Introduction:Trauma is the commonest cause of death in the pediatric populati on,which is prone to diffuse primary brain injury aggravated by secondary insul ts(eg,hypoxia,hypotension).Standard monitoring involves int...Introduction:Trauma is the commonest cause of death in the pediatric populati on,which is prone to diffuse primary brain injury aggravated by secondary insul ts(eg,hypoxia,hypotension).Standard monitoring involves intracranial pressur e(ICP)and cerebral perfusion pressure,which do not reflect true cerebral oxyg enation(oxygen delivery [DO2]).We explore the merits of a brain tissue oxygen-directed critical care guide.Methods:Sixteen patients with major trauma(Inj ury Severity Score,> 16/Pediatric Trauma Score [PTS],< 7)had partial pressure of brain tissue oxygen(PbtO2)monitor(Licox;Integra Neurosciences,Plainsbor o,NJ)placed under local anesthesia using twist-drill craniostomy and definiti ve management of associated injuries.PbtO2 levels directed therapy intensity level(ventilator management,inotrops,blood transfusion,and others).Patien t demographics,short-term physiological parameters,PbtO2,ICP,Glasgow Coma S core,trauma scores,and outcomes were analyzed to identify the patients at risk for low DO2.Results:There were 10 males and 6 females(mean age,14 years)su staining motor vehicle accident(14),falls(1),and assault(1),with a mean In jury Severity Score of 36(16-59);PTS,3(0-7);and Revised Trauma Score,5.5(4-11).Eleven patients(70%)had low DO2(PbtO2,< 20 mmHg)on admission des pite undergoing standard resuscitation affected by fraction of inspired oxygen,PaO2,and cerebral perfusion pressure(P =0.001).Eubaric hyperoxia improved ce rebral oxygenation in the low-DO2 group(P =0.044).The Revised Trauma Score(r = 0.65)showed moderate correlation with PbtO2 and was a significant predictor for low DO2(P =0.001).In patients with PbtO2 of less than 20 mm Hg,PTS corre lated with cerebral oxygenation(r = 0.671,P =0.033).The mean 2-hour PbtO2 a nd the final PbtO2 in survivors were significantly higher than deaths(21.6 vs 7.2 mmHg [P =0.009] and 25 vs 11mmHg [P =0.01]).Although 4 of 6 deaths were from uncontrolled high ICP,PTS and 2-hour low DO2 were significant for roots formo rtality.Conclusions:PbtO2 monitoring allows for early recognition of low-DO2 situations,enabling appropriate therapeutic intervention.展开更多
Objective. Motorbikes (MBs), including motorcycles and dirt bikes, are becoming increasingly popular among children and adolescents. MBs are intended for off-road use. Although children who are younger than 16 years c...Objective. Motorbikes (MBs), including motorcycles and dirt bikes, are becoming increasingly popular among children and adolescents. MBs are intended for off-road use. Although children who are younger than 16 years cannot be licensed to drive cars, they can drive MBs off-road without licenses. The objective of this study was to determine the epidemiology of severe MB injuries to children who are younger than 16 years in Ohio. Methods. Eight hospitals that admit the majority of pediatric trauma patients in Ohio were approached to participate. Cases were identified using hospital trauma registries and were defined as any hospitalized child who was younger than 16 years and sustained MB injuries between January 1, 1995, and December 31, 2001. Results. Six hospitals participated. A total of 182 children were hospitalized with a mean age of 11.4 years (range: 1-15 years). A total of 89.6%were male, 89.0%were white, 68.7%had commercial medical insurance, and 71.4%were from urban areas. From 1995 to 1997, there were an average of 20 annual admissions; however, from 1998 to 2001, there were an average of 30 per year. Of the 85%of patients with injury events documented, 35.5%were riding in streets and 53.3%were unhelmeted. One patient died; 8 required rehabilitation. The mean injury severity score was 9.9 (median: 9), and mean length of hospitalization was 4.6 days (median: 3). Unhelmeted riders had significantly higher injury severity scores than helmeted ones (11.5 vs 8.4). The difference in mean length of hospitalization of unhelmeted compared with helmeted riders approached statistical significance (6.1 vs 3.7 days). Of the 163 patients with documented diagnoses, there were 510 injuries; 68.7%of patients sustained multiple injuries. Of all injuries, the most commonly injured body parts were lower extremity (23.4%), head (22.2%), abdomen/pelvis (13.4%), upper extremity (12.4%), and face (11.8%). The most common injuries were fractures (37.1%), abrasions/contusions (24.4%), lacerations (13.4%), intracranial injuries (7.5%), and solid abdominal organ injuries (7.5%). Central and Southwest Ohio had higher numbers of hospitalized injuries than other areas. Conclusion. Urban, white boys with commercial medical insurance predominated among children with MB-related injuries in Ohio. Most injured children did not wear a helmet and sustained multiple injuries. Not wearing a helmet resulted in significantly increased injury severity and a trend toward increased lengths of stay in the hospital. MB-related injuries increased by ～50%during the study period. Children should not operate MBs until they are old enough to obtain a motor vehicle driver’s license, which occurs at a minimum of 16 years of age. High-risk populations need to be targeted to reduce these injuries, and requiring helmet use while operating MBs should be pursued.展开更多
