HOUSING TEMPERATURE ALTERS BURN-INDUCED HYPERMETABOLISM IN MICE.

Mice used in biomedical research are typically housed at ambient temperatures (22°C-24°C) below thermoneutrality (26°C-31°C). This chronic cold stress triggers a hypermetabolic response that may limit the utility of mice in modeling hypermetabolism in response to burns. To evaluate the effect of housing temperature on burn-induced hypermetabolism, mice were randomly assigned to receive sham, small, or large scald burns.

Patient Factors Associated with Access to Outpatient Pediatric General Surgical Care in a Rural State.

Background: We sought to understand factors impacting timely access to outpatient pediatric general surgical care in a largely rural state.

Methods: We conducted a multi-site retrospective cohort study, evaluating patients <18 years referred for outpatient pediatric general surgical evaluation from 11/1/2017-7/31/2022. Outcomes included obtaining an appointment, completing an appointment, and undergoing an operation.

Adolescents' Perceptions of Screening, Brief Intervention, and Referral to Treatment Service at Pediatric Trauma Centers.

Objective: Screening, brief intervention, and referral to treatment (SBIRT) for adolescent alcohol and drug (AOD) use is recommended to occur with adolescents admitted to pediatric trauma centers. Most metrics on SBIRT service delivery only reference medical record documentation. In this analysis we examined changes in adolescents' perception of SBIRT services and concordance of adolescent-report and medical record data, among a sample of adolescents admitted before and after institutional SBIRT implementation.

Lower incidence of blunt cerebrovascular injury among young, properly restrained children: An ATOMAC multicenter study.

Background: Motor vehicle collision (MVC) remains a leading cause of injury and death among children, but the proper use of child safety seats and restraints has lowered the risks associated with motor vehicle travel. Blunt cerebrovascular injury (BCVI) is rare but significant among children involved in MVC. This study reviewed the incidence of BCVI after MVC causing blunt injury to the head, face, or neck, comparing those that were properly restrained with those that were not.

Development and Validation of a Controlled Vocabulary: An OWL Representation of Organizational Structures of Trauma Centers and Trauma Systems.

In trauma care and trauma care research there exists an implementation gap regarding a consistent controlled vocabulary to describe organizational aspects of trauma centers and trauma systems. This paper describes the development and evaluation of a controlled vocabulary for trauma care organizations. We give a detailed description of the involvement of domain experts in the domain analysis workflow and the authoring of definitions and additional term descriptions.

Hypothermia as an Outcome Predictor Tool in Pediatric Trauma: A Propensity-Matched Analysis.

Objective: Hypothermia is an independent risk factor for mortality in adult trauma patients. Two small studies have shown similar results in pediatric trauma patients. Temperature is not included in any pediatric trauma assessment scores.

Impact of a statewide trauma system on the triage, transfer, and inpatient mortality of injured patients.

Background: In 2009, Arkansas implemented a statewide trauma system to address the high rates of mortality and morbidity due to trauma. The principal objective of the Arkansas Trauma System is to transport patients to the appropriate facility based on the injuries of the patients. This study evaluated four metrics that were crucial to system health.

Injured Children Receive Twice the Radiation Dose at Nonpediatric Trauma Centers Compared With Pediatric Trauma Centers.

Background: Use of cranial CT scans in children has been increasing, in part due to increased awareness of sports-related concussions. CT is the largest contributor to medical radiation exposure, a risk factor for cancer. Long-term cancer risks of CT scans can be two to three times higher for children than for adults because children are more radiosensitive and have a longer lifetime in which to accumulate exposure from multiple scans.

Pediatric vascular injuries: Are we preparing trainees appropriately to meet our needs?

Background: There is no required competency for pediatric vascular injury in surgical training. We sought to describe changes over time for surgical specialists operating on pediatric vascular trauma injuries at a pediatric trauma center.

Methods: Charts were retrospectively reviewed for vascular trauma injuries at a freestanding children's hospital between 1993 and 2015.

OOSTT: a Resource for Analyzing the Organizational Structures of Trauma Centers and Trauma Systems.

