Research Article
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Pediatrik travma hastalarının retrospektif değerlendirilmesi: üçüncü basamak pediatrik yoğun bakım ünitesinin tek merkez deneyimi

Year 2022, , 158 - 164, 26.09.2022
https://doi.org/10.47582/jompac.1134133

Abstract

Amaç: Pediatrik kritik bakım tıbbındaki hızlı gelişme nedeniyle, geçmişteki bazı araştırmalar, pediatrik travma hastalarının daha düşük mortalite ve daha kısa hastanede kalış süresi gibi daha iyi sonuçlara sahip olduğunu ileri sürmüştür. Bununla birlikte, çoğu gelişmekte olan ülkede, pediatrik travma merkezleri çok azdır veya hiç yoktur. Bu çalışmada travma nedeniyle çocuk yoğun bakım ünitemizde (ÇYBÜ) yatan çocukların demografik, klinik özellikleri, yaralanma mekanizmaları ve sonuçlarını tanımlamayı amaçladık.
Gereç ve Yöntem :Ağustos 2020 - Şubat 2022 tarihleri ​​arasında Sağlık Bilimleri Üniversitesi, Sancaktepe Şehit Prof. Dr. İlhan Varank Eğitim ve Araştırma Hastanesi ÇYBÜ’ne başvuran 60 pediatrik travma hastası (0-16 yaş arası) retrospektif olarak değerlendirildi.
Bulgular :ÇYBB’mizde toplam 60 çocuk travma hastası takip edildi. Hastaların medyan yaşı 17 (0-724) aydı ve erkek olgular çoğunluktaydı (n:38, %63,3). ÇYBÜ’de medyan yatış süresi 6 (1-46) gündü. Travma tipine göre yaralanmanın büyük kısmı yüksekten düşme (n:37, %61,7) idi. Travmaya bağlı genel ölüm oranı %13.3 idi.
Sonuç: Düşmeye bağlı kafa travmalarının çok yaygın olduğuna ve mortaliteyi etkilediğine dikkat çekmek isteriz. Mortalite ile laktat, laktat/albümin oranı arasında anlamlı bir ilişki bulduk. Kritik hasta pediatrik hastalarda laktat/albümin oranının mortalite ile ilişkisine yönelik çalışmalar olmasına rağmen literatürde pediatrik travma hastalarında bu konuda herhangi bir veri bulamadık. Çalışmamız pediatrik travma hastalarında laktat/albümin oranı ile mortalite arasındaki ilişki ile ilgili literatüre katkı sağlayacaktır. Vaka sayısı fazla olan pediatrik travma hastalarında laktat/albümin oranı ile mortalite arasındaki ilişkinin araştırılmasını öneriyoruz.

