ABSTRACT
BACKGROUND: Because of the difficulties in evaluating injured children, screening blood tests are recommended. METHODS: Resuscitation blood tests (complete blood count, chem12, coagulation panel, urinalysis) were reviewed for abnormality frequency, injury correlation, managements, and outcome. RESULTS: Panels were obtained on 240 children (age < 16 years) meeting trauma system criteria. Abnormalities were identified as follows: white blood cell/hematocrit/platelets (41%, 27%, 1%), Na/K/Cl/CO(2) (3%, 30%, 23%, 14%), blood ureal nitrogen/creatinine (6%, 0%), prothrombin time/international normalized ratio/partial thromboplastin time (22%, 16%, 6%), aspartate aminotransferase/alanine transferase (43%, 35%), amylase (2%), glucose (77%), and urinalysis (31%). Organ-specific chemistries predicted injury poorly. Transaminasemia correlated with liver injury when levels exceeded 400 U/L. Two children (1%) with hyperamylasemia had abdominal injuries. Coagulation abnormalities correlated with intracranial injury (43%) and Glasgow Coma Scale (GCS 3 to 8; 56%, GCS 9 to 14; 20%, GCS 15; 14%, P <0.05). Only 25 (10%) had interventions for test abnormalities (11 transfusions, 8 fresh frozen plasma, 3 tests repeated, 3 KCl). CONCLUSIONS: Routine laboratory panels are little value in the management of injured children.
Subject(s)
Diagnostic Tests, Routine/statistics & numerical data , Resuscitation/methods , Wounds and Injuries/diagnosis , Wounds and Injuries/therapy , Acrylic Resins , Adolescent , Blood Chemical Analysis , Blood Coagulation Tests , Child , Child, Preschool , Clinical Laboratory Techniques/statistics & numerical data , Critical Care/methods , Diagnostic Tests, Routine/methods , Female , Follow-Up Studies , Glasgow Coma Scale , Health Care Surveys , Humans , Infant , Injury Severity Score , Kidney Function Tests , Liver Function Tests , Male , Multiple Trauma/diagnosis , Multiple Trauma/mortality , Multiple Trauma/therapy , Resuscitation/mortality , Risk Assessment , Sensitivity and Specificity , Survival Analysis , Trauma Centers , Treatment Outcome , Urinalysis , Wounds and Injuries/mortalityABSTRACT
PURPOSE: The aim of this study was to determine the outcome of extremely low-birth-weight infants (ELBW) requiring surgical interventions for the complications of prematurity METHODS: One hundred eighty-seven consecutive infants with a birth weight less than 1,000 g treated over a 5-year period were reviewed. Outcome variables included number and types of surgical procedures; length of stay; survival rate and; pulmonary, neurologic, and gastrointestinal morbidity. RESULTS: Surgical interventions were required in 66 (35%) infants (group S) weighing less than 1,000 g at birth (33% necrotizing enterocolitis/bowel perforation, 36% patent ductus arteriosus, 56% other). Overall mortality rate for group S infants was 23% compared with 22% for those not requiring surgery (group NS; P >.05). Mortality rate rose to 38% for those infants undergoing procedures for necrotizing enterocolitis/bowel perforation (P <.05). Although neurologic and pulmonary morbidity for the entire population were high, there was no difference in their incidence between surgical and nonsurgical groups (29% v 26% and 44% v 65%, group S v group NS, respectively; P >.05). CONCLUSIONS: These data suggest an improving outcome for ELBW infants. Common associated morbidities of prematurity do not appear adversely affected by surgical interventions supporting an aggressive approach to the care of these infants at the extreme of life.
