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Pediatric Trauma

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Pediatric trauma triage: A Pediatric Trauma Society Research Committee systematic review.
Mora MC, Veras L, Burke RV, Cassidy LD, Christopherson N, Cunningham A, Jafri M, Marion E, Lidsky K, Yanchar N, Wu L, Gosain A.
J Trauma Acute Care Surg . 2020 Oct;89(4):623-630.

Rationale for inclusion: High-quality systematic review using PRISMA methodology; identifies important strengths and weaknesses of existing pediatric trauma triage criteria and further areas for study. 

CAVEAT: Qualitative assessment; substantial heterogeneity of underlying studies; provides more questions that answers. 

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Outcomes of civilian pediatric craniocerebral gunshot wounds: A systematic review
Duda T, Sharma A, Ellenbogen Y, Martyniuk A, Kasper E, Engels P, Sharma S.
J Trauma Acute Care Surg . 2020 Aug 3.

Rationale for inclusion: Systematic review of the literature on craniocerebral gunshot wounds in pediatric patients up to age 18. Despite its limitations, this study offers the key takeaway that more than half of pediatric patients with this devastating injury survived, and more than a quarter of them with good functional recovery. Aggressive management of pediatric patients with the devastating mechanism of "GSW to the head" is indicated.

CAVEAT: Review of a relatively small number of cases with high risk for bias due to heterogeneity and varying quality of included studies.

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Timing and volume of crystalloid and blood products in pediatric trauma: An Eastern Association for the Surgery of Trauma multicenter prospective observational study
Polites SF, Moody S, Williams RF, Kayton ML, Alberto EC, Burd RS, Schroeppel TJ, Baerg JE, Munoz A, Rothstein WB, Boomer LA, Campion EM, Robinson C, Nygaard RM, Richardson CJ, Garcia DI, Streck CJ, Gaffley M, Petty JK, Greenwell C, Pandya S, Waters AM, Russell RT, Yorkgitis BK, Mull J, Pence J, Santore MT, MacArthur T, Klinkner DB, Safford SD, Trevilian T, Vogel AM, Cunningham M, Black C, Rea J, Spurrier RG, Jensen AR, Farr BJ, Mooney DP, Ketha B, Dassinger III MS, Goldenberg-Sandau A, Roman JS, Jenkins TM, Falcone, Jr RA.
J Trauma Acute Care Surg. 2020 Jul;89(1):36-42.

Rationale for inclusion:  Large, prospective multicenter study examining the use of crystalloid and transfusion practices in the resuscitation of hemorrhagic shock. The association between increased crystalloid use and prolonged mechanical ventilation and length of ICU and hospital stay reinforces the increasingly accepted practice in adult trauma of avoiding crystalloids for trauma resuscitation.

CAVEAT: Observational study, can only demonstrate association.

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The ABC-D score improves the sensitivity in predicting need for massive transfusion in pediatric trauma patients.
Phillips R, Acker SN, Shahi N, Meier M, Leopold D, Recicar J, Kulungowski A, Patrick D, Moulton S, Bensard D.
J Pediatr Surg. 2020 Feb;55(2):331-334.

Rationale for inclusion: Based on 66 of 211 pediatric trauma patients who required massive transfusion, this single-center study establishes the "ABCD" score as highly sensitive and accurate tool to predict the need for massive transfusion in pediatric trauma patients. The ABCD score adds shock index, base deficit, and lactate levels to the well-established ABC score.

CAVEAT: Retrospective, registry-based study; small study population; all requirements to calculate ABCD score may not be available at time for MTP decision

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Effect of Fresh vs Standard-issue Red Blood Cell Transfusions on Multiple Organ Dysfunction Syndrome in Critically Ill Pediatric Patients: A Randomized Clinical Trial
Spinella PC, Tucci M, Fergusson DA, Lacroix J, Hébert PC, Leteurtre S, Schechtman KB, Doctor A, Berg RA, Bockelmann T, Caro TJ, Chiusolo F, Clayton L, Cholette JM, Guerra GG, Josephson CD, Menon K, Muszynski JA, Nellis ME, Sarpal A, Schafer S, Steiner ME, Turgeon AF, ABC-PICU Investigators, the Canadian Critical Care Trials Group, the Pediatric Acute Lung Injury and Sepsis Investigators Network, the BloodNet Pediatric Critical Care Blood Research Network, and the Groupe Francophone de Réanimation et Urgences P.
JAMA. 2019 Dec 10;322(22):2179-2190.

