Thesis. / Includes vita. Includes bibliographical references (leaves 110-125)

This report will provide an overview of the literature on predictive factors of the development of Post-Traumatic Stress Disorder in pediatric medical trauma patients as well as discuss the influence of cognitive development on the validity of such predictive factors. The report will propose that the validity of current predictive factors, including trauma memory, parental influence, and appraisals of the trauma and its sequelae, may alter across child development due to differences in cognitive abilities. In particular, the report proposes examining the following questions for pediatric patients (5 to 17 years of age) who have endured a medical trauma: 1) Are appraisal predictive values of PTSD moderated by age; 2) Is data-driven processing‟s predictive value of PTSD moderated by parental attitude of avoidance. The report additionally outlines hypotheses as well as proposes the methodology and statistics to examine the proposed hypotheses. Limitations as well as the importance of this study are discussed. / text

No description available.

Background Injuries are the leading cause of death in the United States for children between the ages of 1 and 19 years. Weekend hospital admission has been associated with poor outcomes and higher mortality rates for a variety of diseases. We examined the impact of weekend versus weekday admission on in-hospital morbidity and case-fatality rates for pediatric trauma patients. Methods We performed a cross-sectional analysis on the 2016 Kids’ Inpatient Database. The study population included pediatric trauma patients under the age of 19 years which were stratified by weekend vs weekday admission. Weightings were used to produce national estimates. Multiple logistic regression analyses were performed to assess the odds of in-hospital complications and death after adjusting for a variety of potentially confounding demographic and clinical factors. Results Patients admitted on a weekend were older, more frequently male, White, and privately insured. Weekend admissions had a higher Injury Severity Score (6.7 vs 5.4, p<0.001), as well as higher rate of intensive care unit (ICU) admission (8.5% vs 7.1%, p<0.001) and in-hospital case-fatality rate (1.3% vs 1.1%, p=0.003), but lower rate of in-hospital complications (6.1% vs 6.8%, p<0.001). Unadjusted logistic regression demonstrated that weekend admission was associated with higher odds of in-hospital death as compared to weekday admission (odds ratio 1.20, 95% confidence interval [CI] 1.07 – 1.35), but in the multivariable adjusted model this was no longer statistically significant (adjusted odds ratio [aOR] 1.06, 95% CI 0.94 – 1.20). Weekend admission was associated with lower odds of in-hospital complications (aOR 0.90, 95% CI 0.86 - 0.95), but higher odds of ICU admission (aOR 1.12, 95% CI 1.06 – 1.18). Conclusions Weekend admission in pediatric trauma is associated with higher odds of ICU admission. There does not appear to be an association between weekend admission and odds of in-hospital death, however it may be associated with lower odds of in-hospital complications.

No description available.

Trauma is the main cause of death in paediatric population worldwide. Lithuania has the highest trauma-related mortality in the European Union (EU). Lithuanian standardised injury death rate is 150.9 per 100000 inhabitants while in comparison the mean standardised injury death rate in the EU is 41.4, and the lowest one is in the Netherlands (26.4 injury death rate per 100000 inhabitants). The aim of this study was to analyze the impact of pre-hospital and in-hospital emergent trauma care on severe pediatric trauma outcomes, performing a prospective observational clinical trial in the Vilnius University Children’s Hospital and Vilnius Pre-hospital Emergency Service Center. Trauma registry fields were defined in details and validated during this study. The recommended quality indicators were defined and used for pre-hospital pediatric trauma care and in-hospital emergent management evaluation. The study results showed that the level of pre-hospital care is associated statistically significantly with trauma outcomes: higher pre-hospital care level caused better trauma outcome assessed according to the Glasgow Outcome Scale. The longer time until the first key emergency intervention in hospital was associated statistically significantly with the worse trauma outcomes. Calculation of the Probability of survival (Ps) according to Trauma Score Injury Severity Score model (TRISS) revealed unexpected death (Ps > 50 %) rate 74%. The reasons for fatal outcome in the patient group with... [to full text] / Traumos yra pagrindinė vaikų, paauglių ir jaunų suaugusiųjų mirties priežastis. Stebimas didžiulis skirtumas Europos Sąjungos (ES) šalyse lyginant mirštamumą nuo traumų. Lietuvoje didžiausias ES standartizuotas traumų mirčių dažnis (150.9 mirtys dėl traumų 100.000 gyventojų). Palyginimui: ES šalių vidurkis yra 41.4 mirtys dėl traumos 100.000 gyventojų, mažiausias standartizuotas traumų mirčių dažnis yra Olandijoje – 26.4 mirtys 100.000 gyventojų. Toks skirtumas nurodo potencialią galimybę sumažinti mirčių dėl traumų skaičių, naudojant visas priemones: tiek traumų prevenciją, tiek skubios pagalbos prieinamumą ir kokybę. Darbo tikslas – išanalizuoti vaikų, patyrusių sunkias traumas, ikihospitalinės pagalbos ir skubiosios pagalbos ligoninėje laiko bei apimties įtaką traumų išeitims, atliekant perspektyvinį tyrimą Vilniaus Universiteto Santariškių klinikų Vaikų ligoninėje bei Vilniaus Greitosios medicinos pagalbos stotyje. Rezultatai parodė, kad pagalbos lygis ikihospitaliniu laikotarpiu susijęs su išeitimi: pacientams, gavusiems aukštesnio lygio pagalbą traumos išeitys pagal Glazgo išeičių skalę buvo geresnės. Ilgesnis laikas nuo paciento atvežimo į ligoninę iki pirmos skubiosios intervencijos statistiškai patikimai koreliavo su blogesne traumos išeitimi. Apskaičiavus išgyvenamumo tikimybę (Ps) pagal traumos skalės pažeidimų sunkumo modelį (TRISS), 74 proc. mirčių dėl traumų pateko į netikėtų mirčių (Ps > 50 proc.) kategoriją. Kiekviena netikėta mirtis, identifikuota naudojant... [toliau žr. visą tekstą]

