Physical Examination is the Best Predictor of the Need for Abdominal Surgery in Children Following Motor Vehicle Collision.

BACKGROUND: Exploratory laparotomy in children after motor vehicle collision (MVC) is rare. In the absence of definitive hemorrhage or free abdominal air on radiographic imaging, predictors for operative exploration are conflicting. OBJECTIVE: The purpose of this study was to explore objective findings that may aid in determining which children require operative abdominal exploration after MVC. METHODS: Data from 2010-2014 at an American College of Surgeons-certified level 1 pediatric trauma center were retrospectively reviewed. Demographics, vital signs, laboratory data, radiologic studies, operative records, associated injuries, and outcomes were analyzed and p < 0.05 was considered statistically significant. RESULTS: Eight hundred sixty-two patients 0-18 years of age presented to the hospital after an MVC during the study period. Seventeen patients (2.0%) required abdominal exploration and all were found to have intraabdominal injuries. Respiratory rate was the only vital sign that was significantly altered (p = 0.04) in those who required abdominal surgery compared with those who did not. Physical examination findings, such as the seat belt sign, abdominal bruising, abdominal wound, and abdominal tenderness, were present significantly more frequently in those requiring abdominal surgery (p < 0.0001). Each finding had a negative predictive value for the need for operative exploration of at least 0.98. There were no significant differences in trauma laboratory values or radiographic findings between the 2 groups. CONCLUSION: Data from this study solidify the relationship between specific physical examination findings and the need for abdominal exploration after MVC in children. In addition, these data suggest that a lack of the seat belt sign, abdominal bruising, abdominal wounds, or abdominal tenderness are individually predictive of patients who will not require surgical intervention.

The trauma registry compared to All Patient Refined Diagnosis Groups (APR-DRG).

BACKGROUND: Literature has shown there are significant differences between administrative databases and clinical registry data. Our objective was to compare the identification of trauma patients using All Patient Refined Diagnosis Related Groups (APR-DRG) as compared to the Trauma Registry and estimate the effects of those discrepancies on utilization. METHODS: Admitted pediatric patients from 1/2012-12/2013 were abstracted from the trauma registry. The patients were linked to corresponding administrative data using the Pediatric Health Information System database at a single children's hospital. APR-DRGs referencing trauma were used to identify trauma patients. We compared variables related to utilization and diagnosis to determine the level of agreement between the two datasets. RESULTS: There were 1942 trauma registry patients and 980 administrative records identified with trauma-specific APR-DRG during the study period. Forty-two percent (816/1942) of registry records had an associated trauma-specific APR-DRG; 69% of registry patients requiring ICU care had trauma APR-DRGs; 73% of registry patients with head injuries had trauma APR-DRGs. Only 21% of registry patients requiring surgical management had associated trauma APR-DRGs, and 12.5% of simple fractures had associated trauma APR-DRGs. CONCLUSION: APR-DRGs appeared to only capture a fraction of the entire trauma population and it tends to be the more severely ill patients. As a result, the administrative data was not able to accurately answer hospital or operating room utilization as well as specific information on diagnosis categories regarding trauma patients. APR-DRG administrative data should not be used as the only data source for evaluating the needs of a trauma program.

Detection of missed injuries in a pediatric trauma center with the addition of acute care pediatric nurse practitioners.

Missed injuries contribute to increased morbidity in trauma patients. A retrospective chart review was conducted of pediatric trauma patients from 2010 to 2013 with a documented missed injury. A significant percentage of missed injuries were identified (3.01% during July 2012 to December 2013 vs 0.39% during January 2010 to July 2012) with the addition of acute care trained pediatric nurse practitioners to the trauma service at a pediatric trauma center. The increase is thought to be due to improvement in charting, consistent personnel performing tertiary examinations, and improved radiology reads of outside films.

The complex management of a traumatic brain injury and aortic injury after a motor vehicle crash: a case report.

Blunt aortic injuries are extremely rare in the pediatric population. This case report examines a pediatric patient involved in a motor vehicle crash that resulted in aortic dissection combined with traumatic brain injury. The clinical management of this patient was particularly challenging because of the conflicting needs of optimal management for the head and aortic injuries. Despite the patient's low predicted probability of survival based on Injury Severity Score, the patient had an exceptional outcome.

Seat belt misuse by a child transported in belt-positioning booster seat with deadly consequences.

Child passenger safety has been a major public health victory, but there is still work to be done. This case presentation is about a 5-year-old boy who placed the shoulder portion of the lap-shoulder seat belt behind his back who was recently killed in a motor vehicle crash. This article reviews what trauma nurses need to know about the latest improvements in child passenger safety practices. Also presented are important resources for trauma nurses to share with families to improve travel safety.

