Survival of pediatric blunt trauma patients presenting with no signs of life in the field

Vincent Duron, Rita V. Burke, David Bliss, Henri Ford, Jeffrey S. Upperman

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

BACKGROUND: Prehospital traumatic cardiopulmonary arrest is associated with dismal prognosis, and patients rarely survive to hospital discharge. Recently established guidelines do not apply to the pediatric population because of paucity of data. The study objective was to determine the survival of pediatric patients presenting in the field with no signs of life after blunt trauma. METHODS: We conducted a retrospective analysis of the National Trauma Data Bank research data set (2002-2010). All patients 18 years and younger with blunt traumatic injuries were identified (DRG International Classification of Diseases - 9th Rev. codes 800-869). No signs of life (SOL) was defined on physical examination findings and included the following: pulse, 0; respiratory rate, 0; systolic blood pressure, 0; and no evidence of neurologic activity. These same criteria were reassessed on arrival at the emergency department (ED). Furthermore, we examined patients presenting to the ED who underwent resuscitative thoracotomy (Current Procedural Terminology code 34.02). Our primary outcome was survival to discharge from the hospital. RESULTS: There were a total of 3,115,597 pediatric patients who were found in the field after experiencing blunt trauma. Of those, 7,766 (0.25%) had no SOL. Seventy percent of the patients with no SOL in the field were male. Survival to hospital discharge of all patients presenting with no SOL was 4.4% (n = 340). Twenty-five percent of the patients in the field with no SOL were successfully resuscitated in the field and regained SOL by the time they arrived to the ED (n = 1,913). Of those patients who regained SOL, 13.8% (n = 265) survived to hospital discharge. For patients in the field with no SOL, survival to discharge was significantly higher in patients who did not receive a resuscitative thoracotomy than in those who did. CONCLUSION: Survival of pediatric blunt trauma patients in the field without SOL is dismal. Resuscitative thoracotomy poses a heightened risk of blood-borne pathogen exposure to involved health care workers and is associated with a significantly lower survival rate. LEVEL OF EVIDENCE: Prognostic study, level III; therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)422-426
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume77
Issue number3
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Pediatrics
Survival
Wounds and Injuries
Thoracotomy
Hospital Emergency Service
Current Procedural Terminology
Blood-Borne Pathogens
Blood Pressure
Nonpenetrating Wounds
Patient Discharge
Diagnosis-Related Groups
International Classification of Diseases
Respiratory Rate
Heart Arrest
Nervous System
Physical Examination
Pulse
Survival Rate
Databases
Guidelines

Keywords

  • Emergency
  • pediatric
  • survival
  • thoracotomy
  • trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Survival of pediatric blunt trauma patients presenting with no signs of life in the field. / Duron, Vincent; Burke, Rita V.; Bliss, David; Ford, Henri; Upperman, Jeffrey S.

In: Journal of Trauma and Acute Care Surgery, Vol. 77, No. 3, 01.01.2014, p. 422-426.

Research output: Contribution to journalArticle

Duron, Vincent ; Burke, Rita V. ; Bliss, David ; Ford, Henri ; Upperman, Jeffrey S. / Survival of pediatric blunt trauma patients presenting with no signs of life in the field. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 77, No. 3. pp. 422-426.
@article{db1f7f5da7324b7a811e2ea7dca36f9c,
title = "Survival of pediatric blunt trauma patients presenting with no signs of life in the field",
abstract = "BACKGROUND: Prehospital traumatic cardiopulmonary arrest is associated with dismal prognosis, and patients rarely survive to hospital discharge. Recently established guidelines do not apply to the pediatric population because of paucity of data. The study objective was to determine the survival of pediatric patients presenting in the field with no signs of life after blunt trauma. METHODS: We conducted a retrospective analysis of the National Trauma Data Bank research data set (2002-2010). All patients 18 years and younger with blunt traumatic injuries were identified (DRG International Classification of Diseases - 9th Rev. codes 800-869). No signs of life (SOL) was defined on physical examination findings and included the following: pulse, 0; respiratory rate, 0; systolic blood pressure, 0; and no evidence of neurologic activity. These same criteria were reassessed on arrival at the emergency department (ED). Furthermore, we examined patients presenting to the ED who underwent resuscitative thoracotomy (Current Procedural Terminology code 34.02). Our primary outcome was survival to discharge from the hospital. RESULTS: There were a total of 3,115,597 pediatric patients who were found in the field after experiencing blunt trauma. Of those, 7,766 (0.25{\%}) had no SOL. Seventy percent of the patients with no SOL in the field were male. Survival to hospital discharge of all patients presenting with no SOL was 4.4{\%} (n = 340). Twenty-five percent of the patients in the field with no SOL were successfully resuscitated in the field and regained SOL by the time they arrived to the ED (n = 1,913). Of those patients who regained SOL, 13.8{\%} (n = 265) survived to hospital discharge. For patients in the field with no SOL, survival to discharge was significantly higher in patients who did not receive a resuscitative thoracotomy than in those who did. CONCLUSION: Survival of pediatric blunt trauma patients in the field without SOL is dismal. Resuscitative thoracotomy poses a heightened risk of blood-borne pathogen exposure to involved health care workers and is associated with a significantly lower survival rate. LEVEL OF EVIDENCE: Prognostic study, level III; therapeutic study, level IV.",
keywords = "Emergency, pediatric, survival, thoracotomy, trauma",
author = "Vincent Duron and Burke, {Rita V.} and David Bliss and Henri Ford and Upperman, {Jeffrey S.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1097/TA.0000000000000394",
language = "English (US)",
volume = "77",
pages = "422--426",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Survival of pediatric blunt trauma patients presenting with no signs of life in the field

AU - Duron, Vincent

AU - Burke, Rita V.

