Document Detail

Factors associated with patient exposure and environmental control during pediatric trauma resuscitation.
MedLine Citation:
PMID:  23354260     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Exposure and environmental control are essential components of the advanced trauma life support primary survey, especially during the resuscitation of pediatric patients. Proper exposure aids in early recognition of injuries in patients unable to communicate their injuries, while warming techniques, such as the use of blankets, assist in maintaining normothermia. The purpose of this study was to identify factors associated with exposure compliance and duration during pediatric trauma resuscitation.
METHODS: All pediatric trauma resuscitations over a 4-month period were reviewed for compliance and time to completion of clothing removal and warm blanket placement. Video review data were then linked with clinical data obtained from the trauma registry. Univariate and multivariate analyses were used to determine the associations of patient characteristics, injury mechanism, and clinical factors on exposure compliance and duration.
RESULTS: Of 145 patients, 65 (52%) were never exposed. Lower exposure compliance was associated with increasing age (odds ratio, [OR], 0.90; 95% confidence interval [CI], 0.83-0.98), Glasgow Coma Scale (GCS) score of 14 or greater (OR, 0.16; 95% CI, 0.03-0.76), Injury Severity Score (ISS) of 15 or less (OR, 0.27; 95% CI, 0.09-0.82), and the absence of head injury (OR, 0.26; 95% CI, 0.08-0.87). Among those exposed, the duration of exposure was longer among children with GCS score of less than 14 (4.3 [1.6], p = 0.009), head injuries (3.33 [1.6], p = 0.04), and the need for intubation (8.4 [2.2], p < 0.001). In multivariate analyses, older age and ISS of 15 or less were associated with a decreased odds of exposure (p = 0.009, p = 0.04, respectively), while intubation was associated with increased exposure duration (p = 0.007).
CONCLUSION: Despite the importance of exposure and environmental control during pediatric trauma resuscitation, compliance with these tasks was low, even among severely injured patients. Interventions are needed to promote the proper exposure of patients during the initial evaluation, while also limiting the duration of exposure during examinations and procedures in the trauma bay.
LEVEL OF EVIDENCE: Epidemiologic study, level III.
Deirdre C Kelleher; Lauren J Waterhouse; Samantha E Parsons; Jennifer L Fritzeen; Randall S Burd; Elizabeth A Carter
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  74     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-28     Completed Date:  2013-04-05     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  622-7     Citation Subset:  AIM; IM    
Division of Trauma and Burns, Children's National Medical Center, Washington, District of Columbia 20010, USA.
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MeSH Terms
Advanced Trauma Life Support Care / methods,  standards
Body Temperature
Child, Preschool
Clinical Protocols / standards
Environment, Controlled
Guideline Adherence
Infant, Newborn
Injury Severity Score
Physical Examination / methods,  standards
Resuscitation / methods*,  standards
Retrospective Studies
Trauma Centers / standards
Video Recording
Wounds and Injuries / therapy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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