Standards of Care for the Critically Injured Pediatric Patient

Ramenofsky, Max L.; Morse, Thomas S.

doi:10.1097/00005373-198211000-00007

Cited by 36 publications

(6 citation statements)

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“…The regional planning and development of dedicated trauma care services in designated trauma service centers has shown potential for limiting unnecessary costs through concentration of capital and personnel, improving the quality of care by maintaining the skills of trauma care teams, and establishing suitable mechanisms for transportation and referral of patients through coordination with Emergency Medical Service (EMS) systems [3,4]. The organization of dedicated trauma care resources for the hospital treatment of the serious multi-trauma victim is ideally suited to reorganization [5,6] and serves as a role model for regionalizing other surgical critical care services (e.g., burns [7], spinal cord injuries [8], pediatric trauma [9], reimplantation, and organ retrieval for transplantation) [10, ll].…”

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confidence: 99%

Comprehensive regional trauma/Emergency Medical Services (EMS) delivery systems: The United States experience

1983

World j. surg.

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The early 1970's, as an outgrowth of the American military experience, several pioneer regional trauma/EMS programs showed the way for better planning, organization, and resource deployment for trauma/EMS systems in the civilian community. The experience of the mid and late 1970's has brought an even wider implementation and modeling of trauma/EMS care systems with identification of specific patient problems, designation of trauma service centers, development of protocols, and professional teams on a regionwide basis. Currently, the acceptance of regionalized systems of care for trauma makes it a potentially manageable disease with greater prospect for developing even better systems of trauma care and control in the 1980's. The progressive impact on improving trauma care for this nation will in large part be due to the continued planning and development of regional trauma/EMS systems which have as a key focus the designation of an appropriate limited number of trauma service centers for geographic regions and the nation. There should be little question today that hospitals having extensive experience with injured patients offer better care to these patients than hospitals receiving only an occasional trauma patient. Mortality and morbidity rates are lower in more experienced hospitals where interdisciplinary teams provide coordinated resuscitation, evaluation, and definitive operative management. The skills and teamwork employed in this complex task are improved by practice and repetition, which come only with a large volume of injured patients.

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confidence: 99%

Comprehensive regional trauma/Emergency Medical Services (EMS) delivery systems: The United States experience

1983

World j. surg.

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“…Similar guidelines are being developed for children, but the scientific basis for a pediatric trauma system is far from secure [9]. Despite the fact that accidental deaths have decreased for adults in areas served by a trauma system, the acciden tal death rate in children has not decreased [10], Has the modern trauma system been adequately designed to serve children? This study compares the outcome of children who were transported directly from the scene of the acci dent to a trauma center with the outcome of children who were first taken to an outlying hospital or to the nearest available hospital and then to the trauma center.…”

Section: Introductionmentioning

confidence: 99%

Send Severely Head-Injured Children to a Pediatric Trauma Center

Johnson

Krishnamurthy²

1996

Pediatr Neurosurg

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Between 1985 and 1988, a total of 1,320 head-injured children were seen by the neurosurgical service at the Children’s Hospital in Washington, D.C. (CHOW). This included 1,095 minor injuries, 127 moderate injuries, and 98 severe injuries. Children brought from the scene of an accident were considered direct transports, whereas those taken to another hospital prior to transfer to CHOW were indirect. Of the children that suffered severe head injuries, 56 were admitted directly to the hospital and 42 indirectly. The indirect group had a higher percentage of children with lower coma scores and abused children. The trauma score was significantly higher in the direct group (9 vs. 7). The mortality rate for severe injuries referred directly from the scene of the accident was 26.8%, and the mortality rate for children referred indirectly was 50.0%. The higher number of abused children in the indirect group did not account for the increase in mortality rate (p = 0.021) in this group. This is the first study to show that children brought directly from the scene of an accident to a well-established pediatric trauma center have a significantly better chance of survival than children transported first to the nearest available hospital.

