J Trauma
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For many pediatric intensive care units that routinely operate at near maximal census, planning for a surge of critically ill children in the event of a disaster can be daunting. This brief review discusses the framework of surge planning, alterations of standards of care, and providing critical care outside of the pediatric intensive care unit. There are general consensus-based guidelines on conceptualizing and operationalizing critical care surge planning, but there is little published on modeling outcomes of disasters affecting large numbers of children.
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Trauma is the leading cause of morbidity and mortality in children. During the last few decades, trauma systems have evolved to improve the care of the injured with an ultimate goal of saving lives. As a result, pediatric trauma centers (PTC) have been established to optimize outcomes for injured children. We sought to determine whether injured children treated at PTC or adult trauma centers (ATC) with added qualifications to treat injured children receive better trauma care than those treated at other hospitals or trauma centers. ⋯ Although this analysis does not provide a definitive answer to the question as to which type of trauma center provides better care for injured pediatric patients, it identifies current gaps and disparities in the care of injured children that can be remedied through education and training.
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Improving trauma care and preparing for a disaster require data collection and analysis. Trauma registries capture data for research, measure trauma system outcomes, and support quality improvement through assessment of the appropriateness and effectiveness of the trauma system. ⋯ Aggregating existing data from state trauma registries or using the National Trauma Data Bank may facilitate development of statistical models to help predict survival, injury patterns, and important physiological thresholds. However, representative pediatric-specific trauma registry data are needed to obtain an adequate sample size in pediatric population to extrapolate data to represent the scale of a disaster.
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The significance and management of fever in surgical patients involves several misconceptions that have been perpetuated over the years. This review addresses nine such misconceptions and using evidence from the literature, attempts to clarify such diverse issues as the concept of normal body temperature, the investigation and rationale for the treatment of postoperative fever, the beneficial effects of fever and the potential adverse effects of suppressing fever.
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Each year, pediatric traumatic brain injury (TBI) accounts for 435,000 emergency department visits, 37,000 hospital admissions, and approximately 2,500 deaths in the United States. TBI results in immediate injury from direct mechanical force and shear. Secondary injury results from the release of biochemical or inflammatory factors that alter the loco-regional milieu in the acute, subacute, and delayed intervals after a mechanical insult. ⋯ However, all phase III clinical trials investigating pharmacologic monotherapy for TBI have shown no benefit. A recent National Institutes of Health consensus statement recommends research into multimodality treatments for TBI. This article will review the complex pathophysiology of TBI as well as the possible therapeutic mechanisms of progenitor cell transplantation, hypertonic saline infusion, and controlled hypothermia for possible utilization in multimodality clinical trials.