ABSTRACT
Hospital acquired pressure ulcers (HAPU) are serious, debilitating, and preventable complications in all inpatient populations. Despite evidence of the development of pressure ulcers in the pediatric population, minimal research has been done. Based on observations gathered during quarterly HAPU audits, bedside nursing staff recognized trends in pressure ulcer locations that were not captured using current pressure ulcer risk assessment tools. Together, bedside nurses and nursing leadership created and conducted multiple research studies to investigate the validity and reliability of the Pediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET).
Subject(s)
Nursing Assessment , Pressure Ulcer/prevention & control , Adolescent , Child , Child, Hospitalized , Female , Hospitals, Pediatric , Humans , Male , Michigan/epidemiology , Nursing Staff, Hospital , Pressure Ulcer/epidemiology , Prevalence , Risk Assessment , Risk FactorsABSTRACT
OBJECTIVE: To describe packed RBC utilization patterns in trauma patients admitted to a PICU and study associated outcomes while controlling for severity. DESIGN: Retrospective cohort study. SETTING: The PICU of a tertiary care children's hospital. PATIENTS: All pediatric trauma patients admitted to Helen DeVos Children's Hospital PICU between June 2007 and July 2010, either directly from the emergency department or transferred from another institution. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 389 trauma patients, 107 patients (27.5%) transferred to the PICU were transfused with blood products. Of these transfusions, 81 were packed RBC transfusions and 26 were other blood products. Only 73 of the packed RBC transfusions had a documented time of transfusion: 17 (23.3%) were transfused prior to PICU admission, seven (9.5%) both before and after PICU, and 49 (67.1%) only after PICU admission. After adjusting for injury severity score, transfused patients had higher odds of needing mechanical ventilation (odds ratios, 9.2; 95% CI, 3.6-23.3) and higher risk of mortality (odds ratios, 8.6; 95% CI, 2.6-28.6), when compared with nontransfused patients. Mean age of packed RBC was 19.6 ± 9.3 days (mean ± SD). The impact of age of packed RBCs on mortality was examined as a categorical variable at 14, 21, and 28 days. Packed RBCs more than 28 days old (14/61 patients) were associated with longer lengths of stay (13 ± 12 vs 7 ± 6; p < 0.03), lower discharge Glasgow Coma Scale score (9 ± 6 vs 13 ± 4; p< 0.03), and more mortality (43% vs 13%; p < 0.02) when compared with blood less than 28 days old. CONCLUSIONS: In pediatric trauma patients, transfusion of packed RBC and use of older RBC units are associated with higher risk of adverse outcomes independent of injury severity.
Subject(s)
Critical Care , Erythrocyte Transfusion , Wounds and Injuries/therapy , Adolescent , Age Factors , Child , Child, Preschool , Female , Humans , Injury Severity Score , Length of Stay , Male , Respiration, Artificial , Retrospective Studies , Treatment OutcomeABSTRACT
Currently, there is no nationally recognized evidence-based guideline or protocol for cervical spine clearance in nonalert, noncommunicative, or unreliable pediatric blunt trauma patients. This descriptive survey study sought to identify current practices and elicit expert opinion data regarding pediatric cervical spine clearance in a specialized population of children in trauma centers in the United States. A 93-item electronic Pediatric Cervical Spine Clearance Survey was sent to 309 members of the Pediatric Special Interest Group of the National Society of Trauma Nurses. The main areas of interest in the survey included trauma verification, annual volume of pediatric trauma cases, and sequence and time frames of diagnostic testing for cervical spine clearance by age group. Additional areas of interest were perceived supports and barriers to meeting target time frames for diagnostic testing and outcomes to evaluate the impact of a cervical spine clearance guideline for pediatric blunt trauma. The results from 44 respondents demonstrate that trauma centers are using a variety of diagnostic testing sequences and time frames when clearing children for suspected cervical spine injury.
Subject(s)
Cervical Vertebrae , Emergency Nursing/standards , Pediatric Nursing/standards , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/nursing , Adolescent , Child , Communication Barriers , Consciousness Disorders/diagnosis , Consciousness Disorders/nursing , Evidence-Based Nursing , Health Care Surveys , Humans , Practice Guidelines as TopicABSTRACT
BACKGROUND/PURPOSE: Snowmobiling is a popular form of wintertime recreation but can be associated with significant morbidity and mortality. To better understand snowmobile trauma in children, medical records were reviewed, evaluating the relationships between demographic data, mechanisms, and resultant injuries. In addition, because prior studies of childhood snowmobile fatalities have reviewed only national databases, state and national data were combined to evaluate possible underreporting. METHODS: Medical records were reviewed of children
