Dissolved Barium Causes Toxicity to Groundwater Cyclopoida.

Barium (Ba) dissolution and mobilization in groundwater are predominantly controlled by sulfate because of the low solubility of barium sulfate (BaSO) minerals. Naturally present at low concentrations in groundwater, elevated concentrations of Ba can occur as a result of anthropogenic activities, including use of barite in drill operations, and geogenic sources such as leaching from geological formations. No toxicity data exist for Ba with groundwater organisms (stygofauna) to assess the risk of elevated Ba concentrations.

Optimizing patient selection for ECMO after pediatric hypothermic cardiac arrest.

Background: In 2004, our level 1 regional pediatric trauma center created a protocol to activate ECMO for children with suspected hypothermic cardiac arrest based on inclusion criteria: serum potassium ≤9, submersion <90 min, and core body temperature <30 °C. In 2017, Pasquier et al. developed a model to help predict the survival of adults after hypothermic cardiac arrest (HOPE score) that has not been validated in children.

Effect of Early vs Late Inguinal Hernia Repair on Serious Adverse Event Rates in Preterm Infants: A Randomized Clinical Trial.

Importance: Inguinal hernia repair in preterm infants is common and is associated with considerable morbidity. Whether the inguinal hernia should be repaired prior to or after discharge from the neonatal intensive care unit is controversial.

Objective: To evaluate the safety of early vs late surgical repair for preterm infants with an inguinal hernia.

Use of a statewide solid organ injury procotcol to optimize triage, treatment, and transfer for pediatric abdominal trauma.

Background: The Utah Pediatric Trauma Network (UPTN) is a non-competitive collaboration of all 51 hospitals in the state of Utah with the purpose of improving pediatric trauma care. Created in 2019, UPTN has implemented evidence-based guidelines based on hospital resources and capabilities with quarterly review of data collected in a network-specific database. A blunt solid organ injury (SOI) protocol was developed to optimize treatment of these injuries statewide.

A pediatric teletrauma program pilot project: Improves access to pediatric trauma care and timely assessment of pediatric traumas.

Background: Geographic location is a barrier to providing specialized care to pediatric traumas. In 2019, we instituted a pediatric teletrauma program in collaboration with the Statewide Pediatric Trauma Network at our level 1 pediatric trauma center (PTC). Triage guidelines were provided to partnering hospitals (PHs) to aid in evaluation of pediatric traumas.

Ten-Year Analysis of Complications Related to Simple Basilar Skull Fractures in Children Presenting to a Trauma Center.

Objectives: Head trauma is a common presenting complaint among children requiring urgent medical attention, accounting for more than 600,000 emergency department (ED) visits annually, 4% to 30% of which identify skull fractures among the patient's injuries. Previous literature shows that children with basilar skull fractures (BSFs) are usually admitted for observation. We studied whether children with an isolated BSF have complications precluding them from safe discharge home from the ED.

Pediatric cervical spine clearance: A 10-year evaluation of multidetector computed tomography at a level 1 pediatric trauma center.

Introduction: Efficient and accurate evaluation of the pediatric cervical spine (c-spine) for both injury identification and posttraumatic clearance remains a challenge. We aimed to determine the sensitivity of multidetector computed tomography (MDCT) for identification of cervical spine injuries (CSIs) in pediatric blunt trauma patients.

Methods: A retrospective cohort study was conducted at a level 1 pediatric trauma center from 2012 to 2021.

The Utah Pediatric Trauma Network, a statewide pediatric trauma collaborative can safely help nonpediatric hospitals admit children with mild traumatic brain injury.

Background: Created in 2019, the Utah Pediatric Trauma Network (UPTN) is a transparent noncompetitive collaboration of all hospitals in Utah with the purpose of improving pediatric trauma care. The UPTN implements evidence-based guidelines based on hospital resources and capabilities with quarterly review of data collected in a network-specific database. The first initiative was to help triage the care of traumatic brain injury (TBI) to prevent unnecessary transfers while ensuring appropriate care.

Who should be referred for a CT coronary calcium score? Introducing a simple patient risk questionnaire combining traditional and novel risk factors.

Background: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death. Coronary artery calcium (CAC) strongly predicts the risk of ASCVD. There is a need to know who would benefit most from CAC scanning.

Sledding Accidents at a Level 1 Pediatric Trauma Center Between 2006 and 2016.

