Pre-hospital care of pediatric patients with trauma

Seid, Terrence; Ramaiah, Ramesh; Grabinsky, Andreas

doi:10.4103/2229-5151.100887

Cited by 25 publications

(8 citation statements)

References 16 publications

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“…Fifth, the number of preschool-aged and school-aged children with fatal injuries was lower than that of adults, which may result in a potential source of methodological bias in the assessment. Finally, the study was conducted only in patients admitted in a level I trauma center; whether children received suboptimal prehospital care compared to the adults at a level I trauma center and not at a pediatric trauma center would raise further debate; so the results of this study remained inconclusive [ 37 , 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

The Preschool-Aged and School-Aged Children Present Different Odds of Mortality than Adults in Southern Taiwan: A Cross-Sectional Retrospective Analysis

Peng

Huang

Hsu

et al. 2018

IJERPH

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Background: This study aimed to profile the epidemiology of injury among preschool-aged and school-aged children in comparison to those in adults. Methods: According to the Trauma Registry System of a level I trauma center, the medical data were retrieved from 938 preschool-aged children (aged less than seven years), 670 school-aged children (aged 7–12 years), and 16,800 adults (aged 20–64 years) between 1 January 2009 and 31 December 2016. Two-sided Pearson’s, chi-squared, and Fisher’s exact tests were used to compare categorical data. A one-way analysis of variance (ANOVA) with the Games-Howell post-hoc test was used to assess the differences in continuous variables among different groups of patients. The mortality outcomes of different subgroups were assessed by a multivariable regression model under the adjustment of sex, injury mechanisms, and injury severity. Results: InFsupppjury mechanisms in preschool-aged and school-aged children were remarkably different from that in adults; in preschool-aged children, burns were the most common cause of injury requiring hospitalization (37.4%), followed by falls (35.1%) and being struck by/against objects (11.6%). In school-aged children, injuries were most commonly sustained from falls (47.8%), followed by bicycle accidents (14%) and being struck by/against objects (12.5%). Compared to adults, there was no significant difference of the adjusted mortality of the preschool-aged children (AOR = 0.9; 95% CI 0.38–2.12; p = 0.792) but there were lower adjusted odds of mortality of the school-aged children (AOR = 0.4; 95% CI 0.10–0.85; p = 0.039). The school-aged children had lower odds of mortality than adults (OR, 0.2; 95% CI, 0.06–0.74; p = 0.012), but such lower odds of risk of mortality were not found in preschool-aged children (OR, 0.7; 95% CI, 0.29–1.81; p = 0.646). Conclusions: This study suggests that specific types of injuries from different injury mechanisms are predominant among preschool-aged and school-aged children. The school-aged children had lower odds of mortality than adults; nonetheless there was no difference in mortality rates of preschool-aged children than adults, with or without controlling for sex, injury mechanisms and ISS. These results highlight the importance of injury prevention, particularly for preschool-aged children in Southern Taiwan.

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Section: Discussionmentioning

confidence: 99%

The Preschool-Aged and School-Aged Children Present Different Odds of Mortality than Adults in Southern Taiwan: A Cross-Sectional Retrospective Analysis

Peng

Huang

Hsu

et al. 2018

IJERPH

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“…4, 37 These differences may be even more pronounced in children, as severe pediatric trauma is a relatively rare call for GEMS providers. 38 One group found GEMS had unacceptably high complication and failure rates for pediatric intubation, while HEMS crews provided safe and effective intubation. 39 Finally, trauma center access may also play a role in the benefit of HEMS transport.…”

