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Admission base deficit as a long-term prognostic factor in severe pediatric trauma patients
International Abstracts of Pediatric Surgery thromboembolism was diagnosed at a median of 9 days after admission, with 67% of VTE located at the site of previous or existing central venous line (CVL). Significant risk factors for thrombosis included parenteral nutrition (odds ratio [OR], 20; 95% CI, 1.9-227), CVL (OR, 19; 95% CI, 2-178), deep sedation (OR, 13; 95% CI, 1.6-48), neuromuscular blockade (OR, 10; 95% CI, 1.4-70), inotropic support (OR, 10; 95% CI, 1.7-59), and recombinant factor VIIa administration (P = .012, OR not calculable). Logistic analysis found a 7.9-fold increase in the odds of developing VTE for each additional CVL (P = .005), a 3-fold increase with each additional risk factor present (P = .009), and a 1.3-fold increase for an increase in injury severity (P = .03). Venous thromboembolism was not associated with sepsis, spinal cord injury, fracture, or elevated D-dimer level. The authors conclude that VTE is not a rare event in critically ill children after trauma. Most patients developing thrombosis have multiple risk factors, including poor perfusion, immobility, and presence of a CVL.— Steven Stylianos doi:10.1016/j.jpedsurg.2010.05.038
Admission base deficit as a long-term prognostic factor in severe pediatric trauma patients Hindy-François C, Meyer P, Blanot S, et al. J Trauma 2009;67/6:1272-7 Base deficit (BD) is a prognostic tool that correlates with trauma scores and mortality in adult trauma patients. Retrospective studies have shown that admission BD more than 8 mmol/L is associated with an increased risk of mortality. This is the first prospective European study aimed at evaluating the prognostic value of admission BD in traumatized children. One hundred severely traumatized children were included if an arterial BD had been calculated on arrival in the trauma room of a university hospital. Epidemiologic, medical, and biological data (including admission BD and lactates concentration) were recorded and compared using a univariate analysis. The primary end point was in-hospital mortality. Secondary end points were outcome on discharge and at 6 months. Cutoff values for BD or lactates regarding outcomes were determined using receiver operating characteristic curves if these data had been isolated on multivariate analysis (P b .05). Sixty-eight boys and 32 girls, aged 6.7 years, were enrolled from March 2003 to December 2005, mainly after road traffic accidents. Twenty-two died at the hospital; 34 and 51 children were classified as having a good outcome on hospital discharge and 6 months later, respectively. After the multivariate procedure and receiver operating characteristic curve analysis, admission lactates more than 2.94 mmol/L and admission BD more than 5 mEq/L were independent risk factors for mortality (odds ratio, 2.4; 95% confidence interval, 1.3-4.6) and poor outcome at 6 months (odds ratio, 2.5; 95% confidence interval, 1.13-5.5), respectively. The authors conclude that BD could be used to predict the long-term morbidity and may not be related to morbidity and mortality at discharge.— Steven Stylianos
1921 amputation injuries; and even less is known about these injuries in the pediatric population. An analysis of patients not older than 17 years hospitalized with traumatic amputations using the 2003 Healthcare Cost and Utilization Project Kids' Inpatient Database was performed. National estimates of amputationassociated hospitalizations, rates, resource use, and demographics were calculated. Potentially significant covariate associations were studied using hospital charges and length of stay (LOS). In 2003, 956 cases of traumatic amputations among children not older than 17 years resulted in $21.6 million (standard deviation [SD] = $2.2 million) in inpatient charges and 3,967 days (SD = 354) of hospitalization in the United States. Finger and/or thumb amputations accounted for the majority of injuries (64.0%). Mean (SD) hospital charges and LOS were $23,157 ($49,018) and 4.1 (7.4) days, respectively. Traumatic leg amputations incurred the highest mean hospital charges ($120,275) and longest mean LOS (18.5 days). Older children (15-17 years) experienced a higher hospitalization rate (1.84/100,000) than other age groups. Older age, amputation caused by a motorized vehicle, urban hospital location, children's hospital type, and longer LOS were associated with higher total charges. Amputation caused by lawn mower, motorized vehicle, or explosives/ fireworks and children's hospital type were associated with longer LOS. The authors conclude that pediatric traumatic amputations contribute substantially to the health resource burden in the United States, resulting in $21 million in inpatient charges annually. More effective interventions to prevent these costly injuries among children must be implemented.— Steven Stylianos doi:10.1016/j.jpedsurg.2010.05.040
A review of venovenous and venoarterial extracorporeal membrane oxygenation in neonates and children Keeker SJ, Laituri CA, Ostlie DJ, et al. Eur J Pediatr Surg 2010 (February);20/1:1-4 The use of extracorporeal membrane oxygenation (ECMO) has increased since its inception in the 1980s. As this modality gained wider acceptance, its application in a variety of diseases has increased. The initial use of ECMO required cannulation of both the carotid artery and internal jugular vein (VA ECMO). Ligation of the carotid artery and concern regarding potential longterm sequelae prompted the development of the venous-only ECMO technique (VV ECMO). Various reports in the literature have compared VV ECMO with VA ECMO. The authors present a review of the literature with regard to both physiology and clinical application. Current comparative data between VA and VV ECMO is retrospective. Strict prospective studies are necessary to quantify the potential advantages of VV ECMO and to precisely determine which patients will require VA ECMO.—Thomas A. Angerpointner doi:10.1016/j.jpedsurg.2010.05.041
doi:10.1016/j.jpedsurg.2010.05.039