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“…Οι συχνότερες αιτίες των παιδικών ατυχημάτων, είναι οι κλειστές κακώσεις και περίπου το 90% των ατυχημάτων που απειλούν την ζωή του παιδιού, είναι αποτέλεσμα κλειστών κακώσεων (Ramenofsky, 1988/ Eichelberger, 1985/ Haller, 1990/ Paar, Kasperk, 1992.…”

Section: δευτερο μεροςunclassified

“…Το σύνολο της βαθμολογίας κυμαίνεται από το +12 (έλασσον τραύμα) μέχρι το -6 (θανατηφόρο τραύμα). Διαπιστώνεται λοι- 11-12 0,0 44,3 (Ramenofsky, 1988) ΤΡΑΥΜΑΤΙΚΕΣ ΚΑΚΩΣΕΙΣ ΚΟΙΛΙΑΣ Μηχανισμοί κακώσεως: Οι κακώσεις γενικά της κοιλιακής χώρας αποτελούν ένα πρόβλημα, που απασχολεί όλο και περισσότερο τις σύγχρονες κοινωνίες, ιδιαίτερα του Δυτικού Κόσμου (Cox, 1988/ Feliciano, 1989/ Παναγιωτόπουλος, 1991.…”

Section: δευτερο μεροςunclassified

“…Ο ρόλος της διαγνωστικής περιτοναϊκής έκλυσης στα παιδιά έχει αρκετούς υποστηρικτές στην Παιδοχειρουργική οικογένεια. Αρκετοί Παιδοχειρουργοί πιστεύουν ότι η καλύτερη διαγνωστική προσέγγιση σε παιδί με κάκωση κοιλίας και υποψία κάκωσης του παγκρέατος, είναι ο συνδυασμός ΔΠΕ και αξονικής τομογραφίας για τον καθορισμό ή όχι μιας ερευνητικής λαπαροτομίας (Eichelberger, 1985/ Powell, 1987/ Ramenofsky, 1988/ Akgur, 1993.…”

Section: διάγνωσηunclassified

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Η Συμμετοχή Του Παγκρέατος Κατά Τας Τραυματικάς Κακώσεις Κοιλίας Εις Την Παιδικήν Ηλικίαν

Σπυριδάκης¹

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H παρούσα μελέτη αφορά 18 μικρούς ασθενείς με οξεία μετατραυματική παγκρεατίτιδα και ψευδοκύστη παγκρέατος, οι οποίοι νοσηλεύτηκαν και αντιμετωπίστηκαν συντηρητικά και χειρουργικά στην Κλινική Χειρουργικής Παίδων του Αριστοτελείου Πανεπιστημίου Θεσσαλονίκης, την περίοδο 1982-1998. Στους ασθενείς περιλαμβάνονται, 5 ασθενείς με μετατραυματική οξεία παγκρεατίτιδα και 13 ασθενείς με ψευδοκύστη παγκρέατος.Παρουσιάζεται εκτενώς η εμβρυολογία, η χειρουργική ανατομική και φυσιολογία παγκρέατος ενώ αναλύεται η διαγνωστική μεθοδολογία και η θεραπευτική αντιμετώπιση των μικρών ασθενών που περιλαμβάνονται στη μελέτη.Περιγράφονται οι χειρουργικές μέθοδοι αντιμετώπισης των κακώσεων του παγκρέατος και των ψευδοκύστεων όπως και η συντηρητική αντιμετώπιση μίας ομάδας μικρών ασθενών με οξεία μετατραυματική παγκρεατίτιδα.Αναφέρονται και αναλύονται τα αποτελέσματα και οι επιπλοκές που παρουσιάζουν οι ασθενείς των δύο ομάδων της μελέτης και εξάγονται τα τελικά συμπεράσματα.

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Standards of Care for the Critically Injured Pediatric Patient

Cited by 36 publications

References 0 publications

Comprehensive regional trauma/Emergency Medical Services (EMS) delivery systems: The United States experience

Comprehensive regional trauma/Emergency Medical Services (EMS) delivery systems: The United States experience

Send Severely Head-Injured Children to a Pediatric Trauma Center

Η Συμμετοχή Του Παγκρέατος Κατά Τας Τραυματικάς Κακώσεις Κοιλίας Εις Την Παιδικήν Ηλικίαν

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