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Pediatric Trauma

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Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study.
Babl FE, Borland ML, Phillips N, Kochar A, Dalton S, McCaskill M, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Lyttle MD, Bressan S, Donath S, Molesworth C, Jachno K, Ward B, Williams A, Baylis A, Crowe L, Oakley E, Dalziel SR; Paediatric Research in Emergency Departments International Collaborative (PREDICT).
Lancet. 2017 Jun 17;389(10087):2393-2402.

Rationale for inclusion: Multicenter, prospective observational study of children (<18yrs) with head injuries found that PECARN, CATCH and CHALICE rules all effectively identified children with clinically significant head injuries.

CAVEAT: This is not a statistical comparison of these three rules.

Citations - 10 (as of October 2017)

Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children With Blunt Torso Trauma: A Randomized Clinical Trial.
Holmes JF, Kelley KM, Wootton-Gorges SL, Utter GH, Abramson LP, Rose JS, Tancredi DJ, Kuppermann N.
JAMA. 2017 Jun 13;317(22):2290-2296.

Rationale for inclusion: 925 children randomized to standard trauma evaluations with or without FAST examinations. No improvements in clinical care were reported for those who underwent FAST examination. 

CAVEAT: These were hemodynamically normal children

Citations - 1 (as of October 2017)

Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension.
Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ; RESCUEicp Trial Collaborators.
N Engl J Med. 2016 Sep 22;375(12):1119-30.

Rationale for inclusion: 408 patients with traumatic intracranial hypertension were randomized to decompressive craniectomy or medical therapy.  Decompressive craniectomy resulted in lower mortality but greater vegatitive state and severe disability at 6 months.

Citations - 62 (as of July 2017)

Mortality Among Injured Children Treated at Different Trauma Center Types.
Sathya C, Alali AS, Wales PW3, Scales DC, Karanicolas PJ, Burd RS, Nance ML, Xiong W, Nathens AB.
JAMA Surg. 2015 Sep;150(9):874-81

Rationale for inclusion: Using data from TQIP, the authors demonstrate an association between improved pediatric trauma mortality and receiving care at a pediatric trauma center, rather than at an adult trauma center or a mixed trauma center. This association was particularly true in the youngest children and in the most severely injured children.  This suggests opportunities for quality improvement at all centers where children receive injury care. 

Citations - 18 (as of July 2017)

Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition.
Kochanek PM, Carney N, Adelson PD, Ashwal S, Bell MJ, Bratton S, Carson S, Chesnut RM, Ghajar J, Goldstein B, Grant GA, Kissoon N, Peterson K, Selden NR, Tasker RC, Tong KA, Vavilala MS, Wainwright MS, Warden CR; American Academy of Pediatrics-Section on Neurological Surgery; American Association of Neurological Surgeons/Congress of Neurological Surgeons; Child Neurology Society; European Society of Pediatric and Neonatal Intensive Care; Neurocritical Care Society; Pediatric Neurocritical Care Research Group; Society of Critical Care Medicine; Paediatric Intensive Care Society UK; Society for Neuroscience in Anesthesiology and Critical Care; World Federation of Pediatric Intensive and Critical Care Societies.
Pediatr Crit Care Med. 2012 Jan;13 Suppl 1:S1-82.

Rationale for inclusion: These guidelines provide extensive, evidence based recommendations for the management of traumatic brain injury in children.  They are broadly endorsed by major neurosurgery, neurology, pediatric, and critical care professional societies.

CAVEAT: Guidelines

Citations - 25 (as of July 2017)

Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study.
Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, Nadel FM, Monroe D, Stanley RM, Borgialli DA, Badawy MK, Schunk JE, Quayle KS, Mahajan P, Lichenstein R, Lillis KA, Tunik MG, Jacobs ES, Callahan JM, Gorelick MH, Glass TF, Lee LK, Bachman MC, Cooper A, Powell EC, Gerardi MJ, Melville KA, Muizelaar JP, Wisner DH, Zuspan SJ, Dean JM, Wootton-Gorges SL; Pediatric Emergency Care Applied Research Network (PECARN).
Lancet. 2009 Oct 3;374(9696):1160-70.

Rationale for inclusion: This prospective, multi-center, observational study of 42,412 pediatric trauma patients with head injury and GCS of 14-15 validated a clinical prediction rule that identified children at low risk of clinically-important traumatic brain injury for which head CT could be safely avoided.

