Articles: trauma.
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Pediatric emergency care · Dec 2024
External Validation of the Surgical Intervention for Traumatic Injuries Scale in Children.
The Surgical Intervention for Traumatic Injuries (SITI) scale is intended to predict the likelihood of needing surgical decompression among patients with traumatic brain injury (TBI). We sought to examine the performance of the SITI score to predict likelihood of acute neurosurgical intervention for children with TBI. ⋯ A SITI score of less than 2 is associated with nonoperative management. However, clinicians should not be falsely reassured by a low score in patients with depressed skull fractures.
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The impact of prolonged emergency department length of stay (EDLOS) on appropriately timed pharmacological venous thromboembolism prophylaxis (VTEp) and VTE outcomes is unknown in trauma. ⋯ Prolonged EDLOS delayed pharmacological VTEp in a nation-wide cohort of trauma patients. Absent VTEp, consequently, increased risk of in-hospital VTE, although future study is needed to validate these findings. Timely transfer of stable trauma patients to the floor may improve outcomes by facilitating appropriately timed VTEp administration and decreasing ED overcrowding.
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Electronic (E)-scooters have become increasingly common in Ireland. Our group was the first to publish an analysis of injuries related to these devices in Ireland in 2021. Since then, the use of e-scooters has increased significantly. The primary aim of this study was to re-analyse the trend in scooter-related trauma 4 years later. ⋯ E-scooters remain to be a key contributor to emergency department presentations and complex orthopaedic injuries. The majority of patients require radiological investigation and specialist follow-up, with many needing surgical fixation. The effects of such injuries can have severe long-term consequences for patients and place financial constraints on our health system. With the rollout of e-scooter rental schemes and infrequent helmet use, one can expect the resulting trauma will continue to rise.
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Emergency medical services (EMS) clinicians manage patients with traumatic pneumothoraxes. These may be simple pneumothoraxes that are less clinically impactful, or tension pneumothoraxes that disturb perfusion, lead to shock, and impart significant risk for morbidity and mortality. Needle thoracostomy is the most common EMS treatment of tension pneumothorax, but despite the potentially life-saving value of needle thoracostomy, reports indicate frequent misapplication of the procedure as well as low rates of successful decompression. ⋯ EMS clinicians must determine when pleural decompression is indicated and optimize the safety and effectiveness of the procedure. Furthermore, there is also ambiguity regarding EMS management of open pneumothoraxes. To provide evidence-based guidance on the management of traumatic pneumothoraxes in the EMS setting, the National Association of EMS Physicians (NAEMSP) performed a structured literature review and developed the following recommendations supported by the evidence summarized in the accompanying resource document.