Organizational structures of healthcare organizations has increasingly become a focus of medical research. In the CAFÉ project we aim to provide a web-service enabling ontology-driven comparison of the organizational characteristics of trauma centers and trauma systems. Trauma remains one of the biggest challenges to healthcare systems worldwide.

Use of a Novel Accounting and Grouping Method for Major Trunk Injury-Analysis of Data from a Statewide Trauma Financial Survey.

Major trunk trauma is common and costly, but comparisons of costs between trauma centers (TCs) are rare. Understanding cost is essential to improve quality, manage trauma service lines, and to facilitate institutional commitment for trauma. We have used results of a statewide trauma financial survey of Levels I to IV TC to develop a useful grouping method for costs and clinical characteristics of major trunk trauma.

The Clinical Impact of a Web-Based Image Repository on Radiation Exposure in Injured Children.

Purpose: The long-term cancer risks for children exposed to radiologic images can be two to three times higher than for adults because children are more sensitive to radiation and have a longer lifetime in which to accumulate exposure from CT scans. Injured children often undergo repeat CT imaging if they are transferred from non-pediatric hospitals to a Level I pediatric trauma center (PTC). This study determined the impact of a statewide web-based image repository (WBIR) on repeat imaging among transferred injured children.

Does restraint status in motor vehicle crash with rollover predict the need for trauma team presence on arrival? An ATOMAC study.

Purpose: Restraint status has not been combined with mechanistic criteria for trauma team activation. This study aims to assess the relationship between motor vehicle crash rollover (MVC-R) mechanism with and without proper restraint and need for trauma team activation.

Methods: Patients <16years old involved in an MVC-R between November 2007 and November 2012 at 6 Level 1 pediatric trauma centers were included.

Nonoperative management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE.

Background: Nonoperative management of liver and spleen injury should be achievable for more than 95% of children. Large national studies continue to show that some regions fail to meet these benchmarks. Simultaneously, current guidelines recommend hospitalization for injury grade + 2 (in days).

Determining the hospital trauma financial impact in a statewide trauma system.

Background: There have been no comprehensive studies across an organized statewide trauma system using a standardized method to determine cost.

Study Design: Trauma financial impact includes the following costs: verification, response, and patient care cost (PCC). We conducted a survey of participating trauma centers (TCs) for federal fiscal year 2012, including separate accounting for verification and response costs.

The effectiveness of a statewide trauma call center in reducing time to definitive care for severely injured patients.

Background: The state of Arkansas developed and implemented a comprehensive inclusive trauma system in July 2010. The Arkansas Trauma Communication Center (ATCC) is a central component in the system, designed to facilitate both scene transports and interfacility transfers within the state. The first 18 months of operations were examined to evaluate the relationship between ATCC use and emergency department (ED) length of stay (LOS) at sending facilities for patients who require urgent care.

Blunt cerebrovascular injury in children: underreported or underrecognized?: A multicenter ATOMAC study.

Background: Blunt cerebrovascular injury (BCVI) has been well described in the adult trauma literature. The risk factors, proper screening, and treatment options are well known. In pediatric trauma, there has been very little research performed regarding this injury.

Duodenal injuries in the very young: child abuse?

Background: Duodenal injuries in children are uncommon but have been specifically linked with child abuse in case reports. Owing to the rarity of the diagnosis, few studies to date have looked at the association between duodenal injuries and mechanism in younger child. We hypothesize that duodenal injuries in the very young are significantly associated with child abuse.

Restraint status improves the predictive value of motor vehicle crash criteria for pediatric trauma team activation.

Background: Most trauma centers incorporate mechanistic criteria (MC) into their algorithm for trauma team activation (TTA). We hypothesized that characteristics of the crash are less reliable than restraint status in predicting significant injury and the need for TTA.

Methods: We identified 271 patients (age, <15 y) admitted with a diagnosis of motor vehicle crash.

Acute kidney injury is associated with increased in-hospital mortality in mechanically ventilated children with trauma.

Background: Acute kidney injury (AKI) is associated with significant morbidity and mortality in patients with critical illness; however, its impact on children with trauma is not fully unexplored. We hypothesized that AKI is associated with increased in-hospital mortality.

Methods: A retrospective review of consecutive mechanically ventilated patients aged 0 years to 20 years from 2004 to 2007 with trauma hospitalized at our institution was performed.