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References

  • Ulusoy E, Duman M, Çağlar A, et al. Acute traumatic coagulopathy: the value of histone in pediatric trauma patients.Turk J Haematol 2018; 35: 122-8.
  • Runde D, Beiner J. Calculated decisions: PECARN pediatric head ınjury/trauma algorithm. Pediatr Emerg Med Pract 2018; 15: CD3-CD4.
  • Koltka K, Ilhan M, Gök AFK, Günay K, Ertekin C. Can ionized calcium levels and platelet counts used for estimating the prognosis of pediatric trauma patients admitted to the emergency surgery intensive care? Ulus Travma Acil Cerrahi Derg 2022; 28: 579-84.
  • Ahmed OZ, Burd RS. Management issues in critically ill pediatric patients with trauma. Pediatr Clin North Am 2017; 64: 973-90.
  • Densmore JC, Lim HJ, Oldham KT, Guice KS. Outcomes and delivery of care in pediatric injury. J Pediatr Surg 200; 41: 92-8.
  • MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality N Engl J Med 2006; 354: 366-78.
  • Brook U, Boaz M. Children hospitalized for accidental injuries: Israeli experiences. Patient Educ Counsel 2003; 51: 177-82.
  • Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2: 81-4.
  • McIntosh AM, Tong S, Deakyne SJ, Davidson JA, Scott HF. Validation of the vasoactive-ınotropic score in pediatric sepsis. Pediatr Crit Care Med 2017; 18: 750-7.
  • Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996; 4: 743-52.
  • Voth M, Lustenberger T, Auner B, Frank J, Marzi I. What injuries should we expect in the emergency room? Injury 2017; 48: 2119-24.
  • Costa GA, Delgado AF, Ferraro A, Okay TS. Application of the pediatric risk of mortality (PRISM) score and determination of mortality risk factors in a tertiary pediatric intensive care unit. Clinics (Sao Paulo) 2010; 65: 1087-92.
  • Franzén L, Ortenwall P, Backteman T. Children in Sweden admitted to intensive care after trauma. Injury 2007; 38: 91-7.
  • Akay MA, Gurbuz N, Yayla D, et al. Acil servise başvuran pediatrik travma olgularının değerlendirilmesi. Kocaeli Tıp Derg 2013; 2: 1-5.
  • Herbert HK, van As AB, Bachani AM, et al. Patterns of pediatric injury in South Africa: an analysis of hospital data between 1997 and 2006. J Trauma Acute Care Surg 2012; 73: 168-74.
  • Klem SA, Pollack MM, Glass NL, et al. Resource use, efficiency, and outcome prediction in pediatric intensive care of trauma patients. J Trauma 1990; 30: 32-6.
  • Lefering R, Paffrath T, Bouamra O, et al. Epidemiology of in-hospital trauma deaths. Eur J Trauma Emerg Surg 2012; 38: 3–9.
  • Pollack MM, Ruttimann UE, Getson PR. Pediatric risk of mortality (PRISM) score. Crit Care Med 1988; 16: 1110-6.
  • Mısırlıoglu M, Sapmaz M, Yontem A, Ekinci F, Horoz ÖÖ, Yıldızdaş DD. Çocuk yoğun bakım ünitemizde takip edilen travma hastalarının değerlendirilmesi. Pediatric Practice and Research 2019: 439-45.
  • Melo JR, Di Rocco F, Lemos-Júnior LP, et al. Defenestration in children younger than 6 years old: mortality predictors in severe head trauma. Childs Nerv Syst 2009,25: 1077-83.
  • Mayer T, Walker ML, Johnson DG, Matlak ME. Causes of morbidity and mortality in severe pediatric trauma. JAMA 1981; 245: 719-21.
  • Emeksiz S, Kockuzu E, Yıldız LA, et al. Evaluation of pediatric trauma patients requiring pediatric intensive care follow-up and identifying the differences in refugee children. Türkiye Çocuk Hastalıkları Derg 2021; 15: 394-9.
  • Hassan NE, DeCou JM, Reischman D, et al. RBC transfusions in children requiring intensive care admission after traumatic injury. Pediatr Crit Care Med 2014; 15: 306-13.
  • Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all–cause mortality in critically ill patients: a systematic review and meta–analysis. Crit Care Med 2014; 4: 2118–25.
  • Gibot S. On the origins of lactate during sepsis. Crit Care 2012; 16: 151.
  • Gatta A, Verardo A, Bolognesi M. Hypoalbuminemia. Intern Emerg Med 2012; 7: 193-9.
  • Wang B, Chen G, Cao Y, Xue J, Li J, Wu Y. Correlation of lactate/ albumin ratio level to organ failure and mortality in severe sepsis and septic shock. J Crit Care 2015; 30: 271-5.
  • Aygun F, Durak C, Varol F, Cokgras H, Camcıoglu Y. The lactate/albumin ratio is an effective predictor for mortality in critically ıll children. Türkiye Çocuk Hastalıkları Derg 2020; 14: 493-9.
  • Lichtenauer M, Wernly B, Ohnewein B, et al. The lactate/albumin ratio: a valuable tool for risk stratification in septic patients admitted to ICU. Int J Molecular Sci 2017; 18: 1893.
  • Yilmaz E, Bor C, Uyar M, Demirag K, Çankayali I. Travma hastalarinin yogun bakima kabulündeki laktat, albumin, c-reaktif protein, PaO2/FiO2 ve glukoz düzeylerinin mortaliteye etkisi. J Turk Soc Intens Care 2014; 12: 82-5.
  • Cakir E, Turan IO. Lactate/albumin ratio is more effective than lactate or albumin alone in predicting clinical outcomes in intensive care patients with sepsis. Scand Clin Lab Invest 2021; 81: 225-9.
  • Choi SJ, Ha EJ, Jhang WK, Park SJ. Association between the lactate/albumin ratio and mortality in pediatric septic shock patients with underlying chronic disease: retrospective pilot study. Minerva Pediatr (Torino) 2021; 73: 67-72.