文摘Introduction:Trauma is the commonest cause of death in the pediatric populati on,which is prone to diffuse primary brain injury aggravated by secondary insul ts(eg,hypoxia,hypotension).Standard monitoring involves intracranial pressur e(ICP)and cerebral perfusion pressure,which do not reflect true cerebral oxyg enation(oxygen delivery [DO2]).We explore the merits of a brain tissue oxygen-directed critical care guide.Methods:Sixteen patients with major trauma(Inj ury Severity Score,> 16/Pediatric Trauma Score [PTS],< 7)had partial pressure of brain tissue oxygen(PbtO2)monitor(Licox;Integra Neurosciences,Plainsbor o,NJ)placed under local anesthesia using twist-drill craniostomy and definiti ve management of associated injuries.PbtO2 levels directed therapy intensity level(ventilator management,inotrops,blood transfusion,and others).Patien t demographics,short-term physiological parameters,PbtO2,ICP,Glasgow Coma S core,trauma scores,and outcomes were analyzed to identify the patients at risk for low DO2.Results:There were 10 males and 6 females(mean age,14 years)su staining motor vehicle accident(14),falls(1),and assault(1),with a mean In jury Severity Score of 36(16-59);PTS,3(0-7);and Revised Trauma Score,5.5(4-11).Eleven patients(70%)had low DO2(PbtO2,< 20 mmHg)on admission des pite undergoing standard resuscitation affected by fraction of inspired oxygen,PaO2,and cerebral perfusion pressure(P =0.001).Eubaric hyperoxia improved ce rebral oxygenation in the low-DO2 group(P =0.044).The Revised Trauma Score(r = 0.65)showed moderate correlation with PbtO2 and was a significant predictor for low DO2(P =0.001).In patients with PbtO2 of less than 20 mm Hg,PTS corre lated with cerebral oxygenation(r = 0.671,P =0.033).The mean 2-hour PbtO2 a nd the final PbtO2 in survivors were significantly higher than deaths(21.6 vs 7.2 mmHg [P =0.009] and 25 vs 11mmHg [P =0.01]).Although 4 of 6 deaths were from uncontrolled high ICP,PTS and 2-hour low DO2 were significant for roots formo rtality.Conclusions:PbtO2 monitoring allows for early recognition of low-DO2 situations,enabling appropriate therapeutic intervention.
文摘Objective. Motorbikes (MBs), including motorcycles and dirt bikes, are becoming increasingly popular among children and adolescents. MBs are intended for off-road use. Although children who are younger than 16 years cannot be licensed to drive cars, they can drive MBs off-road without licenses. The objective of this study was to determine the epidemiology of severe MB injuries to children who are younger than 16 years in Ohio. Methods. Eight hospitals that admit the majority of pediatric trauma patients in Ohio were approached to participate. Cases were identified using hospital trauma registries and were defined as any hospitalized child who was younger than 16 years and sustained MB injuries between January 1, 1995, and December 31, 2001. Results. Six hospitals participated. A total of 182 children were hospitalized with a mean age of 11.4 years (range: 1-15 years). A total of 89.6%were male, 89.0%were white, 68.7%had commercial medical insurance, and 71.4%were from urban areas. From 1995 to 1997, there were an average of 20 annual admissions; however, from 1998 to 2001, there were an average of 30 per year. Of the 85%of patients with injury events documented, 35.5%were riding in streets and 53.3%were unhelmeted. One patient died; 8 required rehabilitation. The mean injury severity score was 9.9 (median: 9), and mean length of hospitalization was 4.6 days (median: 3). Unhelmeted riders had significantly higher injury severity scores than helmeted ones (11.5 vs 8.4). The difference in mean length of hospitalization of unhelmeted compared with helmeted riders approached statistical significance (6.1 vs 3.7 days). Of the 163 patients with documented diagnoses, there were 510 injuries; 68.7%of patients sustained multiple injuries. Of all injuries, the most commonly injured body parts were lower extremity (23.4%), head (22.2%), abdomen/pelvis (13.4%), upper extremity (12.4%), and face (11.8%). The most common injuries were fractures (37.1%), abrasions/contusions (24.4%), lacerations (13.4%), intracranial injuries (7.5%), and solid abdominal organ injuries (7.5%). Central and Southwest Ohio had higher numbers of hospitalized injuries than other areas. Conclusion. Urban, white boys with commercial medical insurance predominated among children with MB-related injuries in Ohio. Most injured children did not wear a helmet and sustained multiple injuries. Not wearing a helmet resulted in significantly increased injury severity and a trend toward increased lengths of stay in the hospital. MB-related injuries increased by ～50%during the study period. Children should not operate MBs until they are old enough to obtain a motor vehicle driver’s license, which occurs at a minimum of 16 years of age. High-risk populations need to be targeted to reduce these injuries, and requiring helmet use while operating MBs should be pursued.
