Predicting severe outcomes in pediatric trauma patients: Shock index pediatric age-adjusted vs. age-adjusted tachycardia.

INTRODUCTION: When an injured patient arrives in the Emergency Department (ED), timely and appropriate care is crucial. Shock Index Pediatric Age-Adjusted (SIPA) has been shown to accurately identify pediatric patients in need of emergency interventions. However, no study has evaluated SIPA against age-adjusted tachycardia (AT). This study aims to compare SIPA with AT in predicting outcomes such as mortality, severe injury, and the need for emergent intervention in pediatric trauma patients. MATERIAL AND METHODS: This is a retrospective cross-sectional analysis of patient data abstracted from the Trauma Quality Improvement Program Participant Use Files (TQIP PUFs) for years 2013-2020. Patients aged 4-16 with blunt mechanism of injury and injury severity score (ISS) > 15 were included. 36,517 children met this criteria. Sensitivity, specificity, overtriage, and undertriage rates were calculated to compare the effectiveness of AT and elevated SIPA as predictors of severe injuries and need for emergent intervention. Emergent interventions included craniotomy, endotracheal intubation, thoracotomy, laparotomy, or chest tube placement within 24 h of arrival. RESULTS: AT classified 59% of patients as "high risk," while elevated SIPA identified 26%. Compared to AT patients, a greater proportion of patients with elevated SIPA required a blood transfusion within 24 h (22% vs. 12%, respectively; p < 0.001). In-hospital mortality was higher for the elevated SIPA group than AT (10% vs. 5%, respectively; p < 0.001) as well as the need for emergent operative interventions (43% vs. 32% respectively; p < 0.001). Grade 3 or higher liver/spleen lacerations requiring blood transfusion were also more common among elevated SIPA patients than AT patients (8% vs. 4%, respectively; p < 0.001). AT demonstrated greater sensitivity but lower specificity compared to SIPA across all outcomes. AT showed improved overtriage and undertriage rates compared to SIPA, but this is attributed to identifying a large proportion of the sample as "high risk." CONCLUSIONS: AT outperforms SIPA in sensitivity for mortality, injury severity and emergent interventions in pediatric trauma patients while the specificity of SIPA is high across these outcomes.

Pediatric trauma volume fell during the initial COVID-19 wave but rebounded to new highs for the remainder of 2020.

BACKGROUND: Previous studies have shown a reduction in pediatric trauma volume during COVID-19, but many have looked at a limited number of facilities, analyzed a narrow timeframe, or both. The objective of this analysis was to assess the impact of COVID-19 on pediatric trauma volume for a statewide sample during 2020. Based on previous literature, researchers hypothesized a reduction in volume during the implementation of these policies. METHODS: Retrospective cross-sectional analysis of five years (2016 - 2020) of Indiana's statewide trauma patient registry. Patients under age 15 were included. Those who were transfer patients or missing key data were excluded. In total, 10,926 patients were included in analysis. Baseline years (2016 - 2019) were compared to 2020 to estimate the impact of COVID-19 on pediatric trauma volume. RESULTS: Overall monthly volume of pediatric traumas were lower than baseline in March and April 2020 (though not significantly), but rebounded quickly and were above trend in the latter half of the year. Injury patterns differed in both mechanism and location from previous years. Gunshot wounds were more prevalent than previous years, while the volume of non-accidental traumas fell slightly. Injuries that occurred in private residences rose significantly, while fewer took place in schools. CONCLUSIONS: Results indicated an initial drop in injury volume consistent with previous findings, but these were offset by increased volume in the second half of 2020. The growth in gun violence is concerning and warrants additional research. Changes in behavior in response to the pandemic such as reduced participation in sports and use of playgrounds, reduced driving, and increased time at home help explain the changes observed in injury patterns. These findings emphasize the continued need for pediatric trauma care during the pandemic.

Treatment of Severe Blunt Splenic Injury Varies Across Race and Insurance Type of Pediatric Patients.