Rationale for inclusion: Large, international, multicenter RCT that did not detect a significant difference in the incidence of new/progressive organ dysfunction after transfusing "fresh" (median 5 days) vs. "old" (median 18 days) red blood cells in critically ill children up to age 16 years. Similar to the adult literature, this RCT contradicts the findings of observational and retrospective studies that raised concern about the negative effects of "old" blood transfusions due to storage lesion and other concerns.

CAVEAT: Despite a large number of participants, may have been underpowered in certain subgroups; heterogeneity expected with an international multi-center trial.

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Predictors for Pediatric Blunt Cerebrovascular Injury (BCVI): An International Multicenter Analysis.
Weber CD, Lefering R, Weber MS, Bier G, Knobe M, Pishnamaz M, Kobbe P, Hildebrand F; TraumaRegister DGU.
World J Surg. 2019 Sep;43(9):2337-2347.

Rationale for inclusion: BCVI remains a controversial topic in adult trauma and there is even less clarity in pediatric patients. This database analysis includes more than 8,000 pediatric trauma patients and demonstrates a low incidence (0.5%) but devastating consequences in this patient population, as well as risk factors.

CAVEAT: Retrospective database analysis; imaging practices in this European study might not mirror practices in the US

 

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A review of racial/ethnic disparities in pediatric trauma care, treatment, and outcomes.
LaPlant MB ,Hess DJ.
J Trauma Acute Care Surg. 2019 Mar;86(3):540-550.

Rationale for inclusion: Comprehensive review of the literature on the under-studied yet highly relevant topic of racial and ethnic disparities in the care of pediatric trauma patients.

CAVEAT: Studies underlying this review are heterogenous and of mixed quality

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Reimaging in pediatric blunt spleen and liver injury.
Notrica DM, Sussman BL, Garcia NM, Leys CM, Maxson RT, Bhatia A, Letton RW, Ponsky T, Lawson KA, Eubanks JW 3rd, Alder AC, Greenwell C, Ostlie DJ, Tuggle DW, St Peter SD.
J Pediatr Surg. 2019 Feb;54(2):340-344.

Rationale for inclusion: Secondary analysis of prospective multi-center data on pediatric patients who underwent successful non-operative management of blunt liver and splenic trauma. Of 534 such patients, only 3 patients of the 27 who underwent re-imaging had clinically relevant findings. These results confirm the current guidelines that recommend against routine re-imaging after successful non-operative management of blunt liver or splenic injury in pediatric patients.

CAVEAT: Secondary analysis. Median AAST grade was 3

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Venous Thromboembolic Risk Stratification in Pediatric Trauma: A Pediatric Trauma Society Research Committee Multicenter Analysis.
Labuz DF, Cunningham A, Tobias J, Dixon A, Dewey E, Marenco CW, Escobar MA Jr, Hazeltine MD, Cleary MA, Kotagal M, Falcone RA Jr, Fallon SC, Naik-Mathuria B, MacArthur T, Klinkner DB, Shah A, Chernoguz A, Orioles A, Zagel A, Gosain A, Knaus M, Hamilton NA, Jafri MA.
J Trauma Acute Care Surg. 2021 May 25.

Rationale for inclusion: Trauma registry-based retrospective analysis to verify a previously published VTE risk stratification tool. Based on 86 of 52,524 pediatric trauma patients who had VTE, the alorithm performed well identifying high risk patients with an AUROC of 0.96. The VTE risk stratification tool is provided in this study as reference.