Background: Sledding is not a risk-free winter sport. According to the US Consumer Product Safety Commission, there were an estimated 13,954 sledding accidents requiring medical care in 2010. However, specific information concerning pediatric injuries related to sledding is not well defined.

Adolescent Vaping-Associated Trauma in the Western United States.

Introduction: Electronic cigarettes (e-cigarettes) are handheld, battery-powered vaporizing devices. It is estimated that more than 25% of youth have used these devices recreationally. While vaping-associated lung injury is an increasingly recognized risk, little is known about the risk of traumatic injuries associated with e-cigarette malfunction.

Operative repair in congenital diaphragmatic hernia: How long do we really need to wait?

Objective: To analyze preoperative cardiopulmonary support and define preoperative stability relative to timing of surgical repair for CDH neonates not on ECMO.

Study Design: We retrospectively analyzed repeated measures of oxygenation index (OI; Paw*FiO×100/PaO) among 158 neonates for temporal preoperative trends. We defined physiologic stability using OI and characterized ventilator days and discharge age relative to delay in repair beyond physiologic stability.

Interest in Improving Access to Pediatric Trauma Care Through Telemedicine.

Despite improved outcomes at pediatric trauma centers (PTC), 90% of injured children are not treated at PTCs. Telemedicine may play a role in ensuring patients are transferred to the appropriate level of care. We aimed to determine the level of interest in trauma telemedicine with our PTC among referring facilities.

Congenital diaphragmatic hernia: a narrative review of controversies in neonatal management.

The consequences of most hernias can be immediately corrected by surgical repair. However, this isn't always the case for children born with a congenital diaphragmatic hernia. The derangements in physiology encountered immediately after birth result from pulmonary hypoplasia and hypertension caused by herniation of abdominal contents into the chest early in lung development.

Use of angioembolization in pediatric polytrauma patients: WITH BLUNT SPLENIC INJURYAngioembolization in Pediatric Blunt Splenic Injury.

Background/purpose: We sought to analyze the use of angioembolization (AE) after pediatric splenic injuries at adult and pediatric trauma centers (ATCs/PTCs).

Methods: The National Trauma Data Bank (2010-2015) was queried for patients (<18 years) who experienced blunt splenic trauma. Multivariate logistic regression was used to determine the association of AE with splenectomy.

Early use of autologous blood patch pleurodesis in children is successful in resolving persistent air leaks.

Purpose: Experience with autologous blood patch (ABP) pleurodesis for persistent air leak in the pediatric population is limited. The purpose of this series was to describe the experience with ABP at a single tertiary children's hospital.

Methods: A retrospective study was performed of all thoracic procedures done by the pediatric surgery service over three years.

Established Time Goals Can Increase the Efficiency of Trauma Resuscitation.

Introduction Our institution uses video review as a quality improvement tool. Starting in March 2018, we specifically focused on meeting certain time goals during trauma resuscitation aimed at decreasing time to final disposition. The purpose of this study was to evaluate the effect of establishing strict time goals on total time spent in the trauma bay by pediatric trauma patients.

Ball Magnets Clicked Together on the Epiglottis.

Neodymium ball magnets are commonly ingested by children and are a risk of causing significant morbidity if not addressed appropriately. While most ingested magnets are located distal to the epiglottis in the gastrointestinal tract, they can rarely get lodged across tissues in the mouth and throat such as the epiglottis. Though rare, this represents an impending airway emergency and requires urgent treatment once identified.

Left-sided congenital diaphragmatic hernia: can we improve survival while decreasing ECMO?

Background: Mortality and ECMO rates for congenital diaphragmatic hernia (CDH) remain ~30%. In 2016, we changed our CDH guidelines to minimize stimulation while relying on preductal oxygen saturation, lower mean airway pressures, stricter criteria for nitric oxide (iNO), and inotrope use. We compared rates of ECMO, survival, and survival without ECMO between the two epochs.

Validation of the "CHIIDA" and application for PICU triage in children with complicated mild traumatic brain injury.

Background: The Children's Intracranial Injury Decision Aid (CHIIDA) was developed to predict which patients with complicated mild traumatic brain injury (cmTBI; GCS ≥13 with depressed skull fracture or intracranial injury) would achieve the composite outcome of neurosurgical intervention, intubation >24 h, or death. The study also explored the CHIIDA as a triage tool to determine need for PICU care. The purpose of this study is to externally validate the CHIIDA and assess its effects on PICU triage.