Retrospective evaluation of pediatric trauma patients: a single-center experience of a tertiary pediatric intensive care unit

Year 2022, , 158 - 164, 26.09.2022
https://doi.org/10.47582/jompac.1134133

Abstract

Aim: Due to the rapid development in pediatric critical care medicine, some past studies suggested that pediatric trauma patients have better outcomes such as lower mortality and lower length of hospital stay in the pediatric intensive care unit (PICU). In this study, we aim to describe the demographic, clinical features, mechanisms of injury, and outcomes of children hospitalized in our pediatric intensive care unit due to trauma.
Material and Method: We performed a retrospective evaluation of 60 pediatric trauma patients (between 0 and16 years of age) admitted to the PICU at University of Health Science, Sancaktepe Sehit Prof. Dr. İlhan Varank Training and Research Hospital from August 2020 to February 2022.
Results: A total of 60 pediatric trauma patients were followed up in our PICU. The median age of patients was 17 (0-724) months with a preponderance of male cases (n:38, 63.3%). The median duration of hospitalization in PICU was 6 (1-46) days. According to the trauma type, the majority of the injuries were falling from a height (n:37, 61.7%).
Conclusion: We would like to draw attention to the fact that head traumas due to falling were so common and also affect mortality. The lactate and the lactate/albumin ratio ​​of patients who developed mortality were significantly higher. Although there are studies on the association of lactate/albumin ratio with mortality in critically ill pediatric patients, we could not find any data on this issue in pediatric trauma patients in the literature. Our study will contribute to the literature on the relationship between lactate/albumin ratio and mortality in pediatric trauma patients. We suggest that the relationship between lactate/albumin ratio and mortality should be investigated in pediatric trauma patients with larger case numbers.