CAVEAT: Retrospective analysis, discovered inaccuracies in the trauma registry. Low incidence of VTE in pediatric population (0.16%)

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Computed Tomography Rates and Estimated Radiation-Associated Cancer Risk Among Injured Children Treated at Different Trauma Center Types
Sathya C, Alali AS, Wales PW, Langer JC, Kenney BD, Burd RS, Nance ML, Nathens AB.
Injury. 2019 Jan;50(1):142-148.

Rationale for inclusion: Retrospective study including 130 U.S. trauma centers demonstrating that pediatric trauma patients are more likely to undergo CT scanning at adult and adult/pediatric trauma centers than at specialized pediatric trauma centers. This is particularly true for children with low injury severity, a trauma mechanism of "fall", and teenagers. Increased use of CT scans is not associated with better outcomes but with a significantly increased calculated radiation exposure and presumed cancer risk.

CAVEAT: Retrospective study in TQIP

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Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children.
Lumba-Brown A, Yeates KO, Sarmiento K, Breiding MJ, Haegerich TM, Gioia GA, Turner M, Benzel EC, Suskauer SJ, Giza CC, Joseph M, Broomand C, Weissman B, Gordon W, Wright DW, Moser RS, McAvoy K, Ewing-Cobbs L, Duhaime AC, Putukian M, Holshouser B, Paulk D, Wade SL, Herring SA, Halstead M, Keenan HT, Choe M, Christian CW, Guskiewicz K, Raksin PB, Gregory A, Mucha A, Taylor HG, Callahan JM, DeWitt J, Collins MW, Kirkwood MW, Ragheb J, Ellenbogen RG, Spinks TJ, Ganiats TG, Sabelhaus LJ, Altenhofen K, Hoffman R, Getchius T, Gronseth G, Donnell Z, O'Connor RE, Timmons SD.
JAMA Pediatr. 2018 Nov 1;172(11):e182853.

Rationale for inclusion: This manuscript is a summary of the Pediatric Mild Traumatic Brain Injury Guideline Workgroup of the Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control Board of Scientific Counselors and is the result of an evidence review was conducted from 1990 through 2015. The guideline includes 19 sets of recommendations on the diagnosis, prognosis, and management/treatment of pediatric mTBI that were assigned a level of obligation (ie, must, should, or may) based on confidence in the evidence. Recommendations address imaging, symptom scales, cognitive testing, and standardized assessment for diagnosis; history and risk factor assessment, monitoring, and counseling for prognosis; and patient/family education, rest, support, return to school, and symptom management for treatment

CAVEAT: Guidelines.

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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.

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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

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The association of nonaccidental trauma with historical factors, examination findings, and diagnostic testing during the initial trauma evaluation.
Escobar MA Jr, Flynn-O'Brien KT, Auerbach M, Tiyyagura G, Borgman MA, Duffy SJ, Falcone KS, Burke RV, Cox JM, Maguire SA.
J Trauma Acute Care Surg. 2017 Jun;82(6):1147-1157.

Rationale for inclusion: The Pediatric Trauma Society (PTS) Guidelines Committee Non-Accidental Trauma (NAT) Group published their manuscript “The association of non-accidental trauma with historical factors, exam findings and diagnostic testing during the initial trauma evaluation” in the Journal of Trauma and Acute Care Surgery. The Guideline Committee identified screening for NAT as a key area for guideline development during the first annual PTS meeting when a number of presentations on guidelines were noted to have significant variations across centers. A multi-disciplinary working group was created including PTS members and international experts in NAT from outside of PTS. Subgroups were developed to summarize and assess the quality of the evidence describing the correlation between NAT and the following: bruising, burns, abusive head trauma [AHT], abdominal injuries, fractures, historical factors, and oral trauma. The groups approach was novel in that it focused on these seven specific findings and the likelihood that each alone might be a harbinger of NAT. Over the subsequent two years the group synthesized the highest-quality evidence for each of these findings to be presented in one publication. The associations with NAT were summarized in a table within the article (attached). The authors believe that this table provides a one-page resource for use by ED, traumatologists, and emergency personnel that encapsulate key findings or "satchel knowledge."

