[Epidemiology, risk stratification and outcome of severe pediatric trauma]. / Epidemiologie, Risikostratifizierung und Behandlungsergebnisse nach schwerem kindlichen Trauma.

Accidents and trauma are the leading cause of hospital admissions and major contributors to mortality in children and adolescents. There are age-specific injury patterns and differences in the clinical presentation of pediatric trauma and treatment both at the scene and in the emergency department can be observed. In general, pediatric trauma-scores to appreciate injury severity are adapted from the adult population.The most important factor to increase mortality in the severely injured pediatric population is the extent of a concomitant traumatic brain injury (TBI). In addition, the acute trauma-associated coagulopathy, which is triggered multifactorial, is an independent prognostic marker for mortality in severe trauma. The complexity of all currently available trauma-scores for the pediatric population is one reason why these scores are not unequivocal recommended for the early use in pediatric trauma care. The pediatric BIG-Score was developed to allow an early prognostic stratification for pediatric trauma patients and includes with base excess (BE), INR (International Normalized Ratio) and GCS (Glasgow Coma Scale) relevant prognostic factors for poor outcome. Early risk stratification is crucial in pediatric trauma due to mortality rates ranging between 9% and 15% and with 50% of all fatalities to occur within the first 24 h of hospital admission.

One sensor fits all--a new approach in monitoring brain physiology.

Oxygen plays a pivotal role as a nutrient to the brain. Monitoring partial pressure of oxygen (ptO2) has been shown to correlate with outcome after brain injury if certain tissue-ptO2-goals can be achieved. Oxford Optronix has recently developed a new fiber-optic based sensor (MPBS) with a large tissue sampling volume and long-term stability up to 10 days. Direct comparison of the MPBS sensor with the Licox system was performed using an in-vitro and in-vivo model. No statistically significant differences between the MPBS and the Licox sensor in different settings were found. The response times to a sudden drop in ptO2 was faster for the MPBS than for the Licox probes (time of 80% signal change; 65 +/- 11 vs 110 +/- 14 s; p<0.05).