RISK FACTORS FOR BLUNT CEREBROVASCULAR INJURY IN CHILDREN: DO THEY MIMIC THOSE SEEN IN ADULTS?

Kopelman TR, Berardoni NE, O'Neill PJ, Hedayati P, Vail SJ, Pieri PG, Feiz-Erfan I, Pressman MA. Risk factors for blunt cerebrovascular injury in children: do they mimic those seen in adults? Journal of Trauma Injury, Infection, and Critical Care. 2011;71(3):559-564.

This retrospective study sought to determine whether adult criteria for evaluation of blunt cerebrovascular injury (BCVI) translate to the pediatric population using the Eastern Association for the Surgery of Trauma guidelines. This study was performed at a level 1 trauma center evaluating blunt pediatric patients younger than 15 years over a 5-year period. Study data included patient demographics and presence of adult risk factors for BCVI (Glasgow coma scale <=8, skull base fracture, cervical spine fracture, facial fractures, and soft tissue injury to the neck).

A total of 1209 pediatric trauma patients were admitted during the study period, with 128 patients meeting the criteria for retrospective review based on Eastern Association for the Surgery Trauma criteria. Of these, only 52 patients received subsequent radiographic evaluation. Adult risk factors were present in 91% of patients diagnosed with an injury. Major thoracic injury was found in 67% of patients with carotid artery injury, cervical spine fracture was found in 100% of patients with vertebral artery injury, and stroke occurred in 4 patients. Stroke rate for untreated patients was 38%.

The authors concluded that BCVI in the pediatric trauma patient appears to mimic that in adult patients. The authors advocate for appropriate screening of the high-risk pediatric trauma patients to allow for earlier recognition, treatment, and better outcomes.

PEDIATRIC TRAUMA TRANSPORT PERFORMANCE MEASURES IN A MOUNTAIN STATE: ADHERENCE AND OUTCOMES

Gleich SJ, Bennet TD, Bratton SL, Larsen GY. Pediatric trauma transport performance measures in a mountain state: adherence and outcomes. Journal of Trauma Injury, Infection, and Critical Care. 2011;1-7.

Data from a large regional level 1 trauma center showed that half of all trauma patients admitted to the pediatric trauma center were via interhospital transfer, with an increase in risk-adjusted mortality compared with directly admitted patients. The authors hypothesized that increasing distance from the place of injury to the regional trauma center would be inversely associated with adherence.

The authors analyzed the Primary Children's Medical Center (PCMC) trauma data base for children with injury severity scores (ISSs) higher than 15 from 2006 to 2009 (n = 412) and patient care from referring hospital emergency department triage time of less than 2 hours and total transfer time of 6 hours or less for rural and 4 hours or less for urban place of injury. Fifty percent of these patients were triaged in less than 2 hours (increased to two-thirds when restricted to patients initially evaluated within 100 miles [helicopter range] of PCMC). Factors associated with delayed triage included lower ISSs, less severe head injury, greater distance from trauma center, and primary chest/abdominal injuries. Death and poor outcome did not differ significantly for a triage time of less than 2 hours.

The authors found substantial nonadherance with trauma performance measures for triage of less than 2 hours among pediatric trauma patients with ISSs higher than 15. The authors were inconclusive in their findings, citing low rates of poor outcomes, lack of information on patients who died before arrival to PCMC, and long-term follow-up.