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Life-saving interventions in pediatric trauma

A National Trauma Data Bank experience

Swendiman, Robert A. MD, MPP; Sharoky, Catherine E. MD, MSCE; Russell, Katie W. MD; Goldshore, Matthew A. MD, PhD, MPH; Blinman, Thane A. MD; Nance, Michael L. MD

Journal of Trauma and Acute Care Surgery: December 2019 - Volume 87 - Issue 6 - p 1321–1327
doi: 10.1097/TA.0000000000002478
ORIGINAL ARTICLES
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BACKGROUND Emergent procedures are infrequent in pediatric trauma. We sought to determine the frequency and efficacy of life-saving interventions (LSI) performed for pediatric trauma patients within the first hour of care at a trauma center.

METHODS The National Trauma Data Bank (2010–2014) was queried for patients 19 years or younger who underwent LSIs within 1 hour of arrival to the emergency department. Life-saving interventions included emergency department thoracotomy (EDT) and emergent airway procedures (EAP). Multivariable logistic regression was used to evaluate the influence of patient and hospital characteristics on mortality.

RESULTS Of 725,284 recorded traumatic encounters, only 1,488 (0.2%) pediatric patients underwent at least one of the defined LSI during the 5-year study period (EDT, 1,323; EAP, 187). Most patients (85.6%) were 15 years or older. Mortality was high but varied by procedure type (EDT, 64.3%; EAP, 28.3%). Mortality for patients younger than 1 year undergoing EDT was 100%, decreasing to 62.6% in patients aged 15 years to 19 years. For EAP, mortality ranged from 66.7% for infants to 27.2% in 15-year-old to 19-year-old patients. Lower Glasgow Coma Scale score, higher Injury Severity Score, presence of shock, and a blunt mechanism of injury were independently associated with mortality in the EDT cohort. On average, trauma centers in this study performed approximately one LSI per year, with only 13.8% of cases occurring at a verified pediatric trauma center.

CONCLUSION Life-saving interventions in the pediatric trauma population are uncommon and outcomes variable. Novel solutions to keep proficient at such interventions should be sought, especially for younger children. Guidelines to improve identification of appropriate candidates for LSI are critical given their rare occurrence.

LEVEL OF EVIDENCE Retrospective cohort study, III.

From the Department of Surgery (R.A.S., C.E.S., M.A.G.), University of Pennsylvania Health System, Philadelphia, Pennsylvania; Division of Pediatric Surgery (K.W.R.), Primary Children's Hospital, Salt Lake City, Utah; and Division of Pediatric General, Thoracic, and Fetal Surgery (T.A.B., M.L.N.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Submitted: June 11, 2019, Revised: July 28, 2019, Accepted: July 30, 2019, Published online: August 28, 2019.

Presentations: This research was presented as an oral abstract at the 19th annual Templeton Trauma Symposium on March 1, 2019 in Pittsburgh, PA.

Address for reprints: Michael L. Nance, MD, Department of Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104; email: nance@email.chop.edu.

Online date: August 29, 2019

© 2019 Lippincott Williams & Wilkins, Inc.