Stable Pediatric Blunt Trauma Patients

Qazi, Khajista; Wright, Martha; Kippes, Christopher

doi:10.1097/00005373-199809000-00025

Cited by 32 publications

(4 citation statements)

References 16 publications

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“…13 Many (39%) described 2-tiered trauma team activation criteria. 5,8-10,16,17,21 A number of studies evaluated the accuracy of criteria categories including mechanism 6,8,18,19 and physiologic criteria 2 as well as simplified criteria including only respiratory compromise and intubation. 12 Two studies evaluated variations of the Pediatric Trauma Score, 11,15 and 2 studies applied the current ACS criteria to the trauma population.…”

Section: Resultsmentioning

confidence: 99%

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A Systematic Review of Hospital Trauma Team Activation Criteria for Children

Drendel¹,

Gray²,

Lerner

2019

Pediatr Emer Care

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Objectives: Hospital trauma activation criteria are intended to identify children who are likely to require aggressive resuscitation or specific surgical interventions that are time sensitive and require the resources of a trauma team at the bedside. Evidence to support criteria is limited, and no prior publication has provided historical or current perspectives on hospital practices toward informing best practice. This study aimed to describe the published variation in (1) highest level of hospital trauma team activation criteria for pediatric patients and (2) hospital trauma team membership and (3) compare these finding to the current ACS recommendations. Methods: Using an Ovid MEDLINE In-Process & Other Non-Indexed Citations search, any published description of hospital trauma team activation criteria for children that used information captured in the prehospital setting was identified. Only studies of children were included. If the study included both adults and children, it was included if the number of children assessed with the criteria was included. Results: Eighteen studies spanning 20 years and 13,184 children were included. Hospital trauma team activation and trauma team membership were variable. Nearly all (92%) of the trauma criteria used physiologic factors. Penetrating trauma (83%) was frequently included in the trauma team activation criteria. Mechanisms of injury (52%) were least likely to be included in the highest level of activation. No predictable pattern of criterion adoption was found. Only 2 of the published criteria and 1 of published trauma team membership are consistent with the current American College of Surgeons recommendations. Conclusions: Published hospital trauma team activation criteria and trauma team membership for children were variable. Future prospective studies are needed to define the optimal hospital trauma team activation criteria and trauma team membership and assess its impact on improving outcomes for children.

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Section: Resultsmentioning

confidence: 99%

“…Some published criteria depended heavily on anatomic factors to identify trauma team activation criteria including 14 specific injuries, 2 but 6 criteria included no anatomic factors at all. 6,7,12-14,18…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Hospital Trauma Team Activation Criteria for Children

Drendel¹,

Gray²,

Lerner

2019

Pediatr Emer Care

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“…53,54 From previous studies of pediatric patients in which age has been considered a criterion for an automatic trauma response, 55–58 it has been found that age (specifically young age) may not be an appropriate sole criterion for requiring a higher level of trauma care. There is, however, some literature suggesting a tiered approach to trauma center activation once a patient has reached the emergency department for a range of patient characteristics.…”

Section: Commentmentioning

confidence: 99%

Factors Associated With Trauma Center Use for Elderly Patients With Trauma

Hsia¹

2011

Arch Surg

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Objectives To estimate the likelihood of trauma center admission for injured elderly patients with trauma, determine trends in trauma center admissions, and identify factors associated with trauma center use for elderly patients with trauma. Design Retrospective analysis. Setting Acute care hospitals in California. Patients All patients hospitalized for acute traumatic injuries during the period from January 1, 1999, to December 31, 2008 (n=430 081). Patients who had scheduled admissions for nonacute or minor trauma were excluded. Main Outcome Measure Likelihood of admission to level I or II trauma center was calculated according to age categories after adjusting for patient and system factors. Results Of 430 081 patients admitted to California acute care hospitals for trauma-related diagnoses, 27% were older than 65 years. After adjusting for demographic, clinical, and system factors, compared with trauma patients aged 18–25 years, the odds of admission to a trauma center decreased with increasing age; patients aged 26–45 years had lower odds (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.71–0.80) of being admitted to a trauma center for their injuries than did patients 46–65 years of age (OR, 0.57; 95% CI, 0.54–0.60), patients 66–85 years of age (OR, 0.35; 95% CI, 0.30–0.41), and patients older than 85 years (OR, 0.30; 95% CI, 0.25–0.36). Similar patterns were found when stratifying the analysis by trauma type and severity. Living more than 50 miles away from a trauma center (OR, 0.03; 95% CI, 0.01–0.06) and lack of county trauma center (OR, 0.17; 95% CI, 0.09–0.35) were also predictors of not receiving trauma care. Conclusion Age and likelihood of admission to a trauma center for injured patients were observed to be inversely proportional after controlling for other factors. System-level factors play a major role in determining which injured patients receive trauma care.

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“…Intervention-based measures have been found to perform better than the well-established major trauma definition [ 30 , 31 ], including as a means of evaluating TTA criteria [ 32 ]. Centers should review TTA criteria regularly to ensure that they identify patients who will benefit from a trauma team [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study

Herren,

Palmer,

Landolt

et al. 2023

Children

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Background. Trauma is one of the most common causes of death in childhood, but data on severely injured Swiss children are absent from existing national registries. Our aim was to analyze trauma activations and the profiles of critically injured children at a tertiary, non-academic Swiss pediatric emergency department (PED). In the absence of a national pediatric trauma database, this information may help to guide the design of infrastructure, processes within organizations, training, and policies. Methods. A retrospective analysis of pediatric trauma patients in a prospective resuscitation database over a 2-year period. Critically injured trauma patients under the age of 16 years were included. Patients were described with established triage and injury severity scales. Statistical evaluation included logistic regression analysis. Results. A total of 82 patients matched one or more of the study inclusion criteria. The most frequent age group was 12–15 years, and 27% were female. Trauma team activation (TTA) occurred with 49 patients (59.8%). Falls were the most frequent mechanism of injury, both overall and for major trauma. Road-traffic-related injuries had the highest relative risk of major trauma. In the multivariate analysis, patients receiving medicalized transport were more likely to trigger a TTA, but there was no association between TTA and age, gender, or Injury Severity Score (ISS). Nineteen patients (23.2%) sustained major trauma with an ISS > 15. Injuries of Abbreviated Injury Scale severity 3 or greater were most frequent to the head, followed by abdomen, chest, and extremities. The overall mortality rate in the cohort was 2.4%. Conclusions: Major trauma presentations only comprise a small proportion of the total patient load in the PED, and trauma team activation does not correlate with injury severity. Low exposure to high-acuity patients highlights the importance of deliberate learning and simulation for all professionals in the PED. Our findings indicate that high priority should be given to training in the management of severely injured children in the PED. The leading major trauma mechanisms were preventable, which should prompt further efforts in injury prevention.

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Stable Pediatric Blunt Trauma Patients

Abstract: Mechanisms of injury seem to have limited value as predictors of injury severity in stable pediatric blunt trauma patients. A modified response level for these patients may prove to be a safe and practical alternative to current practice.

Cited by 32 publications

References 16 publications

A Systematic Review of Hospital Trauma Team Activation Criteria for Children

A Systematic Review of Hospital Trauma Team Activation Criteria for Children

Factors Associated With Trauma Center Use for Elderly Patients With Trauma

Pediatric Trauma and Trauma Team Activation in a Swiss Pediatric Emergency Department: An Observational Cohort Study

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