Severe traumatic brain injury in children: an evidence-based review of emergency department management.

More than 1.7 million traumatic brain injuries occur in adults and children each year in the United States, with approximately 30% occurring in children aged <14 years. Traumatic brain injury is a significant cause of morbidity and mortality in pediatric trauma patients. The early management of severe traumatic brain injury is focused on mitigation and prevention of secondary injury, specifically by avoiding hypotension and hypoxia, which have been associated with poorer outcomes. This review discusses methods to maintain adequate oxygenation, maximize management of intracranial hypertension, and optimize blood pressure in the emergency department to improve neurologic outcomes following pediatric severe traumatic brain injury.

Protocolized abuse screening to decrease provider bias and increase capture of potential events.

BACKGROUND: Early identification of child abuse is critical to prevent death and disability. Studies suggest implicit bias of providers may lead to overrepresentation of minority and impoverished children in child abuse reporting. At our institution, universal screening for sexual and physical abuse for all children under 18 years of age was implemented in 2016. A rigorous, objective evaluation protocol focusing on the mechanism of injury and exam findings to improve recognition and eliminate bias was implemented in 2019. FINDINGS: Demographics and clinical characteristics of patients less than 18 years of age were abstracted by chart review (2014-2015) and from a forensic database (2016-2022). International Classification of Diseases codes 995.5 (version 9) and T76.12XA (version 10) were used to identify patients before the establishment of forensic database. Relative frequency and patient characteristics of the three time periods (pre universal screening: 2014-2015, post universal screening: 2016-2019, post protocol implementation: 2020-2022) were compared using Chi-square tests and modified Poisson regression. Universal screening significantly increased the number of cases identified. The demographic profile of potential victims by race significantly changed over the reporting periods with an increased number of white children identified, consistent with state demographics. The proportion of publicly insured patients trended down with universal screening and protocol implementation, despite a significant increase in the number of children publicly insured in the state during this time. CONCLUSION: These single institutional results lend support to objective, evidence-based protocols to help eliminate bias surrounding race and poverty.

Should Teachers Carry Guns? An Emergency Room Survey of Parents of Two New York Communities.

INTRODUCTION: The purpose of this study was to compare parents' perceptions of threats and solutions to school gun violence in two different communities. METHODS: Parents of school-aged children visiting emergency rooms of two large trauma centers in Upstate New York (UNY) and New York City (NYC), between October 2019 and December 2020, were surveyed (UNY: n=202, NYC: n=100). Responses were compared by site, firearm experience, and concern for school safety. RESULTS: Respondents from the two sites differed by sociodemographic characteristics. Of the 302 respondents, 64% feared a school shooting incident, but UNY respondents were less likely to report concern (46.5% vs 99%, p<0.001). UNY respondents were more likely to feel safe for their children (75.3% vs 7%, p<0.001) and to report feeling safer if guns were available to teachers (22.3% vs 6%, p <0.001). Both sites' respondents agreed on the need for armed police presence (76.7% vs 74%, p=0.11). Of the 193 parents concerned about a school shooting, 11.9% indicated feeling safer if guns were available to teachers versus 25.7% of those who were not (p=0.002). Agreement on solutions for making schools safer differed by the site. NYC respondents were unanimously supportive, but UNY support ranged from 52% for metal detectors to 84.5% for controlled entry points. CONCLUSION: Although perceptions of child safety and experience with guns varied by location, most parents agreed on potential solutions, that it should be the security officers, not teachers, who should be carrying firearms and that armed police should be present in schools to provide safety.

Severe Traumatic Brain Injury In Children: An Evidence-Based Review Of Emergency Department Management.

More than 1.7 million traumatic brain injuries occur in adults and children each year in the United States, with approximately 30% occurring in children aged < 14 years. Traumatic brain injury is a significant cause of morbidity and mortality in pediatric trauma patients. Early identification and management of severe traumatic brain injury is crucial in decreasing the risk of secondary brain injury and optimizing outcome. The main focus for early management of severe traumatic brain injury is to mitigate and prevent secondary injury, specifically by avoiding hypotension and hypoxia, which have been associated with poorer outcomes. This issue discusses methods to maintain adequate oxygenation, maximize management of intracranial hypertension, and optimize blood pressure in the emergency department to improve neurologic outcomes following pediatric severe traumatic brain injury.

Severe traumatic brain injury in children: an evidence-based review of emergency department management [digest].

More than 1.7 million traumatic brain injuries occur in adults and children each year in the United States, with approximately 30% occurring in children aged < 14 years. Traumatic brain injury is a significant cause of morbidity and mortality in pediatric trauma patients. Early identification and management of severe traumatic brain injury is crucial in decreasing the risk of secondary brain injury and optimizing outcome. The main focus for early management of severe traumatic brain injury is to mitigate and prevent secondary injury, specifically by avoiding hypotension and hypoxia, which have been associated with poorer outcomes. This issue discusses methods to maintain adequate oxygenation, maximize management of intracranial hypertension, and optimize blood pressure in the emergency department to improve neurologic outcomes following pediatric severe traumatic brain injury. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].