Citation

Javouhey E, Guerin AC, Martin JL, Floret D, Chiron M. Pediatr. Crit. Care Med. 2009; 10(4): 472-478.

Affiliation

Service de reanimation et d'urgences pediatriques, Hopital Edouard Herriot, Place d'Arsonval, Hospices Civils de Lyon, France; UMR T-9405, Joint Unit of Inrets, Bron, France; and Universite de Lyon.

Copyright

(Copyright © 2009, Lippincott Williams and Wilkins)

DOI

10.1097/PCC.0b013e318198b1cb

PMID

19307817

Abstract

OBJECTIVE:: To examine the impact of acute care management on outcome in children severely injured in road accidents. DESIGN AND SETTING:: Prospective follow-up study conducted in 12 French pediatric intensive care units (PICUs) over a 24-month period. PATIENTS:: Excluding those in refractory shock or in brain death at admission, a total of 125 children aged <17 years admitted to PICU with severe trauma (injury severity score >/=16) were included. RESULTS:: Intracranial pressure (ICP) monitoring and admission into a trauma resuscitation room (TRR) were used as proxy markers for the center management aggressiveness. Centers which admitted to TRR and monitored ICP when indicated in >75% of cases were called aggressive centers. Children with ICP monitoring indication admitted to a TRR and ICP monitored, as well as those without indication treated in a TRR, were judged appropriately managed. A poor outcome at PICU discharge was defined as a difference between the baseline and discharge pediatric overall performance category above 3, or a hospital death. Children with traumatic brain injury appropriately managed in a less-aggressive center were more likely to have a poor outcome than those appropriately managed in an aggressive center (odds ratio = 7.56, 95% confidence interval: 1.5-38.4), after adjustment for severity, age, and type of road user. CONCLUSIONS:: The management in a more aggressive center for children admitted to TRR and ICP monitored, when indicated, is associated with a better outcome. This could be explained by a more extensive experience in trauma management.

Language: en