ABSTRACT
Accidents and trauma are the leading cause of hospital admissions and major contributors to mortality in children and adolescents. There are age-specific injury patterns and differences in the clinical presentation of pediatric trauma and treatment both at the scene and in the emergency department can be observed. In general, pediatric trauma-scores to appreciate injury severity are adapted from the adult population.The most important factor to increase mortality in the severely injured pediatric population is the extent of a concomitant traumatic brain injury (TBI). In addition, the acute trauma-associated coagulopathy, which is triggered multifactorial, is an independent prognostic marker for mortality in severe trauma. The complexity of all currently available trauma-scores for the pediatric population is one reason why these scores are not unequivocal recommended for the early use in pediatric trauma care. The pediatric BIG-Score was developed to allow an early prognostic stratification for pediatric trauma patients and includes with base excess (BE), INR (International Normalized Ratio) and GCS (Glasgow Coma Scale) relevant prognostic factors for poor outcome. Early risk stratification is crucial in pediatric trauma due to mortality rates ranging between 9% and 15% and with 50% of all fatalities to occur within the first 24 h of hospital admission.
Subject(s)
Multiple Trauma/classification , Multiple Trauma/epidemiology , Adolescent , Age Factors , Brain Injuries/classification , Brain Injuries/diagnosis , Brain Injuries/epidemiology , Brain Injuries/mortality , Child , Child, Preschool , Cross-Sectional Studies , Female , Germany , Hospital Mortality , Humans , Infant , Male , Multiple Trauma/diagnosis , Multiple Trauma/mortality , Patient Admission/statistics & numerical data , Prognosis , Risk Assessment , Survival Analysis , Trauma Severity IndicesABSTRACT
BACKGROUND AND OBJECTIVES: The empiric use of a high plasma to packed red-blood-cell [fresh frozen plasma:red-blood-cells (FFP:RBC)] ratio in trauma resuscitation for patients with massive bleeding has become well accepted without clear or objective indications. Increased plasma transfusion is associated with worse outcome in some patient populations. While previous studies analyse only patients who received a massive transfusion, this study analyses those that are at risk to receive a massive transfusion, based on the trauma-associated severe haemorrhage (TASH) score, to objectively determine which patients after severe trauma would benefit or have increased complications by the use of a high FFP:RBC ratio. METHODS: Multicentre retrospective study from the Trauma Registry of the German Trauma Society. Multivariate logistic regression and statistical risk adjustments utilized in analyses. RESULTS: A high ratio of FFP:RBC in the ≥15 TASH group was independently associated with survival, with an odds ratio of 2·5 (1·6-4·0), while the <15 TASH group was associated with increased multi-organ failure, 47% vs. 38%, (P<0·005). CONCLUSIONS: A predictive model of massive transfusion upon admission might be able to rapidly identify which severe trauma patients would benefit or have increased complications from the immediate application of a high ratio of FFP:RBCs. This study helps to identify the appropriate population for a prospective, interventional trial.
Subject(s)
Blood Component Transfusion , Erythrocytes/metabolism , Hemorrhage/mortality , Hemorrhage/therapy , Multiple Trauma/complications , Plasma/metabolism , Adult , Aged , Blood Component Transfusion/adverse effects , Blood Component Transfusion/mortality , Female , Hemorrhage/blood , Humans , Injury Severity Score , Male , Middle Aged , Multiple Organ Failure/etiology , Multiple Trauma/blood , Multiple Trauma/mortality , Multiple Trauma/therapy , Odds Ratio , Resuscitation , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
This article describes our study of 36 male patients who were brought to Ruby Memorial Hospital in Morgantown for treatment of non-fatal logging-related injuries. The type and severity of their injuries is described, as well as the host, vehicular/mechanical and environmental factors contributing to the injuries. The suggestions of the patients on how to prevent their injuries are compared to existing OSHA standards.
Subject(s)
Accidents, Occupational/statistics & numerical data , Craniocerebral Trauma/epidemiology , Trees , Accidents, Occupational/prevention & control , Adult , Aged , Aged, 80 and over , Extremities/injuries , Humans , Injury Severity Score , Male , Middle Aged , West Virginia/epidemiologyABSTRACT
Each year, one of every four Americans sustains an injury severe enough to seek medical attention. Injuries account for 25% of all emergency department visits, 12% of all hospital admissions, and cost the nation over $180 billion annually. Despite being the leading cause of mortality for Americans under the age of 40, there is a lack of awareness of the epidemic of injuries and effective methods for their prevention. Many consider injuries to be the result of unavoidable accidents or unfortunate acts of God. In reality, injuries are diseases which have associated risk factors, demographic distributions, seasonal variations, epidemic episodes, and are predictable and preventable. This article describes injuries in West Virginia and discusses basic principles of injury control and prevention.