Citations - 707 (as of July 2017)

Hypothermia therapy after traumatic brain injury in children.
Hutchison JS, Ward RE, Lacroix J, H├ębert PC, Barnes MA, Bohn DJ, Dirks PB, Doucette S, Fergusson D, Gottesman R, Joffe AR, Kirpalani HM, Meyer PG, Morris KP, Moher D, Singh RN, Skippen PW; Hypothermia Pediatric Head Injury Trial Investigators and the Canadian Critical Care Trials Group.
N Engl J Med. 2008 Jun 5;358(23):2447-56.

Rationale for inclusion: This randomized, prospective, multi-center, multinational trial of 225 patients showed that hypothermia initiated within 8 hours of injury and continued for 24 hours did not improve neurologic outcome and could worsen mortality.

Citations - 521 (as of July 2017)

Guidelines for prehospital management of traumatic brain injury 2nd edition.
Badjatia N, Carney N, Crocco TJ, Fallat ME, Hennes HM, Jagoda AS, Jernigan S, Letarte PB, Lerner EB, Moriarty TM, Pons PT, Sasser S, Scalea T, Schleien CL, Wright DW; Brain Trauma Foundation; BTF Center for Guidelines Management.
Prehosp Emerg Care. 2008;12 Suppl 1:S1-52.

Rationale for inclusion: This supplement of Prehospital Emergency Care presents comprehensive, evidence guidelines for the prehospital management of children with traumatic brain injury.

CAVEAT: Guidelines

Citations - 176 (as of July 2017)

Do pediatric patients with trauma in Florida have reduced mortality rates when treated in designated trauma centers?
Pracht EE, Tepas JJ 3rd, Langland-Orban B, Simpson L, Pieper P, Flint LM.
J Pediatr Surg. 2008 Jan;43(1):212-21.

Rationale for inclusion: Relatively recent paper looking at a statewide registry with a large number of patients. Found that designated adult centers performed better than non-trauma centers. However, designated pediatric trauma centers performed better than adult trauma centers

Citations - 86 (as of July 2017)

A comparison of high-dose and standard-dose epinephrine in children with cardiac arrest.
Perondi MB1, Reis AG, Paiva EF, Nadkarni VM, Berg RA.
N Engl J Med. 2004 Apr 22;350(17):1722-30.

Rationale for inclusion: This prospective, randomized, double-blind study of 68 children showed that patients in the high-dose group (0.1 mg/kg) had no difference in return of spontaneous circulation and worse 24-hour mortality and survival to discharge compared to standard dose (0.01 mg/kg) epinephrine. 

Citations - 247 (as of July 2017)

Hyperglycemia and outcomes from pediatric traumatic brain injury.
Cochran A, Scaife ER, Hansen KW, Downey EC.
J Trauma. 2003 Dec;55(6):1035-8.

Rationale for inclusion: This retrospective, single center review of pediatric patients with severe TBI showed that hyperglycemia is associated with poor neurologic outcome.

CAVEAT: Single center, retrospective

Citations - 223 (as of July 2017)

A population-based study of inflicted traumatic brain injury in young children.
Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF, Sinal SH.
JAMA. 2003 Aug 6;290(5):621-6.

Rationale for inclusion: This study of 230,000 children aged 2 years and younger showed a higher risk of inflicted traumatic brain injury in males, children of young mothers, non-European Americans, products of multiple births, and younger infants. This paper helped to define risk factors for inflicted traumatic brain injury.

Citations - 410 (as of July 2017)

A prospective study of short- and long-term outcomes after traumatic brain injury in children: behavior and achievement.
Taylor HG, Yeates KO, Wade SL, Drotar D, Stancin T, Minich N.
Neuropsychology. 2002 Jan;16(1):15-27.

Rationale for inclusion: This longitudinal study across four years of behavior and achievement in children with severe traumatic brain injury (N=53), moderate traumatic brain injury (N=56), and controls (N=80, orthopedic injuries) showed persistent sequelae of traumatic brain injury. The study also showed that post-injury improvement can be influenced by the family environment.

Citations - 381 (as of July 2017)

A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension.
Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, Klug G, Wallace D, Henning R, Tibballs J.
Childs Nerv Syst. 2001 Feb;17(3):154-62.

Rationale for inclusion: This single center, prospective, randomized  trial of 27 children sustaining severe TBI compared medical management plus decompressive craniectomy to medical management alone. They found that early decompressive craniectomy  improves intracranial pressure and episodes of intracranial hypertension with improved long term neurologic outcome.