Project Prescription for Hope (RxH): trauma surgeons and community aligned to reduce injury recidivism caused by violence.

The recidivism rate for violent injuries in the United States has been reported as high as 45 per cent. Based on a retrospective review, the 5-year recidivism rate at the Indiana University/Wishard Trauma Center is 31 per cent, and the 1-year recidivism rate is 8.7 per cent. Individuals who have been admitted with a violent injury are screened by one of the Prescription for Hope (RxH) support specialists (SS). If the individual consents to participate, the SS conducts an in-depth assessment of risk factors. The SS and participant identify personal goals and develop a tailored service plan, which is outlined in a formalized agreement. In the first year of the RxH program (June 1, 2009, to May 31, 2010), 64 patients were enrolled. The most-often referred community services are in the category of social integration (84%). The SS have a 99 per cent success rate in getting clients to initiate services; 82 per cent have completed the services and 12 per cent are still using the services. As of the time of this writing, 34 subjects have been in RxH for at least 1 year. One patient returned to the trauma center in September 2010 with a repeat violent injury; this represents a 2.9 per cent 1-year recidivism rate. In the first 12 months of our program we did not have any participants return with a violent injury (0% recidivism), and we have only had one patient return to date. We conclude that the RxH SS model may play a significant role in decreasing the recidivism of violent injuries.

Firearm suicide: use of a firearm injury and death surveillance system.

BACKGROUND: Suicide is an important public health concern. Firearms are the most common mechanism of suicide death. This study describes the epidemiology of fatal and nonfatal firearm suicide injuries (FSI) in one metropolitan area from 2002 through 2004 using a firearm injury surveillance system. METHODS: Records were obtained of all victims of firearm injuries from hospitals, police, and the coroner. All injuries categorized as suicide were included. RESULTS: Local age adjusted suicide rates were significantly higher than state or national rates for ages 15 to 24, and significantly higher than national rates for ages 25 to 44. Men were FSI victims more than five times as often as women were. There was no seasonal pattern identified. Handguns were used nearly three out of four times. Eighty-six percent of FSI victims died, two-thirds at the scene. Most wounds were in the head or chest. Mental illness or relationship problems were common. Most suicides occurred in a residence. CONCLUSIONS: Community level firearm injury surveillance effectively identifies local trends that may differ from national statistics. Collaboration among various groups is used to support injury prevention programs. These data can both complement and contribute to national statistics.

Characteristics of suicide from 1998-2001 in metropolitan area.

In order to establish effective suicide preventive programs, it is important to know the etiologic factors and causal relationships between suicide and behavior. Coroner data was analyzed for the 468 suicides that occurred in Indianapolis, Indiana during 1998-2001. The age-adjusted suicide rate was 14.08 per 100,000. Almost one-half of the victims had a mental illness and 26% had a history of alcohol/substance abuse. The leading risk factors for suicide were age, impaired health, psychosocial stressors, and access to firearms. This information can be used by health departments and mental health professionals to help reduce suicide.

Open-label olanzapine treatment in bipolar I disorder: clinical and work functional outcomes.

OBJECTIVES: The objective of this study was to describe clinical and work functional outcomes associated with 6-month open-label olanzapine treatment for bipolar I disorder. METHODS: The study consisted of 249 patients entering a 6-month open label phase after 12 weeks of acute double-blind haloperidol or olanzapine treatment. Baseline for analysis was defined as the beginning of open-label treatment. The clinical outcomes were symptomatic remission defined by a Y-MRS total score < or = 12 and a HAM-D total score < or = 8 at the end of 6 months of treatment. The work functional outcomes included work functional scores, the proportion of patients who reported to 'work' as employee, volunteers, students, or house workers and the proportion of patients who specifically reported to 'work for pay'. RESULTS: A total of 240 patients reported work functional outcomes post open-label baseline. Among them, 15.4% patients moved into a 'work group' from a 'no-work group' at baseline, while 7.1% did the opposite (p = 0.0065) and 13.3% reported an improvement to 'work for pay' status from a 'not working for pay' status at baseline, while there was 4.2% of worsening in employment status (p = 0.0007). Overall, improvement in the work functional score was found at all post-baseline time points, beginning at month two (p = 0.003). LIMITATIONS: Results of this study need to be confirmed by double-blind randomized controlled studies. There was a lack of detailed information on work functioning from the questionnaire. CONCLUSIONS: Open-label olanzapine treatment for 6 months was associated with improvements in work functional outcomes in patients with bipolar disorder.