Journal article
Assessment of Non-Routine Events and Significant Physiological Disturbances during Emergency Department Evaluation after Pediatric Head Trauma
Neurotrauma Reports, v 2(1), pp 39-47
01 Jan 2021
PMID: 33748812
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Outcomes following pediatric traumatic brain injury (TBI) are dependent on initial injury severity and prevention of secondary injury. Hypoxia, hypotension, and hyperventilation following TBI are associated with increased mortality. The purpose of this study was to determine the association of non-routine events (NREs) during the initial resuscitation phase with these physiological disturbances. We conducted a video review of pediatric trauma resuscitations of patients with suspected TBI and Glasgow Coma Scale (GCS) scores <13. NREs were rated as “momentary” if task progression was delayed by <1 min and “moderate” if delayed by >1 min. Vital sign monitor data were used to identify periods of significant physiological disturbances. We calculated the association between the rate of overall and moderate NREs per case and the proportion of cases with abnormal vital signs using multi-variate linear regression, controlling for GCS score and need for intubation. Among 26 resuscitations, 604 NREs were identified with a median of 23 (interquartile range [IQR] 17–27.8, range 5–44) per case. Moderate delay NREs occurred in 19 resuscitations (
n
= 32, median 1 NRE/resuscitation, IQR 0.3–1, range 0–5). Oxygen desaturation and respiratory depression were associated with a greater rate of moderate NREs (
p
= 0.008,
p
< 0.001, respectively). We observed no association between duration of hypotension, desaturation, and respiratory depression and overall NRE rate. NREs are common in the initial resuscitation of children with moderate to severe TBI. Episodes of hypoxia and respiratory depression are associated with NREs that cause a moderate delay in task progression. Conformance with resuscitation guidelines is needed to prevent physiological events associated with adverse outcomes following pediatric TBI.
Metrics
Details
- Title
- Assessment of Non-Routine Events and Significant Physiological Disturbances during Emergency Department Evaluation after Pediatric Head Trauma
- Creators
- Emily C Alberto - Division of Trauma and Burn Surgery, Children's National Hospital, Washington DC, USAAllison R Harvey - Division of Trauma and Burn Surgery, Children's National Hospital, Washington DC, USAMichael J Amberson - Department of Pediatrics, Children's National Hospital, Washington DC, USAYinan Zheng - Division of Trauma and Burn Surgery, Children's National Hospital, Washington DC, USAArunachalam A Thenappan - Division of Trauma and Burn Surgery, Children's National Hospital, Washington DC, USAChima Oluigbo - Division of Neurosurgery, Children's National Hospital, Washington DC, USAIvan Marsic - Department of Electrical and Computer Engineering, Rutgers University, Piscataway, New Jersey, USAAleksandra Sarcevic - College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania, USAKaren J O'Connell - Division of Emergency Medicine, Children's National Hospital, Washington DC, USARandall S Burd - Division of Trauma and Burn Surgery, Children's National Hospital, Washington DC, USA
- Publication Details
- Neurotrauma Reports, v 2(1), pp 39-47
- Publisher
- Mary Ann Liebert, Inc., publishers; 140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Information Science
- Web of Science ID
- WOS:000974177700005
- Scopus ID
- 2-s2.0-85142313680
- Other Identifier
- 991014976822904721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Neurosciences