Acidentes de trÃnsito sÃo eventos de etiologia multifatorial potencialmente evitÃveis e decorrentes de fatores como aumento da frota de veÃculos, falhas humanas e leis inadequadas ou insuficientes, e responsÃveis por uma parcela importante da morbidade e mortalidade em menores de idade. O trabalho tem como objetivo: calcular a Escala de Trauma PediÃtrico(PTS) e Escala de Trauma Revisado(RTS) e comparar se hà relaÃÃo de gravidade do trauma com a idade do acidentado. Estudo de abordagem quantitativa e documental, do tipo exploratÃrio e descritivo, ocorrido na cidade de Sobral, com 910 ocorrÃncias com motocicletas envolvendo menores de idade, no perÃodo de 2005 a 2013, cuja coleta de dados ocorreu atravÃs de pesquisa nas folhas de ocorrÃncia do SAMU. A analise foi realizada atravÃs do programa SPSS, respeitando os princÃpios Ãticos da ResoluÃÃo 466/12. RESULTADOS: foram 910 os acidentes de motocicleta envolvendo menores de idade entre os anos de 2005 a 2013, sendo 543(59,7%) do sexo masculino;494(54.3%) estavam na idade entre 16 a 18 anos de idade; 377(41.4%) foram vÃtimas de queda de moto. Na faixa etÃria de 0 a 7 anos de idade houve o predomÃnio dos atropelamentos por moto(36,6%) e as quedas de moto(35,9%). O Escore de Trauma PediÃtrico no grupo etÃrio de zero a 07 anos foi menor(01 ponto), quando comparado aos outros grupos etÃrios. NÃo houve diferenÃas no Escore de Trauma Revisado nos grupos etÃrios estudados. Dentre as variÃveis que compÃe o PTS ganha destaque o trauma musculoesquelÃtico(fraturas e lesÃes de pele) como fator de gravidade. CONCLUSÃO: nos acidentes de motocicleta envolvendo menores 07 anos, a gravidade do trauma foi maior quando comparado a outras faixas etÃrias. O PTS à uma boa ferramenta de triagem prÃ-hospitalar a ser aplicada em crianÃas vÃtimas de acidente com motocicleta. / Traffic accidents are multifactorial events potentially avoidable and due to such factors as increasing vehicle fleet, human error and inadequate or insufficient laws, and account for a significant portion of morbidity and mortality in minors. The work aims to: calculate the Pediatric Trauma Scale (PTS) and Trauma Scale Revised (RTS) and compare if there is a relationship of severity of trauma at the age of the injured. Quantitative approach to study and document, exploratory and descriptive, which occurred in the city of Sobral, with 910 occurrences with motorcycles involving minors in the period 2005-2013, whose data were collected through research in the SAMU occurrence of leaves. The analysis was performed using SPSS, respecting the ethical principles of Resolution 466/12. RESULTS: There were 910 motorcycle accidents involving minors between the years 2005-2013, with 543 (59.7%) were male, 494 (54.3%) were aged 16-18 years old; 377 (41.4%) were motorcycle fall victims. In the age group 0-7 years old there was predominance of pedestrian accidents by motorcycle (36.6%) and motorcycle falls (35.9%). Pediatric Trauma Score in the age group of zero to 07 years was lower (01 points), when compared to other age groups. There were no differences in the Revised Trauma Score of the age groups studied. Among the variables that make up the PTS is highlighted musculoskeletal trauma (fractures and skin lesions) as gravity factor. CONCLUSION: in motorcycle accidents involving minors 07 years, trauma severity was higher when compared to other age groups. The PTS is a good pre-hospital screening tool to be applied in children with motorcycle crash victims.

