Timing of mortality in pediatric trauma patients: A National Trauma Data Bank analysis

McLaughlin, Cory; Zagory, Jessica A.; Fenlon, Michael; Park, Caron; Lane, Christianne J.; Meeker, Daniella; Burd, Randall S.; Ford, Henri R.; Upperman, Jeffrey S.; Jensen, Aaron R.

doi:10.1016/j.jpedsurg.2017.10.006

Cited by 71 publications

(69 citation statements)

References 42 publications

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“…1 While most deaths occur immediately or within hours of the injury, over one-quarter of pediatric trauma deaths are characterized as "late mortality," occurring after at least 24 hours of hospitalization. 2 Children who survive to hospital admission remain at risk for life-threatening complications of their initial injury, the most common being acute respiratory distress syndrome (ARDS). 2 ARDS can be triggered by direct pulmonary insults such as pneumonia and aspiration, or by systemic inflammation, as with sepsis and trauma.…”

Section: Introductionmentioning

confidence: 99%

“…2 Children who survive to hospital admission remain at risk for life-threatening complications of their initial injury, the most common being acute respiratory distress syndrome (ARDS). 2 ARDS can be triggered by direct pulmonary insults such as pneumonia and aspiration, or by systemic inflammation, as with sepsis and trauma. 3 Mortality among children with ARDS of all etiologies ranges from 13-44% depending on the patient population, [4][5][6][7][8][9][10][11][12] highlighting the heterogeneity of the syndrome.…”

Section: Introductionmentioning

confidence: 99%

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Morbidity and Mortality Among Critically Injured Children With Acute Respiratory Distress Syndrome

Killien

Mills

Watson

et al. 2019

Critical Care Medicine

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Objective: To evaluate morbidity and mortality among critically injured children with acute respiratory distress syndrome (ARDS) Design: Retrospective cohort study Setting: 460 Level I/II adult or pediatric trauma centers contributing to the National Trauma Data Bank Patients: 146,058 patients <18 years admitted to an intensive care unit with traumatic injury from 2007-2016 Interventions: None Measurements and Main Results: We assessed in-hospital mortality and need for postdischarge care among patients with and without ARDS, and hospital resource utilization and discharge disposition among survivors. Analyses were adjusted for underlying mortality risk (age, Injury Severity Score, serious brain or chest injury, and admission heart rate and hypotension), and year, transfer status, and facility trauma level designation. ARDS occurred in 2590 patients (1.8%). Mortality was 20.0% among ARDS patients versus 4.3% among non-ARDS patients, with an adjusted relative risk (aRR) of 1.76 (95% CI 1.52-2.04). Post-discharge care was required in an additional 44.8% of ARDS patients versus 16.0% of non-ARDS patients (aRR 3.59, 2.87-4.49), with only 35.1% of ARDS patients discharging to home versus 79.8% of non-ARDS patients. ARDS mortality did not change over the ten-year study period (aRR 1.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Morbidity and Mortality Among Critically Injured Children With Acute Respiratory Distress Syndrome

Killien

Mills

Watson

et al. 2019

Critical Care Medicine

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“…Unfortunately, this limitation is common in pediatric trauma cohorts considering their overall low mortality. (14) Finally, our results concern data in a speci c mountainous area and cannot be apply in an urban trauma system.…”

Section: Discussionmentioning

confidence: 96%

“…Injured children have also higher incidence of early mortality compared to adults. (14) Secondary outcomes were in-hospital death, length of stay in intensive care unit (ICU) and length of stay in hospital. Major trauma patients are usually de ned by an ISS > 15.…”

Section: Outcomes and Triage De Nitionsmentioning

confidence: 99%

Effect of Under Triage on Early Mortality After Major Pediatric Trauma: A Registry-based Propensity Score Matching Analysis

Ageron

Porteaud

Evain

et al. 2020

Preprint

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Backgroundlittle is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24 hour-mortality after major pediatric trauma in a regional trauma systemMethodsThis cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24 hour-mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. ResultsA total of 1 143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 hours. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference: 6.0 [95% CI 1.3-10.7]) and Ps matching analyses (risk difference: 3.1 [95% CI 0.8-5.4]).ConclusionsIn a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.

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“…[4,5] Children with severe injuries, however, constitute a minority of patients at level I or II pediatric trauma centers. [6,7] Because mortality is most likely to occur within 24 hours after injury,[8] the initial resuscitation phase is a critical component of these patients’ care. Quality, efficiency, and cohesiveness of the trauma resuscitation team may be life-saving for severely injured children, but individual provider workload during the resuscitation of these patients is high.…”

Section: Introductionmentioning

confidence: 99%

Impact of simulation-based training on perceived provider confidence in acute multidisciplinary pediatric trauma resuscitation

et al. 2018

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Purpose: Simulation-based training has the potential to improve team-based care. We hypothesized that implementation of an in situ multidisciplinary simulation-based training program would improve provider confidence in team-based management of severely injured pediatric trauma patients. Methods: An in situ multidisciplinary pediatric trauma simulation-based training program with structured debriefing was implemented at a free-standing children’s hospital. Trauma providers were anonymously surveyed one month before (pre-), one month after (post-), and two years after implementation. Results: Survey response rate was 49% (n=93/190) pre-simulation, 22% (n=42/190) post-simulation, and 79% (n=150/190) at two-year follow-up. These providers reported more anxiety (p=0.01) and less confidence (p=0.02) one-month post-simulation. At two-year follow-up, trained providers reported less anxiety (p=0.02) and greater confidence (p=0.01), compared to untrained providers. Conclusions: Implementation of an in situ multidisciplinary pediatric trauma simulation-based training program may initially lead to increased anxiety, but long-term exposure may lead to greater confidence. Level of Evidence: II. Prospective cohort.

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Timing of mortality in pediatric trauma patients: A National Trauma Data Bank analysis

Abstract: Level III: Retrospective cohort study.

Cited by 71 publications

References 42 publications

Morbidity and Mortality Among Critically Injured Children With Acute Respiratory Distress Syndrome

Morbidity and Mortality Among Critically Injured Children With Acute Respiratory Distress Syndrome

Effect of Under Triage on Early Mortality After Major Pediatric Trauma: A Registry-based Propensity Score Matching Analysis

Impact of simulation-based training on perceived provider confidence in acute multidisciplinary pediatric trauma resuscitation

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