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pediatric triage in trauma

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https://www.readbyqxmd.com/read/28328672/pediatric-trauma-under-triage-in-ohio
#1
Juan P Gurria, Lynn Haas, Md Monir Hossain, Mohammad Alfrad Nobel Bhuiyan, Misty Troutt, Suzanne Moody, Richard A Falcone
BACKGROUND: Appropriate and timely triage is an essential component of a trauma system. In the state of Ohio there are 6 verified pediatric trauma centers (PTC) across 8 state regions. The purpose of this study was to better understand the pediatric under-triage rates in the state. METHODS: We utilized the Ohio Trauma Registry from 2007 - 2012, consisting of 14,045 records of children < 16 years admitted to a hospital for greater than 48 hours or who sustained a traumatic death...
March 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28272111/disability-risk-in-pediatric-motor-vehicle-crash-occupants
#2
Andrea N Doud, Samantha L Schoell, Ashley A Weaver, Jennifer W Talton, Ryan T Barnard, John K Petty, Joel D Stitzel
BACKGROUND: Mortality rates among children in motor vehicle crashes (MVCs) are typically low, however non-fatal injuries can vary in severity by imposing differing levels of short- and long-term disability. To better discriminate the severity of non-fatal MVC-injuries, a pediatric-specific disability risk (DR) metric was created. METHODS: The National Automotive Sampling System (NASS-CDS) 2000-2011 was used to define the top 95% most common Abbreviated Injury Scale (AIS) 2+ injuries among pediatric MVC occupants...
March 8, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28235428/validation-of-a-hand-held-point-of-care-device-for-lactate-in-adult-and-pediatric-patients-using-traditional-and-locally-smoothed-median-and-maximum-absolute-difference-curves
#3
Jessica Marie Colon-Franco, Stanley F Lo, Sergey S Tarima, David Gourlay, Amy L Drendel, E Brook Lerner
BACKGROUND: Lactate is commonly used in septic patients and is a viable biomarker for trauma patients. Its pre-hospital use could assist triaging and managing patients with these conditions. METHODS: We evaluated the analytical performance of the point-of-care (POC) StatStrip Xpress Lactate Meter (Nova Biomedical) and compared it to the ABL 800 (Radiometer). We measured lactate in 250 adult and 250 pediatric whole blood samples in 2 laboratories. The performance of the POC meter was assessed by traditional linear regression and Bland-Altman plots, and locally-smoothed (LS) median absolute difference and maximum absolute difference (MAD and MaxAD) curves...
February 21, 2017: Clinica Chimica Acta; International Journal of Clinical Chemistry
https://www.readbyqxmd.com/read/28132766/piloting-a-pediatric-trauma-course-in-western-jamaica-lessons-learned-and-future-directions
#4
Hadley K Wesson, Valerie Plant, Marieka Helou, Karen Wharton, Delroy Fray, Jeffrey Haynes, Charles Bagwell
INTRODUCTION: Pediatric injuries are a leading cause of death in low- and middle-income countries (LMICs). Despite this, there are few formal pediatric-specific trauma educational initiatives available in LMICs. While new educational tools are being developed to address this, they have not been piloted in LMICs. In Jamaica, pediatric injuries are a leading cause of hospital admission but care is limited by a lack of training in triage and stabilization. Our objective was to implement and evaluate a pediatric trauma course in Jamaica to determine the impact this may have on further course development...
January 10, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28108126/expert-perspectives-on-time-sensitivity-and-a-related-metric-for-children-involved-in-motor-vehicle-crashes
#5
Andrea N Doud, Samantha L Schoell, Ashley A Weaver, Jennifer W Talton, Ryan T Barnard, John K Petty, J Wayne Meredith, Joel D Stitzel
OBJECTIVE: Advanced Automatic Crash Notification (AACN) uses vehicle telemetry data to predict risk of serious injury among motor vehicle crash occupants and can thus improve the accuracy with which injured children are triaged by first responders. To better define serious injury for AACN systems (which typically use Abbreviated Injury Scale [AIS] metrics), an age-specific approach evaluating severity, time sensitivity (TS), and predictability of injury has been developed. This study outlines the development of the TS score...
January 17, 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/28107348/predicting-length-of-stay-among-patients-discharged-from-the-emergency-department-using-an-accelerated-failure-time-model
#6
Chung-Hsien Chaou, Hsiu-Hsi Chen, Shu-Hui Chang, Petrus Tang, Shin-Liang Pan, Amy Ming-Fang Yen, Te-Fa Chiu
BACKGROUND: Emergency department (ED) crowding continues to be an important health care issue in modern countries. Among the many crucial quality indicators for monitoring the throughput process, a patient's length of stay (LOS) is considered the most important one since it is both the cause and the result of ED crowding. The aim of this study is to identify and quantify the influence of different patient-related or diagnostic activities-related factors on the ED LOS of discharged patients...
