Introduction
It remains unclear whether trauma centers are effective for the treatment of injured pediatric patients. The aim of this study was to evaluate children’s mortality before and after the establishment a trauma center by using standard mortality ratios (SMR) and a modified observed-expected chart.
Methods
This was a single center, retrospective chart review study that included injured pediatric patients (age <16 years) who were transported to our trauma center by the emergency medical services from 2012 to 2016 in Japan.
Results
Our study included 143 subjects: 45 (31%) were preschoolers aged < 6 years, and 43 (30%) had an injury severity score (ISS) ≥ 16. After the trauma centers established, the number of patients increased (70% increase per month), as did the number of the patients with an ISS of 41–75. The percentage of indirect transportations was significantly higher in the trauma center than in the non-trauma center (49% vs. 28%;
p
< 0.05). The SMR was significantly lower in the trauma-center than in the non-trauma center (0.461 vs. 0.589;
p
< 0.05). The mean value of the modified observed-expected chart was significantly higher in the trauma-center than in the non-trauma center (4.6 vs. 2.3;
p
< 0.05). For the patients who were directly transferred to our center, the transfer distance was greater in the trauma-center than in the non-trauma center (6.8 vs. 6.2 km;
p
< 0.05). The time interval from hospital admission to initiation of computed tomography (15.5 vs. 33 minutes;
p
< 0.05) and to definitive care (44 vs. 64.5 minutes;
p
< 0.05) decreased in the after group compared to the non-trauma center.
Conclusions
The results of our study revealed that the centralization of pediatric injured pediatric patients in trauma centers improved the mortality rate in this population in Japan.
The accuracy of PPATS was superior to other methods for secondary triage of children. Toida C , Muguruma T , Abe T , Shinohara M , Gakumazawa M , Yogo N , Shirasawa A , Morimura N . Introduction of pediatric physiological and anatomical triage score in mass-casualty incident. Prehosp Disaster Med. 2018;33(2):147-152.
Enterovirus D68 (EV-D68) causes respiratory illnesses such as pneumonia, and has been reported to cause acute flaccid myelitis. Enterovirus A71 (EV-A71) is known to cause cardiopulmonary failure due to brainstem encephalitis, but there have been few reports of these conditions being associated with EV-D68. Outbreaks of EV-D68 infection have occurred in the USA, Canada, Europe and Asia. Clinical management is largely supportive and there are no specific antivirals available. The case patient, a 4-year-old girl, had cardiopulmonary failure due to brainstem encephalitis. EV-D68 was isolated from a throat swab. On admission, she had cardiopulmonary failure, which required intensive care using a ventilator and inotropic agents. Her cardiac function improved, but she had residual bulbar paralysis and limb weakness, which resolved over a 6-month period. This case confirms that EV-D68, may cause severe illness due to brainstem encephalitis, similar to that caused by EV-A71.
Foreign body asphyxia is a serious clinical problem with high morbidity and mortality rates. It is relatively common among children, especially those younger than 3 years, because they have a high risk of aspirating foreign bodies owing to their tendency to place objects in their mouth and lack of a well-developed swallowing reflex. Moreover, the neurologic outcome after out-of-hospital cardiac arrests (OHCA) in pediatric patients remains generally poor. Here, we report an unusual pediatric case of asphyxial OHCA caused by foreign bodies obstructing the airway, complicating esophageal foreign body, with a neurologically favorable outcome. This case highlights the importance of adequate treatment for pediatric patients with OHCA, as well as the prompt and efficient management for pediatric patients with foreign bodies obstructing the airway and esophagus.
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