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Identifying Children at Very Low Risk for Blunt Intra-Abdominal Injury in Whom CT of the Abdomen Can Be Avoided Safely.
Streck CJ, Vogel AM, Zhang J, Huang EY, Santore MT, Tsao K, Falcone RA, Dassinger MS, Russell RT, Blakely ML; Pediatric Surgery Research Collaborative.
J Am Coll Surg. 2017 Apr;224(4):449-458.e3.

Rationale for inclusion: Large, multi-institutional prospective study which included data from 14 PTC to develop a 5 variable clinical predication rule combining history, physical exam, chest x-ray and screening labs to identify children at very low risk for any intra-abdoominal injury in whom Abdominal CT is likely unnecessary

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Prevalence and Impact of Admission Acute Traumatic Coagulopathy on Treatment Intensity, Resource Use, and Mortality: An Evaluation of 956 Severely Injured Children and Adolescents.
Liras IN, Caplan HW, Stensballe J, Wade CE, Cox CS, Cotton BA.
J Am Coll Surg. 2017 Apr;224(4):625-632.

Rationale for inclusion: This retrospective review of 956 highest-level activation pediatric trauma patient evaluated used deranged r-TEG parameters to define acute traumatic coagulopathy. Children with coagulopathy had higher mortality, ICU days and ventilator days. This was especially true in children with head injuries. This study introduces r-TEG as a useful tool to assess coagulopathy in injured chidren. 

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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.

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Acute traumatic coagulopathy in a critically injured pediatric population: Definition, trend over time, and outcomes.
Leeper CM, Kutcher M, Nasr I, McKenna C, Billiar T, Neal M, Sperry J, Gaines BA.
J Trauma Acute Care Surg. 2016 Jul;81(1):34-41.

Rationale for inclusion: This ten year retrospective review of 776 children revealed that even a mild elevation of INR, 1.3 or greater, at admission and at 24h is associated with significantly increased mortality.  This association was independent of transfusion, suggesting that the INR is a marker of coagulopathy rather than a target for correction. This is an important paper to describe the phenomenon of acute traumatic coagulopathy in children.

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Nonoperative management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE.
Notrica DM, Eubanks JW, Tuggle DW, Maxson RT, Letton RW, Garcia NM, Alder AC, Lawson KA, St Peter SD, Megison S, Garcia-Filion P.
J Trauma Acute Care Surg. 2015 Oct;79(4):683-93.

Rationale for inclusion: Updated management guidelines for management of liver and spleen injury in children based on GRADE methodology to assess the evidence supporting the guidelines.

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Pediatric specific shock index accurately identifies severely injured children.
Acker SN, Ross JT, Partrick DA, Tong S, Bensard DD.
J Pediatr Surg. 2015 Feb;50(2):331-4.

Rationale for inclusion: This retrospective review of 543 injured children age 4-16 years evaluated the ability of a pediatric adjusted shock index to identify the most severely injured patients.  The shock index-pediatric adjusted (SIPA) is calculated by the heart rate divided by the systolic blood pressure compared to age-specific normal limits. SIPA showed superior ability to discriminate sevely injured children compared to the standard shock index, though many severely injured children did not have an elevated SIPA. 

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Clearly defining pediatric massive transfusion: cutting through the fog and friction with combat data.
Neff LP, Cannon JW, Morrison JJ, Edwards MJ, Spinella PC, Borgman MA.
J Trauma Acute Care Surg. 2015 Jan;78(1):22-8; discussion 28-9.

Rationale for inclusion: The Department of Defense Trauma Registry was used to identify 1,113 combat-injured pediatric trauma patients who received blood product transfusion. Sensitivity and specificity curves for early and in-hospital mortality identified a transfusion threshold of 40 mL/kg of all blood products in the first 24h as the optimal definition for massive transfusion in children.  This paper provides the most evidence based threshold for pediatric massive transfusion to date.  

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Tranexamic acid administration to pediatric trauma patients in a combat setting: the pediatric trauma and tranexamic acid study (PED-TRAX).
Eckert MJ, Wertin TM, Tyner SD, Nelson DW, Izenberg S, Martin MJ.
J Trauma Acute Care Surg. 2014 Dec;77(6):852-8; discussion 858.

