Outcome of Cardiovascular Collapse in Pediatric Blunt Trauma☆,☆☆,★
Section snippets
INTRODUCTION
Trauma is a leading cause of pediatric death and disability in the United States. Each year, more than 22,000 children die and many more are hospitalized as the result of injuries, resulting in annual health care expenditures exceeding $7.5 billion.1, 2 Blunt trauma is responsible for 90% of pediatric trauma and most pediatric trauma deaths and disability.2 Approximately 80% of all pediatric trauma deaths occur within the first hours of injury; it is estimated that half occur at the scene, and
MATERIALS AND METHODS
During the study period of August 1984 through December 1991, 12,420 patients of all ages were admitted to a university Level I trauma center with traumatic injuries. Twenty percent of these trauma patients (2,511 patients) were less than 16 years old. Blunt trauma was the mechanism of injury in 2,120 (84.4%) of these children. The records of all 2,120 patients were screened for evidence of cardiopulmonary arrest or severe hypotension on initial presentation in the medical center ED, and
RESULTS
During the study period, 2,120 consecutive victims of blunt trauma less than 16 years old were evaluated; 2,082 of these patients presented with a systolic blood pressure of more than 50 mm Hg on admission to the ED and formed the nonstudy group. The mean ISS of the 2,082 nonstudy patients was 10.1, and the mean TRISS was 95.2%, with an actual survival of 96.5%. The mean age of these patients was 7.1 years (range, 3 months to 15 years) and the mean length of stay was 6.0 days (Table 1). The
DISCUSSION
Cardiac arrest is a dismal prognostic sign in adult victims of blunt trauma, and resuscitation rarely results in functional survival.4, 5, 6, 7, 8, 9, 10, 11, 12 Reports of small groups of patients have suggested that the survival following cardiac arrest in pediatric trauma victims is as poor as that reported following arrest in adult victims,19, 26 although no large series has been published to confirm this fact. There are, however, important distinctions between the epidemiology of pediatric
CONCLUSION
The outcome of pulseless cardiac arrest or profound hypotension (characterized by a systolic blood pressure of 50 mm Hg or less) among pediatric victims of blunt trauma is dismal. The length of hospitalization and the cost of care is relatively low in these patients; however, reimbursement for their care is still disproportionately poor. Although functional survival is unlikely, if pediatric victims of blunt trauma presenting with pulseless arrest or profound hypotension can be stabilized
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Cited by (70)
Hypotension and the need for transfusion in pediatric blunt spleen and liver injury: An ATOMAC + prospective study
2017, Journal of Pediatric SurgeryExtracorporeal life support use in pediatric trauma: a review of the National Trauma Data Bank
2017, Journal of Pediatric SurgeryWithholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest
2014, Annals of Emergency MedicinePaediatric traumatic out-of-hospital cardiac arrests in Melbourne, Australia
2012, ResuscitationEuropean Resuscitation Council Guidelines for Resuscitation 2010 Section 6. Paediatric life support
2010, ResuscitationCitation Excerpt :After 20 min of resuscitation, the resuscitation team leader should consider whether or not to stop.273,390–394 The relevant considerations in the decision to continue the resuscitation include the cause of arrest,60,395 pre-existing medical conditions, age,41,389 site of arrest, whether the arrest was witnessed,60,394 the duration of untreated cardiopulmonary arrest (‘no flow’), number of doses of adrenaline, the ETCO2 value, the presence of a shockable rhythm as the first or subsequent rhythm,386,387 the promptness of extracorporeal life support for a reversible disease process,396–398 and associated special circumstances (e.g., icy water drowning,277,399,400 exposure to toxic drugs). In some Western societies, the majority of parents prefer to be present during the resuscitation of their child.401–410
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From Vanderbilt University Medical Center, Nashville, Tennessee.
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Address for reprints: Mary Fran Hazinski, RN, MSN, FAAN, Division of Trauma, 2100 Pierce Avenue, 243 MCS, Vanderbilt University Medical Center, Nashville, Tennessee 37212, 615-936-0175, Fax 615-936-0185
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Reprint no. 47/1/55752