Section: Discussionmentioning

confidence: 99%

Helicopters and injured kids

Brown

Leeper

Sperry

et al. 2016

Journal of Trauma and Acute Care Surgery

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Background Helicopter emergency medical services (HEMS) are frequently used to transport injured children, despite unclear evidence of benefit. The study objective was to evaluate the association of HEMS compared to ground emergency medical services (GEMS) transport with outcomes in a national sample of pediatric trauma patients. Methods Patients age ≤15 undergoing scene transport by HEMS or GEMS in the NTDB 2007-2012 were included. Propensity score matching was used to match HEMS and GEMS patients for likelihood of HEMS transport based on demographics, prehospital physiology and time, injury severity, and geographic region. Absolute standardized differences <0.1 indicated adequate covariate balance between groups after matching. The primary outcome was in-hospital survival, while the secondary outcome was discharge disposition in survivors. Conditional logistic regression determined the association between HEMS versus GEMS transport with outcomes while controlling for demographics, admission physiology, injury severity, non-accidental trauma, and in-hospital complications not accounted for in the propensity score. Subgroup analysis was performed in patients with transport time >15 min to capture patients with the potential for HEMS transport. Results A total of 25,700 HEMS/GEMS pairs were matched from 166,594 patients. Groups were well matched with all propensity score variables having absolute standardized differences <0.1. In matched patients, HEMS was associated with a 72% increase in odds of survival compared to GEMS (AOR 1.72; 95%CI 1.26—2.36, p<0.01). Transport mode was not associated with discharge disposition (p=0.47). Subgroup analysis included 17,657 HEMS/GEMS pairs. HEMS was again associated with a significant increase in odds of survival (AOR 1.81; 95%CI 1.24—2.65, p<0.01), while transport mode was not associated with discharge disposition (p=0.58). Conclusions Scene transport by HEMS was associated with improved odds of survival compared with GEMS in pediatric trauma patients. Further study is warranted to understand the underlying mechanisms and develop specific triage criteria for HEMS transport in this population. Level of Evidence III, therapeutic study

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“…The physicians who work at SAMU also provide pediatric care and therefore need to master advanced support procedures. One study recommended intensive training for this type of care and reported frequent weaknesses in its implementation ( 34 , 35 ). In the present series, 51.1% of physicians were considered unprepared for pediatric trauma care, 34.9% reported difficulty in assessing pediatric symptomatology, and 62.4% were unprepared for advanced life support procedures.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of the professional, social and demographic profile and quality of life of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil

Tallo¹,

Abib²,

Baitello³

et al. 2014

Clinics

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OBJECTIVE:To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil and to evaluate their quality of life.METHODS:Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil.RESULTS:Of a total of 902 physicians, including 644 (71.4%) males, 533 (59.1%) were between 30 and 45 years of age and 562 (62.4%) worked in a state capital. Regarding education level, 45.1% had graduated less than five years before and only 43% were specialists recognized by the Brazilian Medical Association. Regarding training, 95% did not report any specific training for their work at SAMU. The main weaknesses identified were psychiatric care and surgical emergencies in 57.2 and 42.9% of cases, respectively; traumatic pediatric emergencies, 48.9%; and medical emergencies, 42.9%. As for procedure-related skills, the physicians reported difficulties in pediatric advanced support (62.4%), airway surgical access (45.6%), pericardiocentesis (64.4%) and thoracentesis (29.9%). Difficulties in using an artificial ventilator (43.3%) and in transcutaneous pacing (42.2%) were also reported. Higher percentages of young physicians, aged 25-30 years (26.7 vs 19.0%; p<0.01), worked exclusively in prehospital care (18.0 vs 7.7%; p<0.001), with workloads >48 h per week (12.8 vs 8.6%; p<0.001), and were non-specialists with the shortest length of service (<1 year) at SAMU (30.1 vs 18.2%; p<0.001) who were hired without having to pass public service exams* (i.e., for a temporary job) (61.8 vs 46.2%; p<0.001). Regarding quality of life, the pain domain yielded the worst result among physicians at SAMU.CONCLUSIONS:The doctors in this sample were young and within a few years of graduation, and they had no specific training in prehospital emergencies. Deficiencies were mostly found in pediatrics and psychiatry, with specific deficiencies in the handling of essential equipment and in the skills necessary to adequately attend to prehospital emergencies. A disrespectful labor scenario was also found; the evaluation of quality of life showed a notable presence of pain on the SF-36 among physicians at SAMU and especially among doctors who had worked for a longer length of time at SAMU.

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Pre-hospital care of pediatric patients with trauma

Cited by 25 publications

References 16 publications

The Preschool-Aged and School-Aged Children Present Different Odds of Mortality than Adults in Southern Taiwan: A Cross-Sectional Retrospective Analysis

The Preschool-Aged and School-Aged Children Present Different Odds of Mortality than Adults in Southern Taiwan: A Cross-Sectional Retrospective Analysis

Helicopters and injured kids

An evaluation of the professional, social and demographic profile and quality of life of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil

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