AU - Bliss, David

AU - Ford, Henri

AU - Upperman, Jeffrey S.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - BACKGROUND: Prehospital traumatic cardiopulmonary arrest is associated with dismal prognosis, and patients rarely survive to hospital discharge. Recently established guidelines do not apply to the pediatric population because of paucity of data. The study objective was to determine the survival of pediatric patients presenting in the field with no signs of life after blunt trauma. METHODS: We conducted a retrospective analysis of the National Trauma Data Bank research data set (2002-2010). All patients 18 years and younger with blunt traumatic injuries were identified (DRG International Classification of Diseases - 9th Rev. codes 800-869). No signs of life (SOL) was defined on physical examination findings and included the following: pulse, 0; respiratory rate, 0; systolic blood pressure, 0; and no evidence of neurologic activity. These same criteria were reassessed on arrival at the emergency department (ED). Furthermore, we examined patients presenting to the ED who underwent resuscitative thoracotomy (Current Procedural Terminology code 34.02). Our primary outcome was survival to discharge from the hospital. RESULTS: There were a total of 3,115,597 pediatric patients who were found in the field after experiencing blunt trauma. Of those, 7,766 (0.25%) had no SOL. Seventy percent of the patients with no SOL in the field were male. Survival to hospital discharge of all patients presenting with no SOL was 4.4% (n = 340). Twenty-five percent of the patients in the field with no SOL were successfully resuscitated in the field and regained SOL by the time they arrived to the ED (n = 1,913). Of those patients who regained SOL, 13.8% (n = 265) survived to hospital discharge. For patients in the field with no SOL, survival to discharge was significantly higher in patients who did not receive a resuscitative thoracotomy than in those who did. CONCLUSION: Survival of pediatric blunt trauma patients in the field without SOL is dismal. Resuscitative thoracotomy poses a heightened risk of blood-borne pathogen exposure to involved health care workers and is associated with a significantly lower survival rate. LEVEL OF EVIDENCE: Prognostic study, level III; therapeutic study, level IV.

AB - BACKGROUND: Prehospital traumatic cardiopulmonary arrest is associated with dismal prognosis, and patients rarely survive to hospital discharge. Recently established guidelines do not apply to the pediatric population because of paucity of data. The study objective was to determine the survival of pediatric patients presenting in the field with no signs of life after blunt trauma. METHODS: We conducted a retrospective analysis of the National Trauma Data Bank research data set (2002-2010). All patients 18 years and younger with blunt traumatic injuries were identified (DRG International Classification of Diseases - 9th Rev. codes 800-869). No signs of life (SOL) was defined on physical examination findings and included the following: pulse, 0; respiratory rate, 0; systolic blood pressure, 0; and no evidence of neurologic activity. These same criteria were reassessed on arrival at the emergency department (ED). Furthermore, we examined patients presenting to the ED who underwent resuscitative thoracotomy (Current Procedural Terminology code 34.02). Our primary outcome was survival to discharge from the hospital. RESULTS: There were a total of 3,115,597 pediatric patients who were found in the field after experiencing blunt trauma. Of those, 7,766 (0.25%) had no SOL. Seventy percent of the patients with no SOL in the field were male. Survival to hospital discharge of all patients presenting with no SOL was 4.4% (n = 340). Twenty-five percent of the patients in the field with no SOL were successfully resuscitated in the field and regained SOL by the time they arrived to the ED (n = 1,913). Of those patients who regained SOL, 13.8% (n = 265) survived to hospital discharge. For patients in the field with no SOL, survival to discharge was significantly higher in patients who did not receive a resuscitative thoracotomy than in those who did. CONCLUSION: Survival of pediatric blunt trauma patients in the field without SOL is dismal. Resuscitative thoracotomy poses a heightened risk of blood-borne pathogen exposure to involved health care workers and is associated with a significantly lower survival rate. LEVEL OF EVIDENCE: Prognostic study, level III; therapeutic study, level IV.

KW - Emergency

KW - pediatric

KW - survival

KW - thoracotomy

KW - trauma

UR - http://www.scopus.com/inward/record.url?scp=84907330786&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84907330786&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000000394

DO - 10.1097/TA.0000000000000394

M3 - Article

C2 - 25159245

AN - SCOPUS:84907330786

VL - 77

SP - 422

EP - 426

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 3

ER -