2017: PloS One
https://www.readbyqxmd.com/read/28041758/emergency-medical-services-ems-versus-non-ems-transport-among-injured-children-in-the-united-states
#7
Michelle M Corrado, Junxin Shi, Krista K Wheeler, Jin Peng, Brian Kenney, Sarah Johnson, Huiyun Xiang
OBJECTIVES: This study aimed to assess the proportions of injured children transported to trauma centers by different transportation modes and evaluate the effect of transportation mode on inter-facility transfer rates using the US national trauma registry. METHODS: We analyzed data from the 2007-2012 National Trauma Data Bank (NTDB) to study trends of EMS versus non-EMS transport. Multivariable logistic regression was used to evaluate the association between transport mode and inter-facility transfer...
March 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27852453/current-use-and-outcomes-of-helicopter-transport-in-pediatric-trauma-a-review-of-18-291-transports
#8
Brian R Englum, Kristy L Rialon, Jina Kim, Mark L Shapiro, John E Scarborough, Henry E Rice, Obinna O Adibe, Elisabeth T Tracy
PURPOSE: The role of helicopter emergency medical services (HEMS) in pediatric trauma remains controversial. We examined its use in pediatric trauma and its effectiveness in children with moderate/severe injuries. METHODS: All blunt/penetrating trauma patients ≤18years old in the National Trauma Data Bank were evaluated for use of HEMS and in-hospital mortality. In a comparative effectiveness study, only patients treated at level I/II pediatric centers with injury severity score (ISS)≥9 were included...
January 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27822127/objective-triage-in-the-disaster-setting-will-children-and-expecting-mothers-be-treated-like-others
#9
Timur Kouliev
The study of disaster triage is made difficult by the complex emotional response of potentially lifesaving intervention that a triage officer must make basing decisions on a succinct and efficient algorithm. A survey of triage professionals in international settings was designed to identify possible emotionally led bias that affects objective decision making in identifying victims most likely to benefit from immediate life support intervention. This survey suggests a lack of correlation between triage priority and predictable clinical outcomes as predicted by the Revised Trauma Score tool...
2016: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27710155/ability-of-the-physiologic-criteria-of-the-field-triage-guidelines-to-identify-children-who-need-the-resources-of-a-trauma-center
#10
E Brooke Lerner, Amy L Drendel, Jeremy T Cushman, Mohamed Badawy, Manish N Shah, Clare E Guse, Arthur Cooper
BACKGROUND: There is limited research on how well the American College of Surgeons/Center for Disease Control and Prevention Guidelines for Field Triage of Injured Patients assist EMS providers in identifying children who need the resources of a trauma center. OBJECTIVE: To determine the accuracy of the Physiologic Criteria (Step 1) of the Field Triage Guidelines in identifying injured children who need the resources of a trauma center. METHODS: EMS providers who transported injured children 15 years and younger to pediatric trauma centers in 3 mid-sized cities were interviewed regarding patient demographics and the presence or absence of each of the Field Triage Guidelines criteria...
March 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27692626/the-utility-of-a-trauma-1-op-activation-at-a-level-1-pediatric-trauma-center
#11
Madison M Hunt, Austin M Stevens, Kristine W Hansen, Stephen J Fenton
PURPOSE: To expedite flow of injured children suspected to require operative intervention, a "trauma 1 OP" (T1OP) activation classification was created. The purpose of this study was to review this strategy at a level 1 pediatric trauma center. METHODS: A retrospective review of T1OP activations between 2003 and 2015 was performed. Children suspected of requiring neurosurgical intervention were classified as trauma 1 OP neuro (T1OP(N)). Comparisons were made to trauma 1 (T1) patients who required emergent operative intervention, excluding orthopedic injuries...
February 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27686481/the-association-of-insurance-status-on-the-probability-of-transfer-for-pediatric-trauma-patients
#12
Emma C Hamilton, Charles C Miller, Bryan A Cotton, Charles Cox, Lillian S Kao, Mary T Austin
BACKGROUND/PURPOSE: The purpose of this study was to evaluate the association of insurance status on the probability of transfer of pediatric trauma patients to level I/II centers after initial evaluation at lower level centers. METHODS: A retrospective review of all pediatric trauma patients (age<16years) registered in the 2007-2012 National Trauma Data Bank was performed. Multiple regression techniques controlling for clustering at the hospital level were used to determine the impact of insurance status on the probability of transfer to level I/II trauma centers...
December 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27670555/pediatric-secondary-overtriage-in-a-statewide-trauma-system
#13
Alexander Leung, Patrick Bonasso, Kevin Lynch, Dustin Long, Richard Vaughan, Alison Wilson, Jorge Con
Secondary overtriage is a term that describes patients who are discharged home shortly after being transferred, an indication that transfer and hospitalization were unnecessary. The study goal was to identify factors associated with secondary triage. A statewide trauma registry was used to identify trauma patients aged less than 18 years during a 6-year period (2007-2012) who were discharged within 48 hours from arrival and did not undergo a surgical procedure. We compared those that were treated at initial facility and those transferred to a second facility using clinical indices including patterns of injury pattern using multivariate logistic regression...
