Epidemiologic aspects of pediatric multiple trauma in a Spanish urban population

Cluster analysis of the spatial distribution of pedestrian deaths and injuries by parishes in Kampala city, Uganda

Studies on pedestrian deaths and injuries at the urban level in Africa mostly provide overall aggregated figures and do not examine variation in the sub-urban units. Using cluster analysis, this study sought to determine if the observed pattern in the distribution of pedestrian injuries and deaths among parishes in Kampala city is significant. Pedestrian crash data from 2015 to 2019 were collected from the Uganda Traffic Police database. Serious and fatal pedestrian injury rates were mapped by parish using ArcMap and cluster analyses conducted. Results from spatial autocorrelation (Moran's Index of 0.18 and 0.17 for fatal and serious injury rates respectively) showed that the distributions were clustered within parishes crossed by highways and located in the inner city respectively. Z-scores of 3.32 (p < 0.01) for serious injury rates and 3.71 (p < 0.01) for fatal injury rates indicated that the clustering was not random. This study's main contribution was providing a detailed spatial distribution of pedestrian fatal and serious injury rates for Kampala; a city in a low developing country in Africa at the micro-scale of a parish. This foundational exploratory paper formed the first step of a broader study examining built environment factors explaining this pattern.

Do children with Glasgow 13/14 could be identified as mild traumatic brain injury?

OBJECTIVE

To identify in mild head injured children the major differences between those with a Glasgow Coma Scale (GCS) 15 and GCS 13/14.

METHOD

Cross-sectional study accomplished through information derived from medical records of mild head injured children presented in the emergency room of a Pediatric Trauma Centre level I, between May 2007 and May 2008.

RESULTS

1888 patients were included. The mean age was 7.6 + or - 5.4 years; 93.7% had GCS 15; among children with GCS 13/14, 46.2% (p<0.001) suffered multiple traumas and 52.1% (p<0.001) had abnormal cranial computed tomography (CCT) scan. In those with GCS 13/14, neurosurgery was performed in 6.7% and 9.2% (p=0.001) had neurological disabilities.

CONCLUSION

Those with GCS 13/14 had frequently association with multiple traumas, abnormalities in CCT scan, require of neurosurgical procedure and Intensive Care Unit admission. We must be cautious in classified children with GCS 13/14 as mild head trauma victims.

Road traffic injuries: a stocktaking

Once we accept that road traffic injury control is a public health problem, and that we have an ethical responsibility to arrange for the safety of individuals, then it follows that health and medical professionals have to assume responsibility for participating in efforts to control this pandemic. Over 1.2 million people die of road traffic crashes annually. Road traffic injuries are among the second to the sixth leading causes of death in the age groups 15-60 years in all countries around the world. Control of road traffic injuries is going to require very special efforts as patterns are different in high- and lower-income countries, and while some countermeasures are applicable internationally, others will need further research and innovation. We will need to focus on the safety of pedestrians, bicyclists and motorcyclists, speed control, and prevention of driving under the influence of alcohol.

Asistencia al paciente politraumatizado. Realidad actual desde la perspectiva de las unidades de cuidados intensivos

OBJECTIVE

To study the epidemiology and management of pediatric trauma patients as well as the organizational, human and technical resources dedicated to these children from the perspective of the pediatric intensive care unit (PICU).

MATERIAL AND METHODS

A standardized data collection form was sent to 43 PICUs in Spain. Items inquired about the existence of training courses, trauma clinical practice guidelines and trauma registers, and which physician was in charge of trauma patients. Data on casuistics, the age of trauma patients, and the availability of human and technical resources, were also recorded.

RESULTS

Twenty-four PICUs completed the questionnaire. The PICU physician was responsible for trauma patient care in 66% of the hospitals. No training courses were available in 59% of the hospitals. No trauma register was available in 62% of the hospitals. Trauma patients represented 11% of PICU admissions, and most patients were aged up to 14 years old. An anesthetist was always at the hospital in 100% of the hospitals. A radiologist and traumatologist were always at the hospital in 91%, a neurosurgeon in 66% and a pediatric surgeon in 50%. The remaining surgical and medical specialties were on call. Continuous intracranial pressure monitoring was available in 87% of the PICUs, jugular venous saturation monitoring in 54% and continuous electroencephalogram and transcranial Doppler ultrasound in 50%. Computed tomography and ultrasound were available at all times in all hospitals. Magnetic nuclear resonance and echocardiography were available at all times in 44% of the hospitals, and arteriography in 42%.

CONCLUSION

In Spain, the organization of pediatric trauma management is based on pediatric teams under the supervision of a PICU physician. Some hospitals show a lack of technical and human resources. Therefore, the minimum criteria required to consider a hospital as a pediatric trauma center should be established. Trauma training courses are required.

[Injury pattern and clinical course of children with multiple injuries in comparison to adults, Ab 11-year analysis at a clinic of maximum utilization]

Due to the small number of polytraumatized children treated in single clinics, only a few studies are available that compare multiply injured children and adults. However, the differences between the two groups with respect to type of injury, injury patterns and pathophysiology may have some crucial effect on the clinical course and are therefore essential for the treatment regime. In this study data about the epidemiology, the preclinical treatment, the clinical course and the complication rates of polytraumatized children and adults were analysed. The aim of this study was to point out the main differences between the two collectives and to compare the results with the current literature. Traffic accidents were the leading cause for trauma (children 77.8%, adults 62.6%). Children more often were transported by helicopter than adults. In both age groups head injuries and fractures of the extremities were most frequent. Adults had a prolonged ventilation time as well as an increased stay in ICU and a regular ward.

Triage scoring systems, severity of illness measures, and mortality prediction models in pediatric trauma

Trauma triage scores, severity of illness measures, and mortality prediction models quantitate severity of injury and stratify patients according to a specified outcome. Triage scoring systems are typically used to assist prehospital personnel determine which patients require trauma center care, but they are not recommended as the sole determinant of triage. Severity of illness measures and mortality prediction models are used in clinical and health services research for risk-adjusted outcomes analyses and institutional benchmarking. As clinicians and researchers, it is imperative that we be knowledgeable of the methodologies and applications of these scoring and risk prediction systems to ensure their quality and appropriate utilization.