Outcomes of an accelerated care pathway for pediatric blunt solid organ injuries in a public healthcare system

Daodu, Oluwatomilayo; Brindle, Mary; Alvarez‐Allende, Carlos R.; Lockyer, Lisette; Weber, Bryce; Lopushinsky, Steven R.

doi:10.1016/j.jpedsurg.2017.01.037

Cited by 10 publications

(26 citation statements)

References 25 publications

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“…One study did not specify the primary organ injury investigated 12. In all six studies grade of injury was limited to a mean or median grade of 2–3 and thus deemed to be low-grade to mid-grade solid organ injuries, which historically require no surgical or radiological intervention 11–16. There was no significant difference in grade of organ injury between early ambulation and late ambulation comparators in any study 11–13…”

Section: Resultsmentioning

confidence: 99%

“…Of the six studies included for analysis, all were undertaken at specialist trauma centres (two paediatric specialist hospitals,14 15 four level 1 trauma centres11–13 16). Two studies focused on paediatric populations with mean ages of 10.4 and 11.8 and median ages of 11.0 (early) and 12.0 (late) 14 15.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies focused on paediatric populations with mean ages of 10.4 and 11.8 and median ages of 11.0 (early) and 12.0 (late) 14 15. The remaining four studies investigated trauma in adult populations with a median age ranging from 27.6 to 31 11–13 16Table 1 shows the demographics of all study participants included.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies investigated liver, spleen and kidney injury, quantifying incidence 11 13 15 16. One study investigated renal injury only 14.…”

Section: Resultsmentioning

confidence: 99%

“…Three included studies were non-randomised cohort studies comparing clinical outcomes in patients undergoing early ambulation with those receiving bed rest 11–13. The three remaining studies were non-randomised case series of early ambulation with no comparator 14–16.…”

Section: Methodsmentioning

confidence: 99%

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Bed rest: outdated following traumatic solid organ injury?

Ashcroft

Khan

2020

BMJ Mil Health

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IntroductionThis systematic review aimed to evaluate early ambulation protocols implemented for traumatic solid organ injury.MethodsThe electronic databases PubMed, Medline (Ovid), Embase and Cochrane Library were searched without time constraint to identify prospective and retrospective analyses, randomised controlled trials, cohort studies, and case series that investigated early ambulation in solid organ trauma.ResultsSix studies met the predefined inclusion criteria and were reviewed. Three studies investigated early ambulation protocols in direct comparison with bed rest. The remaining three studies were early ambulation case series. In all studies there was no convincing evidence to suggest differences in clinical outcomes between early ambulation and bed rest protocols. In all studies early ambulation resulted in a reduced length of hospitalisation and decreased cost to national healthcare services.ConclusionsThis systematic review has found preliminary evidence that suggests bed rest has no clinical benefit in those with low-grade to mid-grade (grades 1–2) solid organ injury. Further studies are required to inform guidance to improve trauma patient outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Four studies investigated liver, spleen and kidney injury, quantifying incidence 11 13 15 16. One study investigated renal injury only 14.…”

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Bed rest: outdated following traumatic solid organ injury?

Ashcroft

Khan

2020

BMJ Mil Health

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Comparing unbalanced and balanced ratios of blood products in massive transfusion to pediatric trauma patients: effects on mortality and outcomes

Sehdev

Grigorian

Kuza

et al. 2020

Eur J Trauma Emerg Surg

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Background The utilization and impact of various ratios of transfusions for pediatric trauma patients (PTPs) receiving a massive transfusion (MT) are unknown. Therefore, we sought to determine the risk for mortality in PTPs receiving an MT of ≥ 6 units of packed red blood cells (PRBC) within 24 h. We compared PRBC: plasma ratio of > 2:1 (Unbalanced Ratios, UR) versus ≤ 2:1 (Balanced Ratios, BR), hypothesizing decreased risk of mortality with BR. Methods The Trauma Quality Improvement Program was queried (2014-2016) for PTPs receiving a MT. A multivariable logistic regression model was used to determine risk of mortality. Results From 239 PTPs receiving an MT, 98 (41%) received an UR, whereas 141 (59%) received a BR. The median ratios, respectively, were 2.7:1 and 1.2:1. Compared to BR patients, UR patients had no differences in injury severity score (ISS), hypotension on admission, and intensive care unit stay (all p > 0.05). The mortality rates for BR and UR were similar (46.1% vs. 52.0%, p = 0.366). Controlling for age, ISS, and severe head injury, UR demonstrated similar risk of mortality compared to BR (p = 0.276). Additionally, ≥ 4:1 ratio versus ≤ 2:1 showed no difference in associated risk of mortality (p = 0.489). Conclusion In contrast to adult studies, this study demonstrated that MT ratios of > 2:1 and even ≥ 4:1 were associated with similar mortality compared to BR for PTPs. These results suggest pediatric MT resuscitation may not require strict BR as has been shown beneficial in adult trauma patients. Future prospective studies are needed to evaluate the optimal ratio for PTP MT resuscitation. Level of evidence III; Retrospective Care Management Study.

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