INTRODUCTION: Racial and ethnic disparities in the management of adult patients with blunt splenic injuries (BSIs) have been previously demonstrated. It is unknown if similar disparities exist in pediatric patients with BSIs. Management of BSIs can include operative management, but nonoperative management (NOM) is preferred. This study assesses the association of race and insurance status on use of NOM among pediatric (aged < 18 y) patients following BSI. MATERIALS AND METHODS: Data were abstracted from the American College of Surgeons Trauma Quality Improvement Program Participant Use Files for calendar years 2013-2017. Multivariate logistic regression was used to evaluate the associations between race or insurance status and NOM while controlling for injury severity, age, and facility type. Secondary outcomes included blood transfusion within 24 h and hospital length of stay. RESULTS: We analyzed 1436 pediatric BSI patients. Black, non-Hispanic patients were less likely (odds ratio: 0.45, 95% confidence interval: 0.21-1.02, P = 0.043) to undergo NOM and stayed 0.6 d longer (P = 0.010) than White, non-Hispanic patients. Uninsured patients were less likely (odds ratio: 0.52, 95% CI: 0.25-1.11, P = 0.080) to undergo NOM and publicly insured patients stayed 0.24 d (P = 0.048) longer than privately insured patients. CONCLUSIONS: We found disparities in use of NOM for Black patients and uninsured patients as well as differences in length of stay. These results extend the literature on racial and socioeconomic disparities in care of trauma patients to pediatric BSI patients. Addressing these disparities requires additional studies aimed at identifying the underlying causes.

Mortality of adolescents with isolated traumatic brain injury does not vary with type of level I trauma center.

BACKGROUND: Pediatric patients with isolated severe traumatic brain injury (TBI) treated at pediatric trauma centers (PTCs) have lower mortality than those treated at adult trauma centers (ATCs) or mixed trauma centers (MTCs). The primary objective of this study was to determine if adolescent patients (15-17 years) with isolated severe TBI also benefited from treatment at PTCs. METHODS: This was a cross-sectional analysis using a national sample of adolescent trauma patients obtained from the American College of Surgeons' Trauma Quality Program Participant Use Files for 2013 to 2017 (n = 3,524). Mortality, the primary outcome variable, was compared between Level I PTCs, ATCs, and MTCs using multiple logistic regression controlling for patient characteristics and injury severity. Secondary outcomes included discharge disposition, utilization of craniotomy, intensive care unit (ICU) utilization, ICU length of stay (LOS), and hospital LOS. RESULTS: Prior to adjustment, patients treated at ATCs (odds ratio [OR], 2.76; p = 0.032) and MTCs (OR, 2.36; p = 0.070) appeared to be at greater risk of mortality than those treated at PTCs. However, after adjustment, this difference disappeared (ATC OR, 1.21; p = 0.733; MTC OR, 0.95; p = 0.919). Patients treated at ATCs and MTCs were more severely injured than those treated at PTCs and more likely to be admitted to an ICU (ATC OR, 2.12; p < 0.001; MTC OR, 1.91; p < 0.001). No other secondary outcome differed between center types. CONCLUSION: Adolescent patients with isolated severe TBI treated at ATCs and MTCs had similar mortality risk as those treated at PTCs. The difference in injury severity across center types warrants additional research. LEVEL OF EVIDENCE: Prognostic/Epidemiological; Level III.

Evaluation of a Nursing-Focused Training and Education Strategy for a Facility Transitioning to a Level I Pediatric Trauma Center.

Background Increasing numbers of facilities are pursuing verification as pediatric trauma centers. Nurses need effective training to provide optimal care for pediatric trauma patients. This study evaluated the implementation of a nursing-focused education strategy that accompanied the process of opening a pediatric trauma center. Method Training comprised a lecture series, skills stations, and simulation. Participation was recorded. Pre- and post-training surveys were used to evaluate effectiveness. Results Participation in training was high (lectures, n = 185; skills stations, n = 151; simulation, n = 301). Survey responses indicated an increased confidence to treat pediatric trauma patients (2 out of 5 vs. 3 out of 5; p < .001). Nearly half (49.1%) of the nurses found simulations to be the most effective element of training on the post-training survey. Conclusion High participation and improved confidence indicate a feasible and effective training curriculum. Simulation was perceived as the most effective training modality. [J Contin Educ Nurs. 2022;53(9):405-410.].