CAVEAT: Single center

Citations - 462 (as of July 2017)

Predicting survival in pediatric trauma patients receiving cardiopulmonary resuscitation in the prehospital setting.
Perron AD, Sing RF, Branas CC, Huynh T.
Prehosp Emerg Care. 2001 Jan-Mar;5(1):6-9.

Rationale for inclusion: This study was a large, retrospective registry review of 729 pediatric trauma patients receiving CPR in the field from 1998-2005. The authors found that prehospital intubation, penetrating mechanism, and receiving additional CPR at the trauma center were predictors of mortality. Overall mortality was 29%.

CAVEAT: Retrospective, trauma registry

Citations - 47 (as of July 2017)

Do pediatric trauma centers have better survival rates than adult trauma centers? An examination of the National Pediatric Trauma Registry.
Osler TM, Vane DW, Tepas JJ, Rogers FB, Shackford SR, Badger GJ.
J Trauma. 2001 Jan;50(1):96-101.

Rationale for inclusion: In this look at variability between mortality rates in pediatric trauma patients between adult and pediatric trauma centers, more severely injured patients were being cared for in adult centers and mortality rate was not different when corrected for this.  Also showed a significant impact of ACS verification.

CAVEAT: This study is 15 years old, and the verification process has changed significantly.  The number of true pediatric trauma centers has grown significantly since this was published and more injured patients may now be preferentially directed to pediatric trauma centers.

Citations - 108 (as of July 2017)

Impact of pediatric trauma centers on mortality in a statewide system.
Potoka DA, Schall LC, Gardner MJ, Stafford PW, Peitzman AB, Ford HR.
J Trauma. 2000 Aug;49(2):237-45.

Rationale for inclusion: Early paper showing that adult trauma centers with added certification in pediatric trauma have better outcomes than adult trauma centers without this qualification. These differences were greatest with head, liver, and spleen injuries. 

CAVEAT: This study is 16 years old, and the verification process has changed significantly.  The defined trauma center designations no longer exist.

Citations - 267 (as of July 2017)

Early fluid resuscitation improves outcomes in severely burned children.
Barrow RE, Jeschke MG, Herndon DN.
Resuscitation. 2000 Jul;45(2):91-6.

Rationale for inclusion: This single institution, retrospective review of 133 children with greater than 50% TBSA burns showed that sepsis, acute kidney injury, and overall mortality was significantly increased when initiation of fluid resuscitation was delayed by two hours or more.

CAVEAT: Single institution, retrospective

Citations - 133 (as of July 2017)

Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial.
Gausche M, Lewis RJ, Stratton SJ, Haynes BE, Gunter CS, Goodrich SM, Poore PD, McCollough MD, Henderson DP, Pratt FD, Seidel JS.
JAMA. 2000 Feb 9;283(6):783-90.

Rationale for inclusion: This prospective, randomized (by odd/even date of arrest), observational, multi-center evaluation of 830 pediatric patients requiring advanced airway management from 1994-1997 compared prehospital endotracheal intubation (N=420) to bag mask ventilation (BVM) (N=410) and found no difference in survival or neurologic outcome.  This suggests that BVM is sufficient for prehospital management of the pediatric airway.

Citations - 762 (as of July 2017)

Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury. The APSA Trauma Committee.
Stylianos S.
J Pediatr Surg. 2000 Feb;35(2):164-7; discussion 167-9.

Rationale for inclusion: This was the first paper to by a national organization (APSA Trauma Committee) to set clear evidence based guidelines for the treatment of children with blunt solid organ injury.

Citations - 241 (as of July 2017)

Analysis of missed cases of abusive head trauma.
Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC.
JAMA. 1999 Feb 17;281(7):621-6.

Rationale for inclusion: The diagnosis of child abuse can be challenging and the consequences of missing the diagnosis can be lethal.  This study evaluates children with a missed diagnosis of abusive head trauma.  In these children, it took seven days to arrive at the correct diagnosis. Over 1/4 of these children were re-injured during that time, and 40% had medical complications related to the missed diagnosis.  Of the five children who died, four of these deaths were preventable if child abuse had been recognized sooner. This paper serves as a clarion call to the healthcare community to have a low threshold for evaluation of potential child abuse, given the potentially devastating consequences of missing this diagnosis. 

Citations - 747 (as of July 2017)

Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS.
Am J Prev Med. 1998 May;14(4):245-58.

