Resuscitative endovascular balloon occlusion of the aorta in trauma patients in youth.

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has received increasing attention for critically uncontrolled hemorrhagic shock. However, the efficacy of REBOA in patients in youth is unknown. OBJECTIVES: The aim of this study was to evaluate the mortality and characteristics of patients of age ≤18 years with severe traumatic injury who received REBOA. METHODS: We retrospectively analyzed observational cohort data from the Japan Trauma Data Bank (JTDB) from 2004 to 2015. All patients ≤18 years old who underwent REBOA were included. Clinical characteristics and mortalities were analyzed and compared among patients ≤15 years old (young children) and 16-18 years old (adolescents). RESULTS: Of the 236,698 patients in the JTDB (2004-2015), 22,907 patients were 18 years old or younger. A total of 3,440 patients without survival data were excluded. Of the remaining 19,467, 54 (0.3%) patients underwent REBOA, among which 15 (27.8%) were young children. Both young children and adolescents who underwent REBOA were seriously injured (median Injury Severity Score [ISS], 41 and 38, respectively). Also, 53.3% of young children and 38.5% of adolescents survived to discharge after undergoing REBOA. CONCLUSION: In a cohort of young trauma patients from the JTDB who underwent REBOA to control hemorrhage, we found that both young children and adolescents who underwent REBOA were seriously injured and had an equivalent survival rate compared to the reported survival rate from studies in adults. REBOA treatment may be a reasonable option in severely injured young patients in the appropriate clinical settings. Further prospective studies are needed to confirm our findings. LEVEL OF EVIDENCE: Epidemiologic study, level III; therapeutic study, level IV.

Trauma patient willingness to participate in alcohol screening and intervention.

BACKGROUND: Screening and brief interventions for alcohol disorders in the trauma setting are not routine. Perceived barriers to screening and treatment include the perception that patients find the topic offensive and the feasibility of screening all patients. The hypothesis of the study was that discussing alcohol use would be acceptable to patients independent of race or screening test score. Additional aims were to describe whether patients had access to alcohol screening via a primary care physician, to see what types of treatment patients thought appropriate, and to evaluate the feasibility of screening all trauma patients for alcohol disorders. METHODS: We surveyed 150 trauma inpatients regarding the offensiveness of discussing alcohol use and the appropriateness of different treatment options. We asked whether they had access to a primary care physician. As part of our routine screening program, we evaluated the proportion of patients we were able to screen with the Alcohol Use Disorders Identification Test, refusal rates, and whether any patients were not screened. Analysis of covariance and logistic regression were used to evaluate responses. RESULTS: A part-time research assistant approached 90% of 163 patients. Seventy percent were successfully screened, of which 45% screened positive for problematic alcohol use. Of the patients we were unable to screen, one third did not speak English and one half had injuries precluding interaction, leaving 16 patients (9.8%) that were "missed." One patient (<1%) refused screening. One hundred fifty consecutive patients participated in the survey. The ethnic distribution was 26% Native American, 40% Hispanic, 30% white, 2% African American, and 2% other. A brief counseling session was acceptable to all ethnic groups. There were ethnic differences in acceptability of other types of treatment. Ninety-four percent of patients thought that somebody from the trauma team should talk with patients about alcohol. Alcohol Use Disorders Identification Test score did not predict whether patients would be offended (p = 0.48). Forty-five percent had a primary care physician and only 10% had ever spoken to their physician about alcohol use. CONCLUSION: The majority of trauma patients are not offended by discussing alcohol use while hospitalized for injury and can feasibly be screened for alcohol disorders. Treatment types may need to be culturally tailored.