Project Number

yok

References

  • Ulusoy E, Duman M, Çağlar A, et al. Acute traumatic coagulopathy: the value of histone in pediatric trauma patients.Turk J Haematol 2018; 35: 122-8.
  • Runde D, Beiner J. Calculated decisions: PECARN pediatric head ınjury/trauma algorithm. Pediatr Emerg Med Pract 2018; 15: CD3-CD4.
  • Koltka K, Ilhan M, Gök AFK, Günay K, Ertekin C. Can ionized calcium levels and platelet counts used for estimating the prognosis of pediatric trauma patients admitted to the emergency surgery intensive care? Ulus Travma Acil Cerrahi Derg 2022; 28: 579-84.
  • Ahmed OZ, Burd RS. Management issues in critically ill pediatric patients with trauma. Pediatr Clin North Am 2017; 64: 973-90.
  • Densmore JC, Lim HJ, Oldham KT, Guice KS. Outcomes and delivery of care in pediatric injury. J Pediatr Surg 200; 41: 92-8.
  • MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality N Engl J Med 2006; 354: 366-78.
  • Brook U, Boaz M. Children hospitalized for accidental injuries: Israeli experiences. Patient Educ Counsel 2003; 51: 177-82.
  • Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2: 81-4.
  • McIntosh AM, Tong S, Deakyne SJ, Davidson JA, Scott HF. Validation of the vasoactive-ınotropic score in pediatric sepsis. Pediatr Crit Care Med 2017; 18: 750-7.
  • Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996; 4: 743-52.
  • Voth M, Lustenberger T, Auner B, Frank J, Marzi I. What injuries should we expect in the emergency room? Injury 2017; 48: 2119-24.
  • Costa GA, Delgado AF, Ferraro A, Okay TS. Application of the pediatric risk of mortality (PRISM) score and determination of mortality risk factors in a tertiary pediatric intensive care unit. Clinics (Sao Paulo) 2010; 65: 1087-92.
  • Franzén L, Ortenwall P, Backteman T. Children in Sweden admitted to intensive care after trauma. Injury 2007; 38: 91-7.
  • Akay MA, Gurbuz N, Yayla D, et al. Acil servise başvuran pediatrik travma olgularının değerlendirilmesi. Kocaeli Tıp Derg 2013; 2: 1-5.
  • Herbert HK, van As AB, Bachani AM, et al. Patterns of pediatric injury in South Africa: an analysis of hospital data between 1997 and 2006. J Trauma Acute Care Surg 2012; 73: 168-74.
  • Klem SA, Pollack MM, Glass NL, et al. Resource use, efficiency, and outcome prediction in pediatric intensive care of trauma patients. J Trauma 1990; 30: 32-6.
  • Lefering R, Paffrath T, Bouamra O, et al. Epidemiology of in-hospital trauma deaths. Eur J Trauma Emerg Surg 2012; 38: 3–9.
  • Pollack MM, Ruttimann UE, Getson PR. Pediatric risk of mortality (PRISM) score. Crit Care Med 1988; 16: 1110-6.
  • Mısırlıoglu M, Sapmaz M, Yontem A, Ekinci F, Horoz ÖÖ, Yıldızdaş DD. Çocuk yoğun bakım ünitemizde takip edilen travma hastalarının değerlendirilmesi. Pediatric Practice and Research 2019: 439-45.
  • Melo JR, Di Rocco F, Lemos-Júnior LP, et al. Defenestration in children younger than 6 years old: mortality predictors in severe head trauma. Childs Nerv Syst 2009,25: 1077-83.
  • Mayer T, Walker ML, Johnson DG, Matlak ME. Causes of morbidity and mortality in severe pediatric trauma. JAMA 1981; 245: 719-21.
  • Emeksiz S, Kockuzu E, Yıldız LA, et al. Evaluation of pediatric trauma patients requiring pediatric intensive care follow-up and identifying the differences in refugee children. Türkiye Çocuk Hastalıkları Derg 2021; 15: 394-9.
  • Hassan NE, DeCou JM, Reischman D, et al. RBC transfusions in children requiring intensive care admission after traumatic injury. Pediatr Crit Care Med 2014; 15: 306-13.
  • Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all–cause mortality in critically ill patients: a systematic review and meta–analysis. Crit Care Med 2014; 4: 2118–25.
  • Gibot S. On the origins of lactate during sepsis. Crit Care 2012; 16: 151.
  • Gatta A, Verardo A, Bolognesi M. Hypoalbuminemia. Intern Emerg Med 2012; 7: 193-9.
  • Wang B, Chen G, Cao Y, Xue J, Li J, Wu Y. Correlation of lactate/ albumin ratio level to organ failure and mortality in severe sepsis and septic shock. J Crit Care 2015; 30: 271-5.
  • Aygun F, Durak C, Varol F, Cokgras H, Camcıoglu Y. The lactate/albumin ratio is an effective predictor for mortality in critically ıll children. Türkiye Çocuk Hastalıkları Derg 2020; 14: 493-9.
  • Lichtenauer M, Wernly B, Ohnewein B, et al. The lactate/albumin ratio: a valuable tool for risk stratification in septic patients admitted to ICU. Int J Molecular Sci 2017; 18: 1893.
  • Yilmaz E, Bor C, Uyar M, Demirag K, Çankayali I. Travma hastalarinin yogun bakima kabulündeki laktat, albumin, c-reaktif protein, PaO2/FiO2 ve glukoz düzeylerinin mortaliteye etkisi. J Turk Soc Intens Care 2014; 12: 82-5.
  • Cakir E, Turan IO. Lactate/albumin ratio is more effective than lactate or albumin alone in predicting clinical outcomes in intensive care patients with sepsis. Scand Clin Lab Invest 2021; 81: 225-9.
  • Choi SJ, Ha EJ, Jhang WK, Park SJ. Association between the lactate/albumin ratio and mortality in pediatric septic shock patients with underlying chronic disease: retrospective pilot study. Minerva Pediatr (Torino) 2021; 73: 67-72.
There are 32 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Articles [en] Araştırma Makaleleri [tr]
Authors

Fatih Varol

Yasar Yusuf Can 0000-0002-1767-1551

Büşra Özgünay

Mehmet Cengiz

Ugur Altas 0000-0001-5871-2033

Şirin Güven 0000-0001-8727-5805

Halit Cam

Project Number yok
Publication Date September 26, 2022
Published in Issue Year 2022

Cite

AMA Varol F, Can YY, Özgünay B, Cengiz M, Altas U, Güven Ş, Cam H. Retrospective evaluation of pediatric trauma patients: a single-center experience of a tertiary pediatric intensive care unit. J Med Palliat Care / JOMPAC / Jompac. September 2022;3(3):158-164. doi:10.47582/jompac.1134133

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