Rationale for inclusion: This retrospective review evaluated 766 children who were treated in the recent conflict in Afghanistan.  Severely injured children were matched on demographics, vital signs, injuries, and labs. In this severely injured, penetrating mechanism-heavy group, children who received TXA experienced decreased mortality and improved neurologic outcome. 

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Identifying children at very low risk of clinically important blunt abdominal injuries.
Holmes JF, Lillis K, Monroe D, Borgialli D, Kerrey BT, Mahajan P, Adelgais K, Ellison AM, Yen K, Atabaki S, Menaker J, Bonsu B, Quayle KS, Garcia M, Rogers A, Blumberg S, Lee L, Tunik M, Kooistra J, Kwok M, Cook LJ, Dean JM, Sokolove PE, Wisner DH, Ehrlich P, Cooper A, Dayan PS, Wootton-Gorges S, Kuppermann N; Pediatric Emergency Care Applied Research Network (PECARN)
Ann Emerg Med. 2013 Aug;62(2):107-116.e2.

Rationale for inclusion: Large, prospective multi-institutional study which included data from 20 pediatric trauma centers which developed a clinical prediction rule using history and physical exam findings  to identify children at very low risk of abdominal injuries requiring intervention in whom abdominal CT could be potentially avoided

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Comparison of hypothermia and normothermia after severe traumatic brain injury in children (Cool Kids): a phase 3, randomised controlled trial.
Adelson PD, Wisniewski SR, Beca J, Brown SD, Bell M, Muizelaar JP, Okada P, Beers SR, Balasubramani GK, Hirtz D; Paediatric Traumatic Brain Injury Consortium.
Lancet Neurol. 2013 Jun;12(6):546-53.

Rationale for inclusion: This phase 3, multicenter, multinational, randomized controlled trial compared hypothermia to normothermia for children with severe traumatic brain injury. The study was terminated early for futility following an interim data analysis on data for that showed no between-group difference in mortality, poor outcomes, or adverse/serious events 3 months after injury. They authors concluded that hypothermia for 48 h with slow rewarming does not reduce mortality of improve global functional outcome after pediatric severe traumatic brain injury.

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Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department.
Babcock L, Byczkowski T, Wade SL, Ho M, Mookerjee S, Bazarian JJ.
JAMA Pediatr. 2013 Feb;167(2):156-61.

Rationale for inclusion: In this single-center, retrospective review of a prospective dataset, the authors identified adolescent age, headache on presentation to the ED, and admission to the hospital risk factors for postconcussive syndrome following mild traumatic brain injury. Postconcussive syndrome occurred in 29% of their mild traumatic brain injury population and manifested in a mean of 7.4 missed days of school. 

CAVEAT: Single center.

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Derivation of a clinical prediction rule for pediatric abusive head trauma.
Hymel KP, Willson DF, Boos SC, Pullin DA, Homa K, Lorenz DJ, Herman BE, Graf JM, Isaac R, Armijo-Garcia V, Narang SK; Pediatric Brain Injury Research Network (PediBIRN) Investigators.
Pediatr Crit Care Med. 2013 Feb;14(2):210-20.

Rationale for inclusion: PEDIBIRN clinical prediction rule is a 4-variable applied to hospitalized patients in the pediatric intensive care unit with intracranial injury on CT or MRI, confirmed as AHT or nAHT. Found to be 96% sensitive, 43% specific for abusive head trauma (AHT) in this patient population with 1+ feature* in child < 3 years. *Acute respiratory compromise before admission; bruising of the torso, ears, or neck; bilateral or interhemispheric subdural hemorrhages or collections; and any skull fractures other than an isolated, unilateral, nondiastatic, linear, parietal fracture.

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Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review.
Maguire SA, Watts PO, Shaw AD, Holden S, Taylor RH, Watkins WJ, Mann MK, Tempest V, Kemp AM.
Eye (Lond). 2013 Jan;27(1):28-36.

