, based on the current literature, that it is reasonable to consider PHT for pediatric patients with hemorrhagic shock, but this is a critical research priority. 10,11 Prior to this study, the best available pediatric literature suggests that clinicians should try to limit the use of crystalloid boluses in children with hemorrhagic shock. Increasing the use of crystalloids in children exhibiting signs of shock has led to increased odds of mechanical ventilation and longer intensive care unit and hospital stays. [12][13][14] In addition, small single-center studies have demonstrated that PHT is safe and feasible and improves physiologic measures of coagulopathy and shock. However, owing to the limited sample size of these studies, to our knowledge, no study has demonstrated an improvement in mortality. [15][16][17][18][19] This evaluation of the Pennsylvania Trauma Systems Foundation registry by Morgan et al 5 provides critical data to suggest that PHT in pediatric trauma patients improves mortality. From their 10-year retrospective cohort of more than 14 000 pediatric trauma patients, 559 (4.0%) received a blood product transfusion and 70 (0.5%) received a PHT. As expected, there were significant differences between patients receiving emergency department transfusions (EDT) and PHT. To address potential selection bias, they developed 3:1 propensity

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“…While for trauma patients the goal is to arrive at the hospital as fast as possible (“scoop and run”), medical patients should be stabilized before transport (“stay and play”). Therefore, there is still an on-going discussion about whether and which invasive and difficult interventions (eg, endotracheal intubation) should be performed on site or whether they critically delay the time to arrival 10,11 . Another difficulty is the lack of a guideline concerning the transport destination that would specify which patients require a higher-level pediatric center or a pediatric trauma center and thus prevent unnecessary secondary transfers 12–14 .…”

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confidence: 99%

Preclinical Pediatric Care by Emergency Physicians

Vetschera

Beliveau

Esswein³

et al. 2022

Pediatr Emer Care

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Objectives: Fewer than 10% of emergency medical system (EMS) calls concern children and adolescents younger than 18 years. Studies have shown that the preclinical care of children differs from that of adults regarding assessment, interventions, and monitoring. The aims of this study were to describe the preclinical care and emergency transport of pediatric patients in Vorarlberg, Austria and to compare trauma and nontrauma cases.Methods: This is a population-based study, analyzing medical records of EMS calls to children and adolescents. We received all patient records of EMS calls to children and adolescents younger than 18 years (n = 4390 in total) from the 2 local EMS providers, the Red Cross Vorarlberg and the Austrian Mountain Rescue Service (Christophorus 8 and Gallus 1) covering a study period of 7 years, from 2013 to 2019. The record data were extracted by automation with an in-house program and subsequently anonymized. Statistical analyses were performed with SPSS Statistics.Results: During the study period, 7.9% of all EMS calls concerned children and adolescents younger than 18 years. For our study, 3761 records were analyzed and 1270 trauma cases (33.8%) were identified. The most common injuries were injuries of the extremities and traumatic brain injury. The frequency of National Advisory Committee of Aeronautics Scores of 4 or higher was 17.7%, similar for all age groups and for trauma as well as nontrauma patients. Mean Glasgow Coma Scale scores were higher in the trauma group than in the nontrauma group (14.2 vs 11.2). In 62.9% of all patients, 1 or more vital parameters were documented. A majority of these values was in the pathologic range for the respective age group. The rate of pulsoxymetry monitoring during transport was low (42.1% in trauma and 30.3% in nontrauma patients) and decreased significantly with patient age. Moreover, while the placing of intravenous lines and monitoring during transport were significantly more frequent in trauma patients, the administration of medication or oxygen was significantly more frequent in nontrauma patients. Conclusions:The pediatric population lacks assessments and monitoring in preclinical care, especially the youngest children and nontrauma patients, although emergency severity scores are similar.

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Prehospital care and transportation of pediatric trauma patients

Cited by 17 publications

References 26 publications

Assessment Dan Manajemen Trauma Pada Anak

Assessment Dan Manajemen Trauma Pada Anak

Prehospital Transfusion in Pediatric Trauma—The Clock Is Ticking

Preclinical Pediatric Care by Emergency Physicians

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