Traumos yra pagrindinė vaikų, paauglių ir jaunų suaugusiųjų mirties priežastis. Stebimas didžiulis skirtumas Europos Sąjungos (ES) šalyse lyginant mirštamumą nuo traumų. Lietuvoje didžiausias ES standartizuotas traumų mirčių dažnis (150.9 mirtys dėl traumų 100.000 gyventojų). Palyginimui: ES šalių vidurkis yra 41.4 mirtys dėl traumos 100.000 gyventojų, mažiausias standartizuotas traumų mirčių dažnis yra Olandijoje – 26.4 mirtys 100.000 gyventojų. Toks skirtumas nurodo potencialią galimybę sumažinti mirčių dėl traumų skaičių, naudojant visas priemones: tiek traumų prevenciją, tiek skubios pagalbos prieinamumą ir kokybę. Darbo tikslas – išanalizuoti vaikų, patyrusių sunkias traumas, ikihospitalinės pagalbos ir skubiosios pagalbos ligoninėje laiko bei apimties įtaką traumų išeitims, atliekant perspektyvinį tyrimą Vilniaus Universiteto Santariškių klinikų Vaikų ligoninėje bei Vilniaus Greitosios medicinos pagalbos stotyje. Rezultatai parodė, kad pagalbos lygis ikihospitaliniu laikotarpiu susijęs su išeitimi: pacientams, gavusiems aukštesnio lygio pagalbą traumos išeitys pagal Glazgo išeičių skalę buvo geresnės. Ilgesnis laikas nuo paciento atvežimo į ligoninę iki pirmos skubiosios intervencijos statistiškai patikimai koreliavo su blogesne traumos išeitimi. Apskaičiavus išgyvenamumo tikimybę (Ps) pagal traumos skalės pažeidimų sunkumo modelį (TRISS), 74 proc. mirčių dėl traumų pateko į netikėtų mirčių (Ps > 50 proc.) kategoriją. Kiekviena netikėta mirtis, identifikuota naudojant... [toliau žr. visą tekstą] / Trauma is the main cause of death in paediatric population worldwide. Lithuania has the highest trauma-related mortality in the European Union (EU). Lithuanian standardised injury death rate is 150.9 per 100000 inhabitants while in comparison the mean standardised injury death rate in the EU is 41.4, and the lowest one is in the Netherlands (26.4 injury death rate per 100000 inhabitants). The aim of this study was to analyze the impact of pre-hospital and in-hospital emergent trauma care on severe pediatric trauma outcomes, performing a prospective observational clinical trial in the Vilnius University Children’s Hospital and Vilnius Pre-hospital Emergency Service Center. Trauma registry fields were defined in details and validated during this study. The recommended quality indicators were defined and used for pre-hospital pediatric trauma care and in-hospital emergent management evaluation. The study results showed that the level of pre-hospital care is associated statistically significantly with trauma outcomes: higher pre-hospital care level caused better trauma outcome assessed according to the Glasgow Outcome Scale. The longer time until the first key emergency intervention in hospital was associated statistically significantly with the worse trauma outcomes. Calculation of the Probability of survival (Ps) according to Trauma Score Injury Severity Score model (TRISS) revealed unexpected death (Ps > 50 %) rate 74%. The reasons for fatal outcome in the patient group with... [to full text]

Inadvertent tracheal tube misplacement and particularly endobronchial intubation are well-known complications of emergency endotracheal intubation (ETI) in pediatric trauma patients, which require repositioning of the tube to avoid impairment of gas exchange. The main aim of study was to identify the frequency of tube misplacement and associated factors of pediatric trauma patients who received ETI either by prehospital physician-staffed emergency medical service (EMS), or at emergency department (ED) admission to a single level-1 trauma center. Sixty-five patients (median age 14 years and median injury severity score 29) were included. Of these, 30 underwent helicopter EMS ETI, 29 ground EMS ETI, and 6 ED ETI. Seventeen cases (26%) of tracheal tube misplacement were recognized. After multivariable analysis, tracheal tube misplacement was independently negatively associated with body weight (OR 0.86; 95% CI, 0.76–0.99; p = 0.032) and helicopter EMS ETI (OR 0.20; 95% CI, 0.04–0.97; p = 0.036). Two of nineteen patients received tube thoracostomy due to endobronchial intubation. Mortality and length of stay were comparable in patients with misplaced tubes and correctly placed tubes. The results suggest that particularly small children require attention to avoid tracheal tube misplacement, which emphasizes the need for special training. Helicopter EMS physicians’ expertise might be beneficial in prehospital pediatric trauma patients requiring advanced airway management.

No description available.