Missed injuries contribute to increased morbidity in trauma patients. A retrospective chart review was conducted of pediatric trauma patients from 2010 to 2013 with a documented missed injury. A significant percentage of missed injuries were identified (3.01% during July 2012 to December 2013 vs 0.39% during January 2010 to July 2012) with the addition of acute care trained pediatric nurse practitioners to the trauma service at a pediatric trauma center. The increase is thought to be due to improvement in charting, consistent personnel performing tertiary examinations, and improved radiology reads of outside films.
Purpose: Traumatic abdominal wall hernia (TAWH) is a rare consequence of blunt abdominal trauma (BAT). We examined a series of patients suffering TAWH to evaluate its frequency, rate of associated concurrent intrabdominal injuries (CAI) and correlation with CT, management and outcomes. Methods: A Level 1 pediatric trauma center trauma registry was queried for children under 18 suffering TAWH from BAT between 2009-2019. Results: 9370 patients were admitted after BAT. TAWH was observed in 11 children, at incidence 0.1%. Eight children (73%) were male, at mean age 10 years, and mean ISS of 16. Six cases (55%) were due to MVC, three (27%) impaled by a handlebar or pole, and two (18%) dragged under large machinery. Seven (64%) had a CAI requiring operative or interventional management. Patients with CAI were similar to those without other injury, with 20% and 50% CT scan sensitivity and specificity for detection of associated injury, respectively. Five patients had immediate hernia repair with laparotomy for repair of intrabdominal injury, three had delayed repair, two have asymptomatic unrepaired TAWH, and one resolved spontaneously. Conclusions: Children with TAWH have high rates of CAI requiring operative repair. CT scans have low sensitivity and specificity for detecting associated injuries. A high suspicion of injury and low threshold for exploration must be maintained in TAWH cases.
Blunt aortic injuries are extremely rare in the pediatric population. This case report examines a pediatric patient involved in a motor vehicle crash that resulted in aortic dissection combined with traumatic brain injury. The clinical management of this patient was particularly challenging because of the conflicting needs of optimal management for the head and aortic injuries. Despite the patient's low predicted probability of survival based on Injury Severity Score, the patient had an exceptional outcome.
The aim of this study was to provide a case series detailing the occurrence of significant and life-threatening injuries outside isolated orthopedic or head injuries sustained by athletes treated at our institution.Methods: This study is a retrospective case series utilizing the trauma registry at a Level I pediatric trauma center. Inclusion criteria included an abdominal solid organ injury Grade III or higher, a major thoracic injury, or an injury resulting in death.
Conclusions:Although there have been great strides in research related to prevention and management of concussions sustained by athletes, there is little formal reporting of the incidence or potential complications of the intrathoracic and intra-abdominal injuries. The four cases described represent a compilation of the most significant competitive sports-related injuries managed at a Level I pediatric trauma center during 2012-2013. The case series shows how competitive sports can lead to injuries that require hospitalization with extensive monitoring and interventions, which may predispose the athlete to further complications and, in the rare case, death. Also significant is that these injuries are not solely limited to high contact sports like football but can be seen in a sport like baseball, which may not be as commonly regarded among parents and coaches as posing a risk for serious contact-related injuries.
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