Effect of Introducing the Mucosal Atomization Device for Fentanyl Use in Out-of-Hospital Pediatric Trauma Patients

AbstractBackgroundPain associated with pediatric trauma is often under-assessed and under-treated in the out-of-hospital setting. Administering an opioid such as fentanyl via the intranasal route is a safe and efficacious alternative to traditional routes of analgesic delivery and could potentially improve pain management in pediatric trauma patients.ObjectiveThe study sought to examine the effect of introducing the mucosal atomization device (MAD) on analgesia administration as an alternative to intravenous fentanyl delivery in pediatric trauma patients. The hypothesis for the study is that the introduction of the MAD would increase the administration of fentanyl in pediatric trauma patients.MethodsThe research utilized a 2-group design (pre-MAD and post-MAD) to study 946 pediatric trauma patients (age <16) transported by a large, urban EMS agency to one of eight hospitals in Marion County, which is located in Indianapolis Indiana. Two emergency medicine physicians independently determined whether the patient met criteria for pain medication receipt and a third reviewer resolved any disagreements. A comparison of the rates of fentanyl administration in both groups was then conducted.ResultsThere was no statistically significant difference in the rate of fentanyl administration between the pre-MAD (30.4%) and post-MAD groups (37.8%) (P = .238). A subgroup analysis showed that age and mechanism of injury were stronger predictors of fentanyl administration.ConclusionContrary to the hypothesis, the addition of the MAD device did not increase fentanyl administration rates in pediatric trauma patients. Future research is needed to address the barriers to analgesia administration in pediatric trauma patients.O'DonnellDP, SchaferLC, StevensAC, WeinsteinE, MiramontiCM, KozakMA. Effect of introducing the mucosal atomization device for fentanyl use in out-of-hospital pediatric trauma patients. Prehosp Disaster Med. 2013;28(4):1-3.

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Plasma ADAMTS13 Activity Associates with Injury Severity in Pediatric Trauma Patients

Blood ◽

10.1182/blood.v128.22.3777.3777 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3777-3777

Author(s):

Jenny K. McDaniel ◽

Ilan I Maizlin ◽

Michelle C. Shroyer ◽

Morgan E. Banks ◽

Jean-Francois Pittet ◽

...

Keyword(s):