Rationale for inclusion: The authors performed a systematic review to report the retinal findings that distinguish AHT from non-abusive head trauma (nAHT). Hospitalized children ages 0-11 with head injury diagnosed on CT or MRI with performance of an eye exam by an ophthalmologist were included. In a child with head trauma and retinal hemorrhages, the OR that the injury was AHT was 14.7 (95% confidence intervals 6.39 - 33.62) and the probability of abuse was 91%. Certain patterns of RH were far commoner in AHT, namely large numbers of RH in both the eyes, present in all layers of the retina, and extension into the periphery, but there was no retinal sign that was unique to abusive injury. RH were rare in accidental trauma and, when present, were predominantly unilateral, few in number and in the posterior pole.

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Predictors of cognitive function and recovery 10 years after traumatic brain injury in young children.
Anderson V, Godfrey C, Rosenfeld JV, Catroppa C.
Pediatrics. 2012 Feb;129(2):e254-61.

Rationale for inclusion: In this single center, prospective, longitudinal study, the authors describes the trajectory of cognitive and functional skills following early childhood TB. They found that children with severe TBI had worst outcomes, with deficits greatest for cognition. Recovery trajectories were similar across severity groups but with significant gains in verbal skills from 12 and 30 months to 12 months and 10 years. Predictors of outcome included preinjury ability (for adaptive function) and family function (social/behavioral skills). Young children appear to make age-appropriate progress for at least to 10 years after injury. Environmental factors were also found to contribute to adaptive and social/behavioral recovery.

CAVEAT: Single center.

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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

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Estimating the probability of abusive head trauma: a pooled analysis.
Maguire SA, Kemp AM, Lumb RC, Farewell DM.
Pediatrics. 2011 Sep;128(3):e550-64.

Rationale for inclusion: PredAHT clinical prediction rule is a CPR based on combinations of six clinical features in hospitalized patients with intracranial injury, confirmed as AHT or nAHT. When ≥ 3 features** were present in children < 3 years with intracranial injury: Sensitivity: 72.3% (95% CI 60.4-81.7); Specificity: 85.7% (95% CI 78.8-90.7). ** Retinal hemorrhage, rib and long-bone fractures, apnea, seizures, and head or neck bruising.

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Autologous bone marrow mononuclear cell therapy for severe traumatic brain injury in children.
Cox CS Jr, Baumgartner JE, Harting MT, Worth LL, Walker PA, Shah SK, Ewing-Cobbs L, Hasan KM, Day MC, Lee D, Jimenez F, Gee A.
Neurosurgery. 2011 Mar;68(3):588-600.

Rationale for inclusion: In this study, the authors show that bone marrow harvest and intravenous mononuclear cell infusion as treatment for severe TBI in children is logistically feasible and safe. Ten children with a severe traumatic brain injury were treated with autologous bone marrow-derived mononuclear cells within 48 hours after TBI. All patients survived and  there were no episodes of harvest-related depression of systemic or cerebral hemodynamics and there was no detectable infusion-related toxicity. cMRI imaging comparing gray matter, white matter, and CSF volumes showed no reduction from 1 to 6 months postinjury and dichotomized Glasgow Outcome Score at 6 months showed 70% with good outcomes and 30% with moderate to severe disability.

CAVEAT: Single center, feasability/safety.

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Bruising characteristics discriminating physical child abuse from accidental trauma.
Pierce MC, Kaczor K, Aldridge S, O'Flynn J, Lorenz DJ.
Pediatrics. 2010 Jan;125(1):67-74.

Rationale for inclusion: The authors sought to identify distinguishing features of abusive and non-abusive bruising characteristics in children, and to create a decision rule to predict abusive trauma based on bruising patterns. This resulted in the classic TEN-4 rule. Body region(s), abused vs. non-abused children: In children <=4 years of age - Torso (chest, abdomen, back, buttocks, genitourinary region, hip) – 77 vs. 6; Ears – 8 vs. 0; Neck – 18 vs. 0; Total for TEN region: 103 bruises in 25 abused children vs. 6 bruises in 6 non-abused children. In infants < 4months - Any region; Total: 74 bruises in 14 abused children vs. 13 bruises in 7 non-abused children. Clinical prediction rule based on TEN-4 (regions and age):  bruising in children < 4 years on trunk, ears, neck; or any bruising in infants < 4 month: 97% Sensitivity; 84% Specificity.