September 2016: American Surgeon
https://www.readbyqxmd.com/read/27438027/privately-insured-medical-patients-are-more-likely-to-have-a-head-ct
#14
Emily M Fortin, Jerry Fisher, Sheng Qiu, Charlene Irvin Babcock
Previous studies suggest overuse disparity of head computed tomography (CT) in white pediatric trauma patients with minor head injuries. Our study is meant to determine if race or insurance status impacts the probability of obtaining head CT in patients with a Glasgow Coma Scale (GCS) = 15. Using the 2008-2010 National Hospital Ambulatory Medical Care Survey for Emergency Departments (NHAMCS) database, the following variables were analyzed: race, emergency medical services (EMS) arrival, triage category, admission status, gender, age, and insurance status...
December 2016: Emergency Radiology
https://www.readbyqxmd.com/read/27157260/using-a-multidisciplinary-and-evidence-based-approach-to-decrease-undertriage-and-overtriage-of-pediatric-trauma-patients
#15
Mauricio A Escobar, Carolynn J Morris
BACKGROUND: The American College of Surgeons Committee on Trauma (ACS-COT) view over- and undertriage rates based on trauma team activation (TTA) criteria as surrogate markers for quality trauma patient care. Undertriage occurs when classifying patients as not needing a TTA when they do. Over-triage occurs when a TTA is unnecessarily activated. ACS-COT recommends undertriage <5% and overtriage 25-35%. We sought to improve the under-triage and over-triage rates at our Level II Pediatric Trauma Center by updating our outdated trauma team activation criteria in an evidence-based fashion to better identify severely injured children and improving adherance to following established trauma team activation criteria...
September 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/26928093/after-hours-call-center-triage-of-pediatric-head-injury-outcomes-after-a-concussion-initiative
#16
Jennifer N Fishe, Anthony A Luberti, Christina L Master, Roni L Robinson, Matthew F Grady, Kristy B Arbogast, Mark R Zonfrillo
OBJECTIVE: The aim of the study was to characterize referral patterns and medical outcomes of children with head injury triaged by an after-hours call center of a large urban pediatric network, both before and after an institutional concussion initiative. The initiative included a revised call center triage algorithm referring patients with a suspected concussion to see a primary care provider (PCP) within 24 hours, concussion-specific continuing education for medical providers, and a new concussion information Web site...
March 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/26808033/helicopters-and-injured-kids-improved-survival-with-scene-air-medical-transport-in-the-pediatric-trauma-population
#17
Joshua B Brown, Christine M Leeper, Jason L Sperry, Andrew B Peitzman, Timothy R Billiar, Barbara A Gaines, Mark L Gestring
BACKGROUND: Helicopter emergency medical services (HEMS) are frequently used to transport injured children, despite unclear evidence of benefit. The study objective was to evaluate the association of HEMS compared with ground emergency medical services (GEMS) transport with outcomes in a national sample of pediatric trauma patients. METHODS: Patients 15 years or younger undergoing scene transport by HEMS or GEMS in the National Trauma Data Bank from 2007 to 2012 were included...
May 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/26808000/development-of-a-pediatric-mass-casualty-triage-algorithm-validation-tool
#18
J Joelle Donofrio, Amy H Kaji, Ilene A Claudius, Todd P Chang, Genevieve Santillanes, Mark X Cicero, Saranya Srinivasan, Alexis Perez-Rogers, Marianne Gausche-Hill
BACKGROUND: Rapid, accurate evaluation and sorting of victims in a mass casualty incident (MCI) is crucial, as over-triage of victims may overwhelm a trauma system and under-triage may lead to an increase in morbidity and mortality. At this time, there is no validation tool specifically developed for the pediatric population to test an MCI algorithm's inherent capabilities to correctly triage children. OBJECTIVE: To develop a set of criteria for outcomes and interventions to be used as a validation tool for testing an MCI algorithm's ability to correctly triage patients from a cohort of pediatric trauma patients...
May 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/26621811/preparing-to-care-for-paediatric-trauma-patients
#19
Paula Pearce
INTRODUCTION: Considerable evidence has discussed the significant workload and advances in clinical care by UK Defence Medical Services (DMS) during recent conflicts in Iraq and Afghanistan. Although the DMS is not doctrinally staffed to deal with children on operations, severely ill and injured paediatric casualties continue to present to military medical facilities; therefore, staff must be competent to deliver the appropriate level of care. This paper reports the paediatric presentations to the emergency department (ED), at the Role 3 Medical Treatment Facility (MTF) in Camp Bastion, Afghanistan, over a 21-month period...
December 2015: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/26577525/immediate-bedding-and-patient-satisfaction-in-a-pediatric-emergency-department
#20
Robert Flood, Paula Szwargulski, Nadeem Qureshi, Mary Bixby, Steven Laffey, Ryan Pratt, James Gerard
BACKGROUND: Immediate bedding has been shown to increase efficiency in general emergency departments (EDs), but little has been published regarding its use in pediatric emergency medicine. OBJECTIVE: Our aims were to improve door-to-provider (DTP) times and patient satisfaction and to better define the relationships between throughput times and patient satisfaction in a pediatric ED. METHODS: On November 1, 2011, we changed to a new immediate bedding triage process in our academic, urban pediatric Level I trauma center...
May 2016: Journal of Emergency Medicine
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