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Does Young Age Merit Increased Emergency Department Trauma Team Response?

INTRODUCTION: To determine if increased trauma team response results in alterations in resource use in a population of children <6 years, especially in those least injured. METHODS: We conducted a retrospective before and after study of children <6 years sustaining blunt trauma and meeting def...

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Autores principales: Holmes, James F., Caltagirone, Ryan, Murphy, Maureen, Abramson, Lisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876296/
https://www.ncbi.nlm.nih.gov/pubmed/24381673
http://dx.doi.org/10.5811/westjem.2013.5.12654
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author Holmes, James F.
Caltagirone, Ryan
Murphy, Maureen
Abramson, Lisa
author_facet Holmes, James F.
Caltagirone, Ryan
Murphy, Maureen
Abramson, Lisa
author_sort Holmes, James F.
collection PubMed
description INTRODUCTION: To determine if increased trauma team response results in alterations in resource use in a population of children <6 years, especially in those least injured. METHODS: We conducted a retrospective before and after study of children <6 years sustaining blunt trauma and meeting defined prehospital criteria. We compared hospitalization rates and missed injuries (injuries identified after discharge from the emergency department/hospital) among patients with and without an upgraded trauma team response. We compared the computed tomography (CT) rate and laboratory testing rate among minimally injured patients (Injury Severity Score [ISS] 6). RESULTS: We enrolled 352 patients with 180 (mean age 2.7 ± 1.5 years) in the upgrade cohort and 172 (mean age 2.6 ± 1.5 years) in the no-upgrade cohort. Independent predictors of hospital admission in a regression analysis included: Glasgow Coma Scale <14 (odds ratio [OR]=11.4, 95% confidence interval [CI] 2.3, 56), ISS (OR=1.55, 95% CI 1.33, 1.81), and evaluation by the upgrade trauma team (OR=5.66, 95% CI 3.14, 10.2). In the 275 patients with ISS <6, CT (relative risk=1.34, 95% CI 1.09, 1.64) and laboratory tests (relative risk=1.71, 95% CI 1.39, 2.11) were more likely to be obtained in the upgrade cohort as compared to the no-upgrade cohort. We identified no cases of a missed diagnosis. CONCLUSION: Increasing the trauma team response based upon young age results in increased resource use without altering the rate of missed injuries. In hospitals with emergency department physicians capable of evaluating and treating injured children, increasing ED trauma team resources solely for young age of the patient is not recommended.
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spelling pubmed-38762962013-12-31 Does Young Age Merit Increased Emergency Department Trauma Team Response? Holmes, James F. Caltagirone, Ryan Murphy, Maureen Abramson, Lisa West J Emerg Med Injury Outcomes INTRODUCTION: To determine if increased trauma team response results in alterations in resource use in a population of children <6 years, especially in those least injured. METHODS: We conducted a retrospective before and after study of children <6 years sustaining blunt trauma and meeting defined prehospital criteria. We compared hospitalization rates and missed injuries (injuries identified after discharge from the emergency department/hospital) among patients with and without an upgraded trauma team response. We compared the computed tomography (CT) rate and laboratory testing rate among minimally injured patients (Injury Severity Score [ISS] 6). RESULTS: We enrolled 352 patients with 180 (mean age 2.7 ± 1.5 years) in the upgrade cohort and 172 (mean age 2.6 ± 1.5 years) in the no-upgrade cohort. Independent predictors of hospital admission in a regression analysis included: Glasgow Coma Scale <14 (odds ratio [OR]=11.4, 95% confidence interval [CI] 2.3, 56), ISS (OR=1.55, 95% CI 1.33, 1.81), and evaluation by the upgrade trauma team (OR=5.66, 95% CI 3.14, 10.2). In the 275 patients with ISS <6, CT (relative risk=1.34, 95% CI 1.09, 1.64) and laboratory tests (relative risk=1.71, 95% CI 1.39, 2.11) were more likely to be obtained in the upgrade cohort as compared to the no-upgrade cohort. We identified no cases of a missed diagnosis. CONCLUSION: Increasing the trauma team response based upon young age results in increased resource use without altering the rate of missed injuries. In hospitals with emergency department physicians capable of evaluating and treating injured children, increasing ED trauma team resources solely for young age of the patient is not recommended. Department of Emergency Medicine, University of California, Irvine School of Medicine 2013-11 /pmc/articles/PMC3876296/ /pubmed/24381673 http://dx.doi.org/10.5811/westjem.2013.5.12654 Text en Copyright © 2013 the authors. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Injury Outcomes
Holmes, James F.
Caltagirone, Ryan
Murphy, Maureen
Abramson, Lisa
Does Young Age Merit Increased Emergency Department Trauma Team Response?
title Does Young Age Merit Increased Emergency Department Trauma Team Response?
title_full Does Young Age Merit Increased Emergency Department Trauma Team Response?
title_fullStr Does Young Age Merit Increased Emergency Department Trauma Team Response?
title_full_unstemmed Does Young Age Merit Increased Emergency Department Trauma Team Response?
title_short Does Young Age Merit Increased Emergency Department Trauma Team Response?
title_sort does young age merit increased emergency department trauma team response?
topic Injury Outcomes
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876296/
https://www.ncbi.nlm.nih.gov/pubmed/24381673
http://dx.doi.org/10.5811/westjem.2013.5.12654
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