Challenges in the Multidisciplinary Management of Pediatric Patients with Intestinal Failure During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic had profound effects on the management of pediatric patients with intestinal failure. Limitations in personal protective equipment and other necessary supplies led to changes in home care of central venous catheters. Limitations for in-person clinic visits led to changes in care delivery systems and contributed to delays in care and delays in the progression toward enteral autonomy. The emotional strain of living with chronic illness during a pandemic caused hardships that are still being felt. Delays in surgical care also potentially delayed children weaning from parenteral nutrition. The global pandemic of COVID-19 and its far-reaching effects on society contributed to challenges and changes in the multidisciplinary care of pediatric patients with intestinal failure, of which the full effect is still unknown. [Pediatr Ann. 2022;51(7):e277-e280.].

Nationwide secondary overtriage in level 3 and level 4 trauma centers: are these transfers necessary?

BACKGROUND: Secondary overtriage (SO) refers to the interfacility transfer of trauma patients who are rapidly discharged home without surgical intervention by the receiving institution. SO imposes a financial hardship on patients and strains trauma center resources. Most studies on SO have been conducted from the perspective of the receiving hospital, which is usually a level 1 trauma center. Having previously studied SO from the referring rural hospital's perspective, we sought to identify variables contributing to SO at the national level. METHODS: Using data from the 2008-2012 National Trauma Data Bank, we isolated patients transferred to level 1 trauma centers who were: (1) discharged home within 48 h and (2) did not undergo any surgical procedure. This population was subsequently compared with similar patients treated at and discharged directly from level 3 and 4 centers. Multivariate logistic regression analysis was used to isolate variables that independently influenced a patient's risk of undergoing SO. Injury patterns were characterized by use of subspecialty consultants. RESULTS: A total of 99,114 patients met inclusion criteria, of which 13.2% were discharged directly from level 3 or 4 trauma centers, and 86.8% of them were transferred to a level 1 trauma center before discharge. The mean Injury Severity Score of the nontransfer and transfer groups was 5.4 ± 4.5 and 7.3 ± 5.7, respectively. Multivariate regression analysis showed that Injury Severity Score > 15, alcoholism, smoking, drug use, and certain injury patterns involving the head, vertebra, and face were associated with being transferred. In this minimally injured population, factors protective against transfers were: age > 65 y, female gender, systolic blood pressure <80, a head computed tomography scan and orthopedic injuries. CONCLUSIONS: SO results from the complex interplay of variables including patient demographics, facility characteristics, and injury type. The inability to exclude a potentially devastating neurologic injury seems to drive SO.