Injury Severity ◽

Pediatric Trauma ◽

Initial Presentation ◽

Trauma Patients ◽

Adamts13 Activity ◽

Acute Traumatic Coagulopathy ◽

Time Period ◽

Increased Risk ◽

Significant Difference ◽

Traumatic Coagulopathy

Abstract Background: Acute traumatic coagulopathy occurs in both pediatric and adult trauma patients and is associated with an increased risk of mortality. Trauma patients not only have increased risk for hemorrhagic complications, but also are at increased risk for thrombosis due to multiple factors including local tissue injury, inflammation, and immobility. The complex underlying pathophysiology of coagulation abnormalities associated with traumatic injury have yet to be fully elucidated. Additionally, there are significant differences in the hemostatic system of pediatric patients compared to adults. Objectives: The purpose of this study was to determine the levels of coagulation parameters including von Willebrand factor (VWF) antigen and ADAMTS13 activity in pediatric trauma patients and evaluate for possible association with injury severity and/or mortality. Methods: This study utilized plasma specimens collected from pediatric trauma patients that presented to our institution over a 2-year time period. The specimens were collected at initial presentation and 24 hours later. The injury severity was estimated using both the Glasgow Coma Scale (GCS) and Injury Severity Score (ISS). A cohort of control samples was obtained from pediatric patients for elective surgical procedures over the same time period. Plasma VWF antigen was determined by a sandwich ELISA; plasma ADAMTS13 activity was determined by FRETS-VWF73. The results were determined by nonparametric tests for the differences in median values. Results: A total of 106 trauma patient samples at initial time point, 78 trauma samples at 24 hour time point, and 54 control samples were obtained and utilized for study. There were statistically significant differences (p<0.05) in the plasma levels of VWF antigen, ADAMTS13 activity, and the ratio of ADAMTS13 activity to VWF antigen for the trauma patient samples at initial presentation when compared to controls (Table 1). At 24 hours, there were still statistically significant differences between ADAMTS13 activity and the ratio of ADAMTS13 activity to VWF antigen in trauma patients compared to controls, but there was no significant difference in VWF antigen between the two cohorts (Table 2). There was a significant difference between the decrease in ADAMTS13 activity and injury severity as estimated by ISS ³ 15 or GCS < 8 at both time points; however, ADAMTS13 activity was not statistically different in survivors vs. non-survivors. A higher VWF antigen level at initial presentation was the only factor found to be significantly different in non-survivors. Conclusions: This study demonstrates significant differences in plasma ADAMTS13 activity and VWF antigen in pediatric trauma patients compared to controls. In patients with more severe injuries as estimated by GCS and ISS, there was also a significant association with decreased levels of ADAMTS13 activity. These finding may underlie part of the prothrombotic propensity in microcirculation that occurs in patients post-trauma. Further investigation is warranted to better understand the mechanisms of acute traumatic coagulopathy and potential prognostic factors, and to determine the most effective interventions for acute traumatic coagulopathy in the pediatric population. Disclosures Zheng: Ablynx: Consultancy; Alexion: Research Funding.

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Attachment dimensions and forgiveness of others: A meta-analysis

Journal of Social and Personal Relationships ◽

10.1177/0265407519841716 ◽

2019 ◽

Vol 36 (11-12) ◽

pp. 3960-3985

Author(s):

Shannon L. Hirst ◽

Erica G. Hepper ◽

Harriet R. Tenenbaum

Keyword(s):

Meta Analysis ◽

Attachment Anxiety ◽

Future Research ◽

Sample Population ◽

Publication Type ◽

Systematic Analysis ◽

Significant Difference ◽

Negative Effect ◽

Forgiveness Of Others ◽

Attachment Dimensions

Forgiveness, as a response to interpersonal transgressions, has multiple societal and individual benefits. Individual differences in attachment have been identified as a predictor not only of forgiveness but of state responses frequently associated with forgiveness. The current meta-analysis is the first systematic analysis of the effect of attachment dimensions (i.e., anxiety and avoidance) on forgiveness of others. Analysis of published and unpublished studies ( k = 26) identified significant, small-to-medium effects of attachment anxiety ( r = −.25) and attachment avoidance ( r = −.18) on forgiveness of others. No significant difference was obtained between measures of state and trait forgiveness. The moderating effects of study paradigm, attachment measure, publication type, and sample population were also investigated. The findings of a stable negative effect of insecure attachment dimensions on forgiveness of others provide a base for future research that may focus on reducing attachment anxiety and avoidance to support forgiveness.

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Impact of stress-induced hyperglycemia on the outcome of children with trauma: A cross-sectional analysis based on propensity score-matched population

Scientific Reports ◽

10.1038/s41598-019-52928-6 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Yi-Wen Tsai ◽

Shao-Chun Wu ◽

Chun-Ying Huang ◽

Shiun-Yuan Hsu ◽

Hang-Tsung Liu ◽

...

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Injury Severity ◽

Pediatric Trauma ◽

Trauma Patients ◽

Cross Sectional ◽

Icu Admission ◽

Significant Difference ◽

History Of ◽

Sectional Analysis

Abstract This was a retrospective study of pediatric trauma patients and were hospitalized in a level-1 trauma center from January 1, 2009 to December 31, 2016. Stress-induced hyperglycemia (SIH) was defined as a hyperglycemia level ≥200 mg/dL upon arrival at the emergency department without any history of diabetes or a hemoglobin A1c level ≥6.5% upon arrival or during the first month of admission. The results demonstrated that the patients with SIH (n = 36) had a significantly longer length of stay (LOS) in hospital (16.4 vs. 7.8 days, p = 0.002), higher rates of intensive care unit (ICU) admission (55.6% vs. 20.9%, p < 0.001), and higher in-hospital mortality rates (5.6% vs. 0.6%, p = 0.028) compared with those with non-diabetic normoglycemia (NDN). However, in the 24-pair well-balanced propensity score-matched patient populations, in which significant difference in sex, age, and injury severity score were eliminated, patient outcomes in terms of LOS in hospital, rate of ICU admission, and in-hospital mortality rate were not significantly different between the patients with SIH and NDN. The different baseline characteristics of the patients, particularly injury severity, may be associated with poorer outcomes in pediatric trauma patients with SIH compared with those with NDN. This study also indicated that, upon major trauma, the response of pediatric patients with SIH is different from that of adult patients.

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Percutaneous versus Open Tracheostomy in the Pediatric Trauma Population

The American Surgeon ◽

10.1177/000313481007600307 ◽

2010 ◽

Vol 76 (3) ◽

pp. 276-278 ◽

Cited By ~ 3

Author(s):

Ashish Raju ◽

D'Andrea K. Joseph ◽

Cheickna Diarra ◽

Steven E. Ross

Keyword(s):

Injury Severity ◽

Percutaneous Tracheostomy ◽

Pediatric Trauma ◽

Retrospective Chart Review ◽

Feeding Tube ◽

Tube Placement ◽

Trauma Patients ◽

Complication Rates ◽

Trauma Population ◽

Significant Difference

The purpose of this study was to determine the safety and efficacy of percutaneous versus open tracheostomy in the pediatric trauma population. A retrospective chart review was conducted of all tracheostomies performed on trauma patients younger than 18 years for an 8-year period. There was no difference in the incidence of brain, chest, or facial injury between the open and percutaneous tracheostomy groups. However, the open group had a significantly lower age (14.2 vs. 15.5 years; P < 0.01) and higher injury severity score (26 vs. 21; P = 0.015). Mean time from injury to tracheostomy was 9.1 days (range, 0 to 16 days) and was not different between the two methods. The majority of open tracheostomies were performed in the operating room and, of percutaneous tracheostomies, at the bedside. Concomitant feeding tube placement did not affect complication rates. There was not a significant difference between complication rates between the two methods of tracheostomy (percutaneous one of 29; open three of 20). Percutaneous tracheostomy can be safely performed in the injured older child.

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Effects of Comfort Education on Maternal Comfort and Labor Pain

The Journal of Perinatal Education ◽

10.1891/1058-1243.26.2.96 ◽

2017 ◽

Vol 26 (2) ◽

pp. 96-104

Author(s):

Abby E. Garlock ◽

Janet B. Arthurs ◽

Robert J. Bass

Keyword(s):

Pain Control ◽

Comparison Group ◽

Intervention Group ◽

Hospital Setting ◽

Labor Pain ◽

Control Group ◽

Group Design ◽

Significant Difference ◽

Quasi Experimental

ABSTRACTThe effects of providing education regarding comfort options available in the hospital setting on level of maternal comfort and pain during labor were explored in a quasi-experimental pretest/posttest comparison group design (N = 80). No significant difference was found in maternal comfort or pain between the intervention group that received comfort education and the control group. Comfort education did result in change for plans to maintain comfort during labor (p = .000), an increased use of comfort measures during labor (p = .000), and an increased probability of continuation with original plans for pain control during labor. Providing education for maintaining comfort during labor can allow women to make informed choices during labor.

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Computed Tomography with Intravenous Contrast is Not Associated with Development of Acute Kidney Injury in Severely Injured Pediatric Patients

The American Surgeon ◽

10.1177/000313481908500101 ◽

2019 ◽

Vol 85 (1) ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Paul K. McGaha ◽

Jeremy Johnson ◽

Tabitha Garwe ◽

Zoona Sarwar ◽

Prasenjeet Motghare ◽

...

Keyword(s):

Acute Kidney Injury ◽

Ct Scan ◽

Injury Severity ◽

Pediatric Trauma ◽

Kidney Injury ◽

Trauma Patients ◽

Severely Injured ◽

Intravenous Contrast ◽

Trauma Population ◽

Significant Difference

Data for the incidence of acute kidney injury (AKI) related to intravenous contrast administration in the pediatric trauma population are limited. Obtaining a creatinine value before elective CT scans is a relatively accepted standard of care. We sought to determine whether there was any significant difference in the incidence of AKI between severely injured patients who received IV contrast and those who did not. We reviewed data from the trauma registry at our Level I pediatric trauma center. We limited the patients to severely injured pediatric traumas (<15 years old) directly transported from the scene of injury with a creatinine level measured on arrival. Two hundred and eleven patients were included in the study. AKI was defined by the criteria of the AKI Network. We then compared incidence of AKI in those who received a CT scan with IV contrast with those who did not receive IV contrast. The two groups were comparable in age, gender, Glasgow Coma Scale, Injury Severity Score, mean creatinine on arrival, and mean creatinine post–CT scan/arrival. There was no significant difference in AKI between the two. In a subgroup analysis of patients presenting in shock, there was no significant difference in AKI. Our study suggests that IV contrast is not associated with the development of AKI in severely injured pediatric trauma patients. Although obtaining a creatinine value before exposure is ideal, a CT scan with IV contrast in severely injured children should not be delayed to obtain a creatinine value.

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Injured Adolescents, Not Just Large Children: Difference in Care and Outcome between Adult and Pediatric Trauma Centers

The American Surgeon ◽

10.1177/000313481307900325 ◽

2013 ◽

Vol 79 (3) ◽

pp. 267-273 ◽

Cited By ~ 24

Author(s):

Kazuhide Matsushima ◽

Eric W. Schaefer ◽

Eugene J. Won ◽

Pamela A. Nichols ◽

Heidi L. Frankel

Keyword(s):

Regression Models ◽

Multivariable Analysis ◽

Pediatric Trauma ◽

Trauma Patients ◽

Complication Rates ◽

Trauma Centers ◽

Significant Difference ◽

Multivariable Regression ◽

Multivariable Regression Models ◽

Emergent Laparotomy

Adolescent injury victims receive care at adult trauma centers (ATCs) and pediatric trauma centers (PTCs). The purpose of this study was to identify care variations and their impact on the outcome of adolescent trauma patients treated at PTC versus ATC. We queried the Pennsylvania Trauma Systems Foundation database for trauma patients between 13 and 18 years of age from 2005 to 2010. Mortality and hospital complication rates between ATC and PTC were compared in univariable and multivariable analysis. In addition, the differences in the delivery of care were also compared. Of 9033 total patients, 6027 (67%) received care at an ATC. Patients in the ATC group were older (16.7 vs 14.9 years, P < 0.001) and more severely injured (Injury Severity Score: 14.5 vs 12.2, P < 0.001). Admission diagnostic computed tomography (CT), emergent laparotomy and craniotomy, blood transfusion, and drug screening were more frequently performed at an ATC. After adjustment for potential confounders in multivariable regression models, treatment at a PTC was significantly associated with fewer CTs for transferred patients (odds ratio [OR], 0.28; P < 0.001) and with less frequent emergent laparotomy for all patients (OR, 0.65; P = 0.007). The ATC group had a significantly higher hospital mortality rate (2.9 vs 0.9%, P < 0.001) and complication rate (9.7 vs 4.8%, P < 0.001). However, these outcomes were not significantly different between PTC and ATC in multivariable regression models. In the state of Pennsylvania, there were no significant differences in risk-adjusted outcomes between PTC and ATC despite significant difference in use of CT scanning and emergent laparotomy.

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