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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, multicenter, observational study of 42,412 pediatric trauma pateints with head injury and GCS of 14-15 validated a clnical prediction rule that identifield children at low risk of clinically-important traumatic brain injury for which head CT could be safely avoided.

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Hypothermia therapy after traumatic brain injury in children.
Hutchison JS, Ward RE, Lacroix J, Hébert 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.

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Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients.
MRC CRASH Trial Collaborators, Perel P, Arango M, Clayton T, Edwards P, Komolafe E, Poccock S, Roberts I, Shakur H, Steyerberg E, Yutthakasemsunt S.
BMJ. 2008 Feb 23;336(7641):425-9.

Rationale for inclusion: Original study of CRASH data that allowed for prediction of outcome of brain injury from presentation exam and CT.  Predictive model/calculator that can be used in trauma bay to determine longterm outcome after brain injury, validated multiple times since then.

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Do pediatric patients with trauma in Florida have reduced mortality rates when treated in designated trauma centers?
Pracht EE, Tepas JJ, 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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

Computed tomography--an increasing source of radiation exposure.
Brenner DJ, Hall EJ.
N Engl J Med. 2007 Nov 29;357(22):2277-84.

Rationale for inclusion: Summary article which highlights the rapid expansion of abdominal CT and the biologic effects of low doses of ionizing radiation, primarily cancer risks, particularly in children. This study highlights the need for wide dissemination of pediatric trauma management guidelines

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Variation in treatment of pediatric spleen injury at trauma centers versus nontrauma centers: a call for dissemination of American Pediatric Surgical Association benchmarks and guidelines.
Stylianos S, Egorova N, Guice KS, Arons RR, Oldham KT.
J Am Coll Surg. 2006 Feb;202(2):247-51. Epub 2005 Dec 19.

Rationale for inclusion: Study comparing outcomes for children with blunt spleen injuries at TC and non-TC showing siginificantly lower rates of operative intervention at trauma centers

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

A comparison of high-dose and standard-dose epinephrine in children with cardiac arrest.
Perondi MB, 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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

Identification of children with intra-abdominal injuries after blunt trauma.
Holmes JF, Sokolove PE, Brant WE, Palchak MJ, Vance CW, Owings JT, Kuppermann N.
Ann Emerg Med. 2002 May;39(5):500-9.

Rationale for inclusion: Landmark study designed to determine the utility of routine lab testing in determining children with intra-abdominal injuries following blunt abdominal trauma

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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.

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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  - To review the number of citations for this landmark paper, visit Google Scholar.

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 childrens sustaining severe TBI compared compared medical management plus decompressive craniectomy to medical management alsona. They found that early decompressive craniectomy  improves intracranial pressure and epidodes of intracranial hypertension with improved long term neurologic outcome.

CAVEAT: Single Center

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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, amd overall mortality was significantly increased when initiation of fluid resuscitation was delayed by two hours or more.

CAVEAT: Single institution, retrospective.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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, multicenter 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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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: *Acute respiratory compromise before admission; bruising of the torso, ears, or neck; bilateral or interhemispheric subdural hemorrhages or collections; and any skull fractures other than an isolated, unilateral, nondiastatic, linear, parietal fracture.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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 resuscitaion 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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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 hpertonic salining in the management of pedric TBI.

CAVEAT: Single Center

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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. Broeslow tape performace was best in the 2.5 kg-10 kg and 10 kg-25 kg weigh 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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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 show be based on patient physiology rather than imaging.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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

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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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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: The authors ultimately posit this 4-variable CPR could theoretically improve the accuracy of AHT screening in PICU settings.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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 nonaccidental 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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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 differs from adult spleen injuris, and how the approach to these injuries could be different in children than in adults.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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  - To review the number of citations for this landmark paper, visit Google Scholar.

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