Pediatric traumatic amputations and hospital resource utilization in the United States, 2003 Conner KA, McKenzie LB, Xiang H, et al. J Trauma 2010;68/l:131-7 Despite the severity of consequences associated with traumatic amputation, little is known about the epidemiology or health care resource burden of
Transglutaminases, involucrin, and loricrin as markers of epidermal differentiation in skin substitutes derived from human sweat gland cells Tharakan S, Pontiggia L, Biedermann T. Pediatr Surg Int 2010 (January); 26(1):71-7 In a multiproject research line, the authors from the University Children's Hospital of Zurich/Switzerland are currently testing whether a morphologically and functionally near-normal epidermis can be cultured from human
Admission base deficit as a long-term prognostic factor in severe pediatric trauma patients Hindy-François C, Meyer P, Blanot S, et al. J Trauma 2009;67/6:1272-7 Base deficit (BD) is a prognostic tool that correlates with trauma scores and mortality in adult trauma patients. Retrospective studies have shown that admission BD more than 8 mmol/L is associated with an increased risk of mortality. This is the first prospective European study aimed at evaluating the prognostic value of admission BD in traumatized children. One hundred severely traumatized children were included if an arterial BD had been calculated on arrival in the trauma room of a university hospital. Epidemiologic, medical, and biological data (including admission BD and lactates concentration) were recorded and compared using a univariate analysis. The primary end point was in-hospital mortality. Secondary end points were outcome on discharge and at 6 months. Cutoff values for BD or lactates regarding outcomes were determined using receiver operating characteristic curves if these data had been isolated on multivariate analysis (P b .05). Sixty-eight boys and 32 girls, aged 6.7 years, were enrolled from March 2003 to December 2005, mainly after road traffic accidents. Twenty-two died at the hospital; 34 and 51 children were classified as having a good outcome on hospital discharge and 6 months later, respectively. After the multivariate procedure and receiver operating characteristic curve analysis, admission lactates more than 2.94 mmol/L and admission BD more than 5 mEq/L were independent risk factors for mortality (odds ratio, 2.4; 95% confidence interval, 1.3-4.6) and poor outcome at 6 months (odds ratio, 2.5; 95% confidence interval, 1.13-5.5), respectively. The authors conclude that BD could be used to predict the long-term morbidity and may not be related to morbidity and mortality at discharge.— Steven Stylianos
1921 amputation injuries; and even less is known about these injuries in the pediatric population. An analysis of patients not older than 17 years hospitalized with traumatic amputations using the 2003 Healthcare Cost and Utilization Project Kids' Inpatient Database was performed. National estimates of amputationassociated hospitalizations, rates, resource use, and demographics were calculated. Potentially significant covariate associations were studied using hospital charges and length of stay (LOS). In 2003, 956 cases of traumatic amputations among children not older than 17 years resulted in $21.6 million (standard deviation [SD] = $2.2 million) in inpatient charges and 3,967 days (SD = 354) of hospitalization in the United States. Finger and/or thumb amputations accounted for the majority of injuries (64.0%). Mean (SD) hospital charges and LOS were $23,157 ($49,018) and 4.1 (7.4) days, respectively. Traumatic leg amputations incurred the highest mean hospital charges ($120,275) and longest mean LOS (18.5 days). Older children (15-17 years) experienced a higher hospitalization rate (1.84/100,000) than other age groups. Older age, amputation caused by a motorized vehicle, urban hospital location, children's hospital type, and longer LOS were associated with higher total charges. Amputation caused by lawn mower, motorized vehicle, or explosives/ fireworks and children's hospital type were associated with longer LOS. The authors conclude that pediatric traumatic amputations contribute substantially to the health resource burden in the United States, resulting in $21 million in inpatient charges annually. More effective interventions to prevent these costly injuries among children must be implemented.— Steven Stylianos doi:10.1016/j.jpedsurg.2010.05.040
A review of venovenous and venoarterial extracorporeal membrane oxygenation in neonates and children Keeker SJ, Laituri CA, Ostlie DJ, et al. Eur J Pediatr Surg 2010 (February);20/1:1-4 The use of extracorporeal membrane oxygenation (ECMO) has increased since its inception in the 1980s. As this modality gained wider acceptance, its application in a variety of diseases has increased. The initial use of ECMO required cannulation of both the carotid artery and internal jugular vein (VA ECMO). Ligation of the carotid artery and concern regarding potential longterm sequelae prompted the development of the venous-only ECMO technique (VV ECMO). Various reports in the literature have compared VV ECMO with VA ECMO. The authors present a review of the literature with regard to both physiology and clinical application. Current comparative data between VA and VV ECMO is retrospective. Strict prospective studies are necessary to quantify the potential advantages of VV ECMO and to precisely determine which patients will require VA ECMO.—Thomas A. Angerpointner doi:10.1016/j.jpedsurg.2010.05.041
doi:10.1016/j.jpedsurg.2010.05.039
Pediatric traumatic amputations and hospital resource utilization in the United States, 2003 Conner KA, McKenzie LB, Xiang H, et al. J Trauma 2010;68/l:131-7 Despite the severity of consequences associated with traumatic amputation, little is known about the epidemiology or health care resource burden of
Transglutaminases, involucrin, and loricrin as markers of epidermal differentiation in skin substitutes derived from human sweat gland cells Tharakan S, Pontiggia L, Biedermann T. Pediatr Surg Int 2010 (January); 26(1):71-7 In a multiproject research line, the authors from the University Children's Hospital of Zurich/Switzerland are currently testing whether a morphologically and functionally near-normal epidermis can be cultured from human