Rationale for inclusion: This study evaluated exposure to adverse events in childhood and the relationship to adult health.  It identified a graded "dose response" relationship between adverse events in childhood (physical abuse, sexual abuse, emotional abuse) and causes of death in adulthood (ischemic heart disease, cancer, lung disease, liver disease, etc.). This study highlights the potentially widespread, lifetime benefits to prevention and treatment of child abuse. 

Citations - 5948 (as of July 2017)

Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial.
Olds DL, Eckenrode J, Henderson CR Jr, Kitzman H, Powers J, Cole R, Sidora K, Morris P, Pettitt LM, Luckey D.
JAMA. 1997 Aug 27;278(8):637-43.

Rationale for inclusion: Long term follow up to a prospective randomized trial to prevent child abuse demonstrates beneficial effects to families fifteen years later.  The intervention of home visits by a nurse prenatally and through the first two years correlated with decreased child abuse and neglect, decreased number of subsequent pregnancies, decreased use of welfare, decreased substance abuse, and decreased criminal behavior.

Citations - 1637 (as of July 2017)

Influence of a statewide trauma system on pediatric hospitalization and outcome.
Hulka F, Mullins RJ, Mann NC, Hedges JR, Rowland D, Worrall WH, Sandoval RD, Zechnich A, Trunkey DD.
J Trauma. 1997 Mar;42(3):514-9.

Rationale for inclusion: A dated study, but with an interesting conclusion that prevention efforts may have a much larger impact on pediatric trauma mortality the establishment of a trauma system.

Citations - 134 (as of July 2017)

Send severely head-injured children to a pediatric trauma center.
Johnson DL, Krishnamurthy S.
Pediatr Neurosurg. 1996 Dec;25(6):309-14.

Rationale for inclusion: One of the first papers to show that particularly in children with traumatic brain injury, delivery directly to a pediatric trauma center rather than first stopping at a non-trauma center has a positive survival effect.

Citations - 82 (as of July 2017)

Nonoperative management of blunt hepatic and splenic injury in children.
Bond SJ, Eichelberger MR, Gotschall CS, Sivit CJ, Randolph JG.
Ann Surg. 1996 Mar;223(3):286-9.

Rationale for inclusion: A foundation paper demonstrating that nonoperative treatment of solid organ injury can be very successful.  156 children treated non-operatively for blunt solid organ injury over 6 years. 97.4% success rate.

Citations - 181 (as of July 2017)

The outcome for children with blunt trauma is best at a pediatric trauma center.
Hall JR, Reyes HM, Meller JL, Loeff DS, Dembek R.
J Pediatr Surg. 1996 Jan;31(1):72-6; discussion 76-7.

Rationale for inclusion: Early paper to suggest that the difference in outcome between adult and pediatric trauma centers only applies to blunt trauma patients, with little difference with respect to penetrating trauma.

Citations - 181 (as of July 2017)

Rib fractures in children--resuscitation or child abuse?
Betz P, Liebhardt E.
Int J Legal Med. 1994;106(4):215-8.

Rationale for inclusion: This autopsy study of 233 infants and children  helped define the rib fracture pattern (anterior) that is rarely seen with resuscitation and closed-chest massage. This study refutes the hypothesis that rib fractures in children are caused by "inexperienced resuscitation in a panic-like reaction". 

CAVEAT: Retrospective

Citations - 69 (as of July 2017)

Hypertonic saline lowers raised intracranial pressure in children after head trauma.
Fisher B, Thomas D, Peterson B.
J Neurosurg Anesthesiol. 1992 Jan;4(1):4-10.

Rationale for inclusion: This prospective, double-blind, crossover study evaluated the impact of 3% saline compared to 0.9% saline. 3% saline infusion significantly reduced ICP after traumatic brain injury in children. This study help define the role of hypertonic saline in the management of pediatric TBI.

CAVEAT: Single center

Citations - 229 (as of July 2017)

A rapid method for estimating weight and resuscitation drug dosages from length in the pediatric age group.
Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW.
Ann Emerg Med. 1988 Jun;17(6):576-81.

Rationale for inclusion: This first published use of the Broselow tape was a prospective, blinded, observational study of  937 children that compared the weight derived from the Broselow tape to patient's actual weight. Broselow tape performance was best in the 2.5 kg-10 kg and 10 kg-25 kg weight ranges. These results enabled further development of the Broselow tape and led to its widespread use in pediatric trauma to assess weight and weight-based drug dosage.

Citations - 189 (as of July 2017)

Hepatic and splenic injury in children: role of CT in the decision for laparotomy.
Brick SH, Taylor GA, Potter BM, Eichelberger MR.
Radiology. 1987 Dec;165(3):643-6.

Rationale for inclusion: One of the first attempts at development of an imaging based grading system for solid organ injuries in pediatrics. They showed that CT can help define the need of operative intervention but more importantly showed that an operation should be based on patient physiology rather than imaging.

Citations - 106 (as of July 2017)

Intraosseous fluid administration: a parenteral alternative in pediatric resuscitation.
Harte FA, Chalmers PC, Walsh RF, Danker PR, Sheikh FM.
Anesth Analg. 1987 Jul;66(7):687-9.

Rationale for inclusion: This early case report describes the  use of the intraosseous vascular access for resuscitation in critically ill children.

CAVEAT: Case report

Citations - 30 (as of July 2017)

Preventing child abuse and neglect: a randomized trial of nurse home visitation.
Olds DL, Henderson CR Jr, Chamberlin R, Tatelbaum R.
Pediatrics. 1986 Jul;78(1):65-78.

Rationale for inclusion: A rare prospective randomized trial in child abuse examined the intervention of home visitation by a nurse during the prenatal and infant time periods.  During these two years, children in the intervention group had fewer instances of abuse and neglect, fewer ED visits, and fewer accidents and poisonings.  This study demonstrates that effective prevention of child abuse is possible and has meaningful benefits. 

Citations - 1140 (as of July 2017)

Upper abdominal trauma in children: imaging evaluation.
Kaufman RA, Towbin R, Babcock DS, Gelfand MJ, Guice KS, Oldham KT, Noseworthy J.
AJR Am J Roentgenol. 1984 Mar;142(3):449-60.

Rationale for inclusion: One of the first studies to demonstrate the effectiveness (and superiority) of CT in trauma compared to scintigraphy and ultrasound.  100 patients over 20 months.  CT clearly provided the most information.

Citations - 141 (as of July 2017)

Organization and function of a regional pediatric trauma center: does a system of management improve outcome?
Haller JA Jr, Shorter N, Miller D, Colombani P, Hall J, Buck J.
J Trauma. 1983 Aug;23(8):691-6.

Rationale for inclusion: One of the first papers to look at establishment of a trauma system and its beneficial effect on morbidity and mortality in pediatric trauma  patients.

Citations - 78 (as of July 2017)

CT of blunt abdominal trauma in childhood.
Berger PE, Kuhn JP.
AJR Am J Roentgenol. 1981 Jan;136(1):105-10.

Rationale for inclusion: The original paper describing the validity of CT scanning for the assessment of children with abdominal trauma. They did elegant studies comparing CT, angiogram, and IVP.  

Citations - 119 (as of July 2017)

Nonoperative management of traumatized spleen in children: how and why.
Ein SH, Shandling B, Simpson JS, Stephens CA.
J Pediatr Surg. 1978 Apr;13(2):117-9.

Rationale for inclusion: This was one of the first papers to describe a systematic approach to the non-operative treatment of splenic injury.  The authors describe a large 35 year experience.  This work has been the foundation for modern non-operative treatment of blunt solid organ injury.

Citations - 204 (as of July 2017)

The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation.
Caffey J.
Pediatrics. 1974 Oct;54(4):396-403.

Rationale for inclusion: The injury mechanism of common infant non-accidental trauma is first described in this paper.  It identifies shaking rather than blunt battering as the cause of subdural hematoma, ocular hemorrhage, and brain injury. It clarifies how severely injured infants may not have significant external findings of trauma. This paper was important in dispelling the notion of a "spontaneous" subdural hematoma in infants. 

Citations - 748 (as of July 2017)

Splenic trauma in children.
Upadhyaya P, Simpson JS.
Surg Gynecol Obstet. 1968 Apr;126(4):781-90.

Rationale for inclusion: Another highly cited foundation paper describing normal patterns of splenic injury in children, how these differ from adult spleen injuries, and how the approach to these injuries could be different in children than in adults.

Citations - 230 (as of July 2017)

The battered-child syndrome.
Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK.
JAMA. 1962 Jul 7;181:17-24.

Rationale for inclusion: Kempe's paper is the first to describe the medical manifestations of non-accidental trauma.  The authors coined the phrase "battered child syndrome" to characterize the constellation of findings including childhood fractures, subdural hematoma, soft tissue swelling, skin bruising, failure to thrive, and sudden death. They highlight the importance of injury that does not correlate to the described history. This early paper remains compelling and foresightedly contemporary.

Citations - 4004 (as of July 2017)

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