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Pediatric major resuscitation--respiratory compromise as a criterion for mandatory surgeon presence
Barish H Edil1, David W Tuggle, Susan Jones
1Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
Insights
Prehospital respiratory compromise in injured children is a strong indicator for major resuscitation needs. This finding supports using respiratory distress as a criterion for pediatric trauma response.
Area of Science:
- Pediatric Trauma Surgery
- Emergency Medicine
- Resuscitation Science
Background:
- The American College of Surgeons Committee on Trauma established criteria for major resuscitation (MR) response times.
- These criteria have been applied to pediatric trauma patients without robust supporting data.
- The validity of current criteria for pediatric major resuscitations requires further investigation.
Purpose of the Study:
- To evaluate prehospital intubation/respiratory compromise (IRC) as a predictor for major resuscitation in pediatric trauma.
- To determine if IRC is a valid criterion for defining a major resuscitation in children.
Main Methods:
- Retrospective analysis of a level I trauma center's registry.
- Data collected included age, Injury Severity Score (ISS), IRC, mortality, hospital and ICU length of stay, and emergency operations.
- Statistical analysis employed Chi2 with Yates correction and Mann-Whitney rank-sum tests.
Main Results:
- 118 patients met criteria for major resuscitation; 40 had prehospital IRC, 78 did not.
- Significant differences observed in ISS, ICU length of stay, and mortality (P < .001).
- Mortality was 45% in patients with IRC versus 0% in those without IRC.
Conclusions:
- Prehospital respiratory compromise in pediatric trauma patients is associated with higher ISS, longer ICU stays, and increased mortality.
- Prehospital respiratory distress in injured children serves as a reasonable criterion for defining a major resuscitation within a trauma system.
Unlabelled:
The American College of Surgeons Committee on Trauma has indicated that there are minimum criteria for a trauma surgeon to respond to a major resuscitation (MR) within 15 minutes. These criteria have been required for children without significant data to support their validity. Our hypothesis is that prehospital intubation/respiratory compromise (IRC) as a criterion to define an MR will be an accurate predictor.
Methods:
The trauma registry of a level I trauma center was used for data collection of age, injury severity score (ISS), IRC, mortality, hospital days, intensive care unit (ICU) days, and emergency operations. Chi2 with Yates correction and Mann-Whitney rank-sum testing was used for statistical analysis expressed as mean +/- SEM.
Results:
One hundred eighteen patients were encoded as MR. Forty patients had prehospital IRC and 78 patients did not. There were statistically significant differences seen in ISS, ICU length of stay, and mortality (P < .001). Forty-five percent of patients with IRC died. None of the patients without IRC died.
Conclusion:
Injured children with prehospital IRC are significantly more likely to die, have a higher ISS, and a longer ICU length of stay. Prehospital respiratory distress in injured children in our trauma system is a reasonable criterion to define an MR in children.
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