· 2017. 11. 22. · Maricopa Integrated Health System Summer Magoteaux, BSN RN Phoenix Children’s Hospital Todd Nickoles, BSN RN MBA Jessica Swietzer David W. Tellez, MD FCCM

www.pedtrauma.org

WPTC-Syllabus-2017.indd 1WPTC-Syllabus-2017.indd 1 6/30/2017 3:57:47 PM6/30/2017 3:57:47 PM

Dear Conference Attendee,

The Western Pediatric Trauma Conference welcomes you to the Bacara Resort & Spa on the Santa Barbara shore. We hope that the beautiful location, between the Pacifi c and the Santa Ynez Mountains, offers opportunities for both relaxation and learning.

We would like to thank:

• The faculty who have generously taken time from their busy schedules to share their expertise

• The moderators, planning committee, and many others who have joined our team to prepare for this conference

• The exhibitors who support this conference and bring cutting-edge products and services to enhance pediatric trauma services

• Most of all, our attendees, without whom this conference would not be possible!

Enclosed you will fi nd a layout of the conference facilities, course schedule, abstracts, and information about obtaining your continuing education credit.

It is our hope that as you soak in the sun and shore, you also absorb ideas to improve pediatric trauma care and outcomes. Thank you again for attending the Western Pediatric Trauma Conference in Santa Barbara, California. We hope to see you again next year in Park City, Utah.

Sincerely,

WP TC P lanning C ommitteeWestern Pediatric Trauma Conference Planning Committee

Welcome

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3

Collaborating Hospitals .......................................................................... 4Planning Committee ................................................................................. 5Agenda ...................................................................................................... 6Facility Map .............................................................................................. 11General Information ................................................................................ 12Faculty ........................................................................................................ 13Certifi cates and Evaluations ................................................................... 15Objectives.................................................................................................. 16Evaluation and Disclosures ..................................................................... 23WPTC 2018 .............................................................................................. 24Abstracts .................................................................................................... 26Notes ......................................................................................................... 55

Table of

Contents

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Collaborating

Hospitals

This activity has been created in collaboration with the following agencies.

Provided by:

In collaboration with:

4


Board of Directors & FacultyDavid M. Notrica, MD FACSAssociate Professor of SurgeryUniversity of Arizona - PhoenixTrauma Medical DirectorPhoenix Children’s Hospital

Eric R. Scaife, MD FACSProfessor of SurgeryUniversity of Utah Chief, Division of Pediatric SurgeryPrimary Children’s Hospital

Steven L. Moulton, MD FACSProfessor of SurgeryUniversity of ColoradoMedical DirectorTrauma and Burn ProgramsChildren’s Hospital Colorado

MembersChildren’s Hospital ColoradoRay A. Cuellar, BSJohn Recicar, BSN MBA MHAJason Stoneback, MD

Children’s Hospital MinnesotaMelea Anderson, DNP RN CPNP MBADavid Hirschman, MDNathan Kreykes, MD

Children’s Hospital Los AngelesAaron Jensen, MD

Children’s Hospital Orange CountyDavid Gibbs, MDAmy Waunch, MSN RN FNP CEN

Maricopa Integrated Health SystemSummer Magoteaux, BSN RN

Phoenix Children’s HospitalTodd Nickoles, BSN RN MBAJessica SwietzerDavid W. Tellez, MD FCCM

Primary Children’s HospitalStephen J. Fenton, MD FACSKris Hansen, BSN RNHilary Hewes, MDCarrie Roberts, BS

Santa Barbara Cottage HospitalSue Fortier, MS RN CENStephen Kaminski, MD

St. Luke’s Children’s HospitalSharon Chow, MN RN CPEN

University Health System San AntonioLillian Liao, MDJenny Oliver, RN

Planning

Committee

5


Agenda

Tuesday, July 11, 20175:00-8:00 p.m. Welcome Reception and Early Sign-in

Wednesday, July 12, 20177:00 a.m. Sign-in & Continental Breakfast

7:30 Welcome and Opening Remarks David M. Notrica, MD FACS 7:45 The Evidence-based Evaluation of Children with Abdominal Trauma Nathan Kuppermann, MD MPH 8:30 Firearm Injury Prevention: The Approach of the American College of Surgeons Committee on Trauma Ronald M. Stewart, MD FACS 9:00 Re-imaging After Blunt Abdominal Trauma: What Have We Learned in 20 Years? David M. Notrica, MD FACS 9:30 Break with the exhibitors 10:00 Scientifi c Abstracts/Best Practice Podium Presentations 11:00 Neuroprognostication after Traumatic Brain Injury Craig Press, MD PhD 11:30 Key Principles of Pediatric Genitourinary and Anorectal Trauma Lillian F. Liao, MD MPH 12:00 p.m. Lunch 1:00 Bandidos de Bacara Point-Counterpoint: Pediatric Trauma Activation Criteria Sigmund J. Kharasch, MD and Lillian F. Liao, MD MPH 1:30 ECMO in Environmental Hypothermia Stephen J. Fenton, MD FACS 2:00 Refi ning Pediatric Trauma Resuscitation

R. Todd Maxson, MD FACS 2:30 Poster presentations and visit exhibitors 3:30-3:45 Evaluation and wrap up 6:00-8:00 Manuscript Review Committee Meeting - Closed Meeting 11:30

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Bout of the

Day

de Bacara

Wednesday, July 12, 2017 at 1:00 pm

Who will become Bacara’s


Agenda

Thursday, July 13, 20177:00 a.m. Sign-in & Continental Breakfast

7:30 Screening Practices for Non-Accidental Trauma – A Surgeon’s Perspective Jonathan I. Groner, MD 8:00 Scientifi c/Best Practice Podium Presentations 8:30 American College of Surgeons Committee on Trauma Update and Future Direction - Stop the Bleed Ronald M. Stewart, MD FACS 9:00 Developing a Pediatric Trauma Program in an Adult Trauma Center Paul B. Harrison, MD FACS 9:30 Break with the exhibitors 10:00 Control the Chaos - Automated Compression Devices David W. Tellez, MD FCCM 10:30 Skeletal Maturity Implications for the Fixation of Long Bone Fractures Jason Stoneback, MD 11:00 Traumatic Bronchus Avulsion Case Report

Eric R. Scaife, MD FACS 11:30 The Science of Teamwork

Jared W. Henricksen, MD 12:00 p.m. Lunch 1:00 Shark Attack Point-Counterpoint: Neurotrauma Resuscitation Monitoring: High Tech vs. Low Tech P. David Adelson, MD FACS FAAP and Craig Press, MD PhD 1:30 Traumatic Brain Injury Prediction Rules in Children: Generating/Validating the Evidence, Translation to Practice, and Shared Decision Making Nathan Kuppermann, MD MPH 2:00 Break with the exhibitors 2:30 Pediatric Neurotrauma and Neurocritical Care Management P. David Adelson, MD FACS FAAP 3:00 Disaster Preparedness, Response, and Recovery Considerations for Children

Jeffrey Upperman, MD FAAP FACS 3:30-3:45 Evaluation and Wrap Up 5:00-8:00 5th Annual Volleyball Tournament

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Monitoring in Neuro-Intensive Care

Bout of the

Day

Thursday, July 13, 2017 at 1:00 pm

Who will be the


Agenda

Friday, July 14, 20177:00 a.m. Sign-in & Continental Breakfast

7:30 Pediatric Peripheral Vascular Injuries R. Todd Maxson, MD FACS 8:00 Considerations in Complex Facial Dog Bite