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Analysis of Pediatric Trauma in Combat Zone to Inform High-Fidelity Simulation Predeployment Training.
Reeves, Patrick T; Auerbach, Marc M; Le, Tuan D; Caldwell, Nicole W; Edwards, Mary J; Mann-Salinas, Elizabeth A; Gurney, Jennifer M; Stockinger, Zsolt T; Borgman, Matthew A.
Afiliação
  • Reeves PT; Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX.
  • Auerbach MM; Department of Surgery, Institute for Surgical Research, San Antonio Military Medical Center, San Antonio, TX.
  • Le TD; Department of Emergency Medicine, Yale University, New Haven, CT.
  • Caldwell NW; Department of Surgery, Institute for Surgical Research, San Antonio Military Medical Center, San Antonio, TX.
  • Edwards MJ; Department of Surgery, Institute for Surgical Research, San Antonio Military Medical Center, San Antonio, TX.
  • Mann-Salinas EA; Department of Surgery, San Antonio Military Medical Center, San Antonio, TX.
  • Gurney JM; Department of Surgery, Institute for Surgical Research, San Antonio Military Medical Center, San Antonio, TX.
  • Stockinger ZT; Department of Surgery, Institute for Surgical Research, San Antonio Military Medical Center, San Antonio, TX.
  • Borgman MA; Department of Surgery, Institute for Surgical Research, San Antonio Military Medical Center, San Antonio, TX.
Pediatr Crit Care Med ; 19(4): e199-e206, 2018 04.
Article em En | MEDLINE | ID: mdl-29369076
ABSTRACT

OBJECTIVES:

The military uses "just-in-time" training to refresh deploying medical personnel on skills necessary for medical and surgical care in the theater of operations. The burden of pediatric care at Role 2 facilities has yet to be characterized; pediatric predeployment training has been extremely limited and primarily informed by anecdotal experience. The goal of this analysis was to describe pediatric care at Role 2 facilities to enable data-driven development of high-fidelity simulation training and core knowledge concepts specific to the combat zone. SETTING AND PATIENTS A retrospective review of the Role 2 Database was conducted on all pediatric patients (< 18 yr) admitted to Role 2 in Afghanistan from 2008-2014.

INTERVENTIONS:

Three cohorts were determined based on commercially available simulation models Group 1 less than 1 year, Group 2 1-8 years, Group 3 more than 8 years. The groups were sub-stratified by point of injury care, pre-hospital management, and Role 2 facility medical/surgical management. MEASUREMENTS AND MAIN

RESULTS:

Appropriate descriptive statistics (chi square and Student t test) were utilized to define demographic and epidemiologic characteristics of this population. Of 15,404 patients in the Role 2 Database, 1,318 pediatric subjects (8.5%) were identified. The majority of patients were male (80.0%) with a mean age of 9.5 years (± SD, 4.5). Injury types included penetrating (56%), blunt (33%), and burns (7%). Mean transport time from point of injury to Role 2 was 198 minutes (±24.5 min). Mean Glasgow Coma Scale and Revised Trauma Score were 14 (± 0.1) and 7.0 (± 1.4), respectively. Role 2 surgical procedures occurred for 424 patients (32%). Overall mortality was 4% (n = 58).

CONCLUSIONS:

We have described the epidemiology of pediatric trauma admitted to Role 2 facilities, characterizing the spectrum of pediatric injuries that deploying providers should be equipped to manage. This analysis will function as a needs assessment to facilitate high-fidelity simulation training and the development of "pediatric trauma core knowledge concepts" for deploying providers.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Lesões Relacionadas à Guerra / Hospitais Militares Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Child / Child, preschool / Female / Humans / Infant / Male País/Região como assunto: America do norte / Asia Idioma: En Revista: Pediatr Crit Care Med Assunto da revista: PEDIATRIA / TERAPIA INTENSIVA Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Lesões Relacionadas à Guerra / Hospitais Militares Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Child / Child, preschool / Female / Humans / Infant / Male País/Região como assunto: America do norte / Asia Idioma: En Revista: Pediatr Crit Care Med Assunto da revista: PEDIATRIA / TERAPIA INTENSIVA Ano de publicação: 2018 Tipo de documento: Article