Global Survey of Demand‐Side Factors and Incentives that Influence Advanced Trauma Life Support (ATLS) Promulgation

Stewart, Barclay T; Mehta, Kajal; Drago, Monique N; Henry, Sharon M.; Joseph, Kimberly; Strong, Kathryn; Trostchansky, Julio; Jørgensen, Jørgen J.; Leung, Gilberto Ka-Kit; Abi-Saad, George S.; Bulger, Eileen M.; Mock, Charles

doi:10.1007/s00268-022-06461-9

Cited by 5 publications

(6 citation statements)

References 49 publications

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“…To account for differences in vital sign parameters across age groups, SI was stratified by age (<12 months, 1 to <2 years, 2 to <5 years, 5 to <12 years, and 12–16 years). For each age group, a cutoff SI was calculated from the highest normal value of HR and the lowest normal value of SBP taken from the vital sign ranges in the Advanced Trauma Life Support, 9th Edition 14 . This definition has been used in prior studies 13 Table 1.…”

Section: Methodsmentioning

confidence: 99%

Prehospital shock index and systolic blood pressure are highly specific for pediatric massive transfusion

Zhu¹,

Braverman²,

Goddard³

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:While massive transfusion protocols (MTPs) are associated with decreased mortality in adult trauma patients, there is limited research on the impact of MTP on pediatric trauma patients. The purpose of this study was to compare pediatric trauma patients requiring massive transfusion with all other pediatric trauma patients to identify triggers for MTP activation in injured children. METHODS:Using our level I trauma center's registry, we retrospectively identified all pediatric trauma patients from January 2015 to January 2018. Massive transfusion (MT) was defined as infusion of 40 mL/kg of blood products in the first 24 hours of admission. Patients missing prehospital vital sign data were excluded from the study. We retrospectively collected data including demographics, blood utilization, variable outcome data, prehospital vital signs, prehospital transport times, and Injury Severity Scores. Statistical significance was determined using Mann-Whitney U test and χ 2 test. p Values of less than 0.05 were considered significant. RESULTS:Thirty-nine (1.9%) of the 2,035 pediatric patients met the criteria for MT. All-cause mortality in MT patients was 49% (19 of 39 patients) versus 0.01% (20 of 1996 patients) in non-MT patients. The two groups significantly differed in Injury Severity Score, prehospital vital signs, and outcome data.Both systolic blood pressure (SBP) of <100 mm Hg and shock index (SI) of >1.4 were found to be highly specific for MTwith specificities of 86% and 92%, respectively. The combination of SBP of <100 mm Hg and SI of >1.4 had a specificity of 94%. The positive and negative predictive values of SBP of <100 mm Hg and SI of >1.4 in predicting MT were 18% and 98%, respectively. Based on positive likelihood ratios, patients with both SBP of <100 mm Hg and SI of >1.4 were 7.2 times more likely to require MT than patients who did not meet both of these vital sign criteria. CONCLUSION:Pediatric trauma patients requiring early blood transfusion present with lower blood pressures and higher heart rates, as well as higher SIs and lower pulse pressures. We found that SI and SBP are highly specific tools with promising likelihood ratios that could be used to identify patients requiring early transfusion.

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Section: Methodsmentioning

confidence: 99%

Prehospital shock index and systolic blood pressure are highly specific for pediatric massive transfusion

Zhu¹,

Braverman²,

Goddard³

et al. 2021

J Trauma Acute Care Surg

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“…Only patients with GCS = 14, other signs of altered mental status or basilar skull fracture signs should receive a CT immediately. This group includes only 14% of all pediatric traumata [27] (Figure 3).…”

Section: Atls Guidelines For Ct Scans On Pediatric Traumamentioning

confidence: 99%

Pediatric Carotid Injury after Blunt Trauma and the Necessity of CT and CTA—A Narrative Literature Review

Krüger,

Kamp,

Alfen

et al. 2024

JCM

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Background: Blunt carotid injury (BCI) in pediatric trauma is quite rare. Due to the low number of cases, only a few reports and studies have been conducted on this topic. This review will discuss how frequent BCI/blunt cerebrovascular injury (BCVI) on pediatric patients after blunt trauma is, what routine diagnostics looks like, if a computed tomography (CT)/computed tomography angiography (CTA) scan on pediatric patients after blunt trauma is always necessary and if there are any negative health effects. Methods: This narrative literature review includes reviews, systematic reviews, case reports and original studies in the English language between 1999 and 2020 that deal with pediatric blunt trauma and the diagnostics of BCI and BCVI. Furthermore, publications on the risk of radiation exposure for children were included in this study. For literature research, Medline (PubMed) and the Cochrane library were used. Results: Pediatric BCI/BCVI shows an overall incidence between 0.03 and 0.5% of confirmed BCI/BCVI cases due to pediatric blunt trauma. In total, 1.1–3.5% of pediatric blunt trauma patients underwent CTA to detect BCI/BCVI. Only 0.17–1.2% of all CTA scans show a positive diagnosis for BCI/BCVI. In children, the median volume CT dose index on a non-contrast head CT is 33 milligrays (mGy), whereas a computed tomography angiography needs at least 138 mGy. A cumulative dose of about 50 mGy almost triples the risk of leukemia, and a cumulative dose of about 60 mGy triples the risk of brain cancer. Conclusions: Given that a BCI/BCVI could have extensive neurological consequences for children, it is necessary to evaluate routine pediatric diagnostics after blunt trauma. CT and CTA are mostly used in routine BCI/BCVI diagnostics. However, since radiation exposure in children should be as low as reasonably achievable, it should be asked if other diagnostic methods could be used to identify risk groups. Trauma guidelines and clinical scores like the McGovern score are established BCI/BCVI screening options, as well as duplex ultrasound.

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“…The ATLS protocol provides the emergency room physician and surgeon with a working template of blood loss sources. Blood on the floor, plus four more is the aphorism that reflects sources of hemorrhage including chest, abdomen, pelvis/retroperitoneum and major long bones [12]. The initial focused abdominal ultrasound for trauma evaluates the pericardium, right upper quadrant, left upper quad-rant and pelvis for the presence of blood loss.…”

Section: Continued Shock With Ensuing Acidosis Represents the Final E...mentioning

confidence: 99%

Evolving Trends in Trauma Resuscitation

Walker ML

2023

ACMCR

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Global Survey of Demand‐Side Factors and Incentives that Influence Advanced Trauma Life Support (ATLS) Promulgation

Cited by 5 publications

References 49 publications

Prehospital shock index and systolic blood pressure are highly specific for pediatric massive transfusion

Prehospital shock index and systolic blood pressure are highly specific for pediatric massive transfusion

Pediatric Carotid Injury after Blunt Trauma and the Necessity of CT and CTA—A Narrative Literature Review

Evolving Trends in Trauma Resuscitation

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