Lynn Schweer

Multidisciplinary pediatric trauma team training using high-fidelity trauma simulation.

BACKGROUNDnTrauma resuscitations require a high level of team performance. This study evaluated the impact of a comprehensive effort to improve trauma care through multidisciplinary education and the use of simulation training to reinforce training and evaluate performance.nnnMETHODSnFor a 1-year period, expanded trauma education including monthly trauma simulation sessions using high-fidelity simulators was implemented. All members of the multidisciplinary trauma resuscitation team participated in education, including simulations. Each simulation session included 2 trauma scenarios that were videotaped for debriefing as well as subsequent analysis of team performance. Scored simulations were divided into early (initial 4 months) and late (final 4 months) for comparison.nnnRESULTSnFor the first year of the program, 160 members of our multidisciplinary team participated in the simulation. In the early group, the mean percentage of appropriately completed tasks was 65%, whereas in the late group, this increased to 75% (P < .05). Improvements were also observed in initial assessment, airway management, management of pelvic fractures, and cervical spine care.nnnCONCLUSIONSnTraining of a multidisciplinary team in the care of pediatric trauma patients can be enhanced and evaluated through the use of high-fidelity simulation. Improvements in team performance using innovative technology can translate into more efficient care with fewer errors.

Unnecessary Imaging, Not Hospital Distance, or Transportation Mode Impacts Delays in the Transfer of Injured Children

Objectives: Timely transfer of injured children to pediatric trauma centers (PTCs) that can address their unique needs is important. This study was designed to understand the characteristics of transferred injured children. Methods: Data from our level I PTC over 5 years (2002-2006) were reviewed. Transferred patients were divided based on time from injury to arrival at our PTC: early (<2 hours) and late (>2 hours). Data collected included demographics, Injury Severity Scale score, Glasgow Coma Scale score, mode of transportation, referring hospital information including pretransfer imaging, and disposition from our emergency room. Results: Seven hundred forty-eight patients were included. Eighty-two percent (n = 612) were in the late group and arrived, on average, 6 hours after those transferred early (420 vs 69.9 minutes, P < 0.05). Seventy-nine percent (n = 147) of transfers with severe injuries (Injury Severity Scale score >15) and 47% (n = 15) of those with severe head injuries (Glasgow Coma Scale score <8) arrived late. The disproportionate number of late transfers was consistent among all transferring hospitals regardless of distance and only slightly improved in the group transferred by air ambulance. In addition, those transferred late had significantly more pretransfer imaging (49% vs 23%, P = 0.0025). Conclusions: Despite the advantages of care in trauma centers, a significant number of severely injured children are transferred well beyond 2 hours after injury. This study has demonstrated that this pattern of delayed transfer is a systemic problem occurring among all transferring hospitals regardless of distance or mode of patient transfer and is associated with increased use of imaging before transfer.

Pediatric Trauma Nurse Practitioners Increase Bedside Nurses' Satisfaction With Pediatric Trauma Patient Care

Purpose Our Level I Pediatric Trauma Center employs pediatric nurse practitioners (PNP) to manage inpatients. We hypothesized that the involvement of a PNP would lead to increased nursing staff satisfaction with patient care. Methods Children admitted to the trauma service were randomized to PNP or resident care groups. Nurses caring for these children were asked to fill out a satisfaction survey regarding the care that the child received. Findings Sixty-five nurses participated. Nurses scored the PNP group significantly higher in human qualities, information given about the tests, management of the childs pain, and response time to pages/questions. Conclusions Involvement of the PNP leads to higher nursing satisfaction scores compared with residents while providing equivalent care for injured children.

Pediatric airbag injuries: The Ohio experience

BACKGROUND/PURPOSEnWe sought to determine if properly restrained children, less than 13 years of age, placed in the front passenger seat are at greater risk for trauma from airbag deployment than unrestrained children.nnnMETHODSnThe charts of children treated at any of 3 regional pediatric trauma centers in Ohio were reviewed for airbag injuries sustained in motor vehicle crashes between January 1995 and September 1998. Injury Severity Scores (ISS) were compared with Mann-Whitney Rank Sum Test and outcome data with Fishers Exact Tests. Statistical significance was set at P< or =.05.nnnRESULTSnTwenty-seven children aged 1 month to 12 years sustained airbag-related injuries. Sixty-one percent were girls. ISS ranged from 1 to 75 with a mean score (+/- SD) of 10 (14.5). All crashes were at reported speeds of less than 45 mph, and 64% were head-on collisions. No significant differences in the mean ISS (P = .074) occurred between groups. Both groups had similar closed head, ocular and facial injuries, extremity fractures, and number of deaths (P = 1.0). Abdominal organ injury was exclusive to the restrained group. Decapitation only occurred among unrestrained children.nnnCONCLUSIONnOur data showed that airbags, with or without proper safety restraints, can lead to mortality or serious morbidity in children.

Pediatric SBIRT: understanding the magnitude of the problem.

Screening and brief intervention with referral to treatment (SBIRT) have recently been instituted for the adult and older adolescent trauma populations. However, questions persist regarding prevalence in the younger than 18-year population, youngest age for providing alcohol and drug screening, and whether an opportunity is being missed for this population. This article provides a review of literature for the 12-to 17-year-old population regarding alcohol and drug use, adolescent brain maturation, specific adolescent risk considerations, and results of a national survey regarding the frequency and methodology of providing SBIRT for the 12-to 17-year-old population.

Mild traumatic brain injury in children: just another bump on the head?

ABSTRACT Mild traumatic brain injury (MTBI) is frequently encountered in pediatrics and challenges healthcare practitioners to provide safe, consistent, cost-effective care. Clinical management of children who sustain MTBI poses dilemmas for healthcare practitioners. This article will provide an overview of pediatric MTBI including definition, issues impacting diagnosis and management, risk factors for intracranial injury, indications for diagnostic imaging, disposition, and return to sports/activity. Knowledge and understanding of MTBI in children aid healthcare practitioners to make informed competent recommendations for care. Clinicians must have a thorough understanding and working knowledge of pediatric MTBI to aid clinical decisions and optimize patient outcomes.