Pediatric trauma patients with isolated airway compromise or Glasgow Coma Scale less than 8: does immediate attending surgeon's presence upon arrival make a difference?

Optimal trauma care requires an attending pediatric surgeon to head a trauma team for the most severely injured patients. Recently, the American College of Surgeons-Committee on Trauma has added “Glasgow Coma Scale (GCS)

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Veröffentlicht in:Journal of pediatric surgery 2005, Vol.40 (1), p.103-106
Hauptverfasser: Lui, Felix, Gormley, Paula, Sorrells, Donald L., Biffl, Walter L., Kurkchubasche, Arlet G., Tracy, Thomas F., Luks, Francois I.
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container_end_page 106
container_issue 1
container_start_page 103
container_title Journal of pediatric surgery
container_volume 40
creator Lui, Felix
Gormley, Paula
Sorrells, Donald L.
Biffl, Walter L.
Kurkchubasche, Arlet G.
Tracy, Thomas F.
Luks, Francois I.
description Optimal trauma care requires an attending pediatric surgeon to head a trauma team for the most severely injured patients. Recently, the American College of Surgeons-Committee on Trauma has added “Glasgow Coma Scale (GCS)
doi_str_mv 10.1016/j.jpedsurg.2004.09.029
format Article
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Recently, the American College of Surgeons-Committee on Trauma has added “Glasgow Coma Scale (GCS) &lt;8” and “airway compromise” to the existing anatomical and physiological criteria for immediate attending presence. This report analyzes the outcome of children who met these isolated criteria and were treated before the change in guidelines was made. The trauma registry of this level I trauma center was queried for all pediatric patients with GCS &lt;8 or airway compromise. Age, sex, initial GCS, Revised Trauma Score, Injury Severity Score, outcome, and probability of survival (TRISS methodology) were recorded. The subgroup of patients for whom an attending surgeon was not immediately present was further analyzed. Over a 5-year period, 2895 trauma patients (aged 0-16 years) were admitted. One hundred fifteen patients had a GCS &lt;8 and/or airway compromise. In 61 cases, an attending surgeon was not present upon patient arrival. Of these patients, 24 died (group D), 15 were discharged to a rehabilitation facility (group R), and 22 were discharged home (group H). Ten patients with a probability of survival of lower than 0.5 survived. Only 4 of the 24 patients who died had a probability of survival of &gt;0.5 (mean, 0.697). All 4 had an Injury Severity Score &gt;25 and a GCS ≤4. All deaths were reviewed through a quality improvement program and were deemed nonpreventable by objective reviewers. Patient outcome was not affected by the presence or absence of an attending surgeon upon patient arrival. Outcome of severely injured children with GCS &lt;8 or airway compromise met and, in some cases, exceeded expectations of survival according to the TRISS methodology. The lack of immediate attending surgeon's presence does not appear to have negatively influenced the outcome in these children. 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Recently, the American College of Surgeons-Committee on Trauma has added “Glasgow Coma Scale (GCS) &lt;8” and “airway compromise” to the existing anatomical and physiological criteria for immediate attending presence. This report analyzes the outcome of children who met these isolated criteria and were treated before the change in guidelines was made. The trauma registry of this level I trauma center was queried for all pediatric patients with GCS &lt;8 or airway compromise. Age, sex, initial GCS, Revised Trauma Score, Injury Severity Score, outcome, and probability of survival (TRISS methodology) were recorded. The subgroup of patients for whom an attending surgeon was not immediately present was further analyzed. Over a 5-year period, 2895 trauma patients (aged 0-16 years) were admitted. One hundred fifteen patients had a GCS &lt;8 and/or airway compromise. In 61 cases, an attending surgeon was not present upon patient arrival. Of these patients, 24 died (group D), 15 were discharged to a rehabilitation facility (group R), and 22 were discharged home (group H). Ten patients with a probability of survival of lower than 0.5 survived. Only 4 of the 24 patients who died had a probability of survival of &gt;0.5 (mean, 0.697). All 4 had an Injury Severity Score &gt;25 and a GCS ≤4. All deaths were reviewed through a quality improvement program and were deemed nonpreventable by objective reviewers. Patient outcome was not affected by the presence or absence of an attending surgeon upon patient arrival. Outcome of severely injured children with GCS &lt;8 or airway compromise met and, in some cases, exceeded expectations of survival according to the TRISS methodology. The lack of immediate attending surgeon's presence does not appear to have negatively influenced the outcome in these children. 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Of these patients, 24 died (group D), 15 were discharged to a rehabilitation facility (group R), and 22 were discharged home (group H). Ten patients with a probability of survival of lower than 0.5 survived. Only 4 of the 24 patients who died had a probability of survival of &gt;0.5 (mean, 0.697). All 4 had an Injury Severity Score &gt;25 and a GCS ≤4. All deaths were reviewed through a quality improvement program and were deemed nonpreventable by objective reviewers. Patient outcome was not affected by the presence or absence of an attending surgeon upon patient arrival. Outcome of severely injured children with GCS &lt;8 or airway compromise met and, in some cases, exceeded expectations of survival according to the TRISS methodology. The lack of immediate attending surgeon's presence does not appear to have negatively influenced the outcome in these children. Based on this series, there is no evidence to justify mandatory immediate presence of an attending surgeon for these 2 criteria alone.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>15868567</pmid><doi>10.1016/j.jpedsurg.2004.09.029</doi><tpages>4</tpages></addata></record>
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subjects Adolescent
Child
Child, Preschool
Glasgow Coma Scale - statistics & numerical data
Humans
Infant
Infant, Newborn
Injury Severity Score
Medical Staff, Hospital - statistics & numerical data
Outcome and Process Assessment (Health Care)
Patient Care - statistics & numerical data
Patient Care Team
Registries
Respiratory Insufficiency - etiology
Respiratory Insufficiency - therapy
Retrospective Studies
Rhode Island - epidemiology
Survival Analysis
Time Factors
Trauma Centers - manpower
Trauma Centers - statistics & numerical data
Wounds and Injuries - complications
Wounds and Injuries - epidemiology
title Pediatric trauma patients with isolated airway compromise or Glasgow Coma Scale less than 8: does immediate attending surgeon's presence upon arrival make a difference?
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