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BLUNT CEREBROVASCULAR INJURY
While blunt cerebrovascular injury (BCVI) has been well described in the adult trauma literature, there has been very little research performed regarding this injury.
This is a retrospective cohort study of pediatric patients less than 15 years old admitted to Level 1 pediatric trauma centers between October 2009 and June 2011 with head, neck, or face injuries who were high risk for BCVI based on Memphis criteria. The specific aims of this study are to describe the frequency of these injuries and any implemented treatment/therapies, and to determine and describe the imaging modality (if any) performed in those pediatric patients.
Blunt cerebrovascular injury in children: underreported or underrecognized?: A multicenter ATOMAC study PubMed Link
Injuries in children are uncommon but have been specifically linked with child abuse in case reports. Owing to the rarity of duodenal injury diagnosis in children, few studies to date have looked at the association between duodenal injuries and mechanism.
The specific aims of this study are to describe the characteristics of children diagnosed with duodenal injuries and to determine if there is an association between mechanism of injury—namely, child abuse—and duodenal transections, and to determine whether the association between duodenal transection and mechanism of injury is modified by age. This is a retrospective cohort study of patients aged 0 to 5 years admitted to pediatric trauma centers between 1991 to 2011.
Duodenal injuries in the very young: child abuse? PubMed Link
In determining the need for trauma team activation (TTA) in motor vehicle crashes, the current criteria are the same for adult and pediatric patients.
This study aims to examine the sensitivity and specificity of these criteria in pediatric trauma patients while also considering the restraint status of the patient. The patient cohort for this study is pediatric patients less than 16 years old involved in an MVC-R between November 2007 and November 2012.
Does restraint status in motor vehicle crash with rollover predict the need for trauma team presence on arrival? An ATOMAC study PubMed Link
NONOPERATIVE MANAGEMENT OF BLUNT LIVER & SPLEEN INJURY
Recently, a new guideline for management of pediatric solid organ injury based on hemodynamic status has been adopted by several level I pediatric trauma centers. This is a prospective study of patients managed by this protocol—18 years or younger—to validate its application and to systematically evaluate the natural history of solid organ injury (liver and spleen) to clarify the associated clinical outcome.
The specific aims of this study are 1) to determine the proportion of patients that failed the non-operative management algorithm (Figure 1), 2) to determine the frequency of delayed bleeding, complications, and hospital readmission, 3) to evaluate adherence to the NOM algorithm and the association with failed NOM in liver and/or spleen injury, and 4) to define factors and predictors associated with SOI and its management.
Nonoperative management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE PubMed Link
The impact of morbid obesity on solid organ injury in children using the ATOMAC protocol at a pediatric level I trauma center PubMed Link
Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC+ study PubMed Link
Hypotension and the need for transfusion in pediatric blunt spleen and liver injury: An ATOMAC+ prospective study PubMed Link
Early vasopressor administration in pediatric blunt liver and spleen injury: An ATOMAC+ study PubMed Link
Hemodilution in pediatric trauma: Defining the expected hemoglobin changes in patients with liver and/or spleen injury: An ATOMAC+ secondary analysis PubMed Link
ATOMAC SOI Algorithm v12.0 – Spanish
ATOMAC SOI Algorithm v12.0 – Korean
INTERNAL EDUCATION FOR PEDIATRIC TRAUMA
The American College of Surgeons Committee on Trauma has indicated that an internal educational process (IEP) for trauma providers could be generated within a trauma center or within regional trauma centers to provide an alternative method of trauma education without the travel and expense of outside formal continuing medical education (CME).
The specific aim of this study is to evaluate an IEP using a cloud computing based data warehouse for trauma related internal education between a Level 1 pediatric trauma center and three PTCs seeking ACS-PTC verification.
The use of a computer-based internal education program for pediatric trauma centers: a multicenter ATOMAC study PubMed Link
Massive transfusion protocols (MTPs) are considered valuable in pediatric trauma. Important questions regarding the survival benefit and optimal blood component ratio remain unknown.
The specific aims of this study are to describe current MTP initiation criteria, thresholds, compliance, and patient outcomes and toevaluate if the current MTPs at each center effectively minimizes coagulopathy and improves pediatric patient outcomes. This is a retrospective study including pediatric patients 18 or younger from January 2007 through December 2013who either had the institutional MTP or received >20 mL/kg or > 2 units packed red blood cells (PRBCs).
Massive transfusion in pediatric trauma: An ATOMAC perspective PubMed Link
Several recent studies have demonstrated the severity of air gun projectile injuries and suggest that the frequency has declined with targeted education.
This study reviewed pediatric patients that sustained air gun injuries at six Level 1 Pediatric Trauma Centers and identified injury patterns most likely to require operative intervention. Pediatric injuries resulting from air gun projectiles remain a significant health concern.
Air Guns: A Contemporary Review of Injuries at Six Pediatric Level I Trauma Centers PubMed Link