@article{ref1,
title="Management of severely injured children in road accidents in France: Impact of the acute care organization on the outcome",
journal="Pediatric critical care medicine",
year="2009",
author="Javouhey, Etienne and Guerin, Anne-Celine and Martin, Jessica L. and Floret, D. and Chiron, Mireille",
volume="10",
number="4",
pages="472-478",
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.<p /> <p>Language: en</p>",
language="en",
issn="1529-7535",
doi="10.1097/PCC.0b013e318198b1cb",
url="http://dx.doi.org/10.1097/PCC.0b013e318198b1cb"
}