Assessing pediatric trauma specimen integrity.

OBJECTIVE: This study investigated the quality of trauma specimens by comparing line draws to venipuncture. DESIGN: The draw type (line or venipuncture); container type (Vacutainer or Microtainer); and suitability for processing (processed/hemolyzed/clotted) of routinely collected trauma specimens was analyzed. SETTING: The clinical laboratory of a Level I Pediatric Trauma Center. MAIN OUTCOME MEASURE: Hemolyzed trauma specimens were analyzed according to method of collection, collector, and type of container to identify issues resulting in unusable samples. RESULTS: The data shows that for 13% of all draws, portions of the results were affected by hemolysis. Sixteen percent of line draws and 6% of venipunctures were hemolyzed (p = 0.04). There was no statistical association with who collected the sample (p = 0.07) or type of container (p = 1.00). CONCLUSION: Based on this sample of data, the laboratory recommends that, whenever possible, venipunctures be performed for laboratory testing of blood specimens to improve trauma specimen integrity.

Pediatric bereavement: supporting the family and each other.

Childhood deaths are relatively uncommon but very stressful to both family members and health care providers. Bereavement programs are helpful in guiding and supporting the family into and through the bereavement process. Trauma nurses are vital members of the bereavement team. This article briefly describes and current literature on the subject of bereavement outlines the components of a comprehensive bereavement program and lists current challenges for nurses in this important area of nursing.

Missed and missing cases of abusive injuries: the magnitude and the measurement of the problem.

OBJECTIVE: The authors' objective is to describe the disparity between the case-fatality rates for inflicted versus unintentional injuries of children, and to emphasize its utility as a way of estimating the effectiveness of the ascertainment of inflicted injuries of children. METHOD: Determination, comparison, and explanation of the case-fatality-rate disparity in four injury databases were derived from hospitalized injury cases. RESULTS: The CFR disparity is 6-14-fold in the 4 injury databases. The CFR disparity varies strongly and inversely with the observed incidence of inflicted injuries in the databases. CONCLUSIONS: A large disparity between the case fatality rates (CFRs) of inflicted and unintentional injuries exists in a number of injury databases. Inflicted injuries have much higher CFRs than unintentional injuries. The disparity can be accounted for by "missed" (incorrectly diagnosed) and "missing" (unseen) cases. PRACTICE IMPLICATIONS: Present diagnostic criteria for physically abusive (inflicted) injuries are forensically-driven and too conservative for public health purposes. New public-health-oriented case definitions for "inflicted injury" are needed. Programs to reduce injury recidivism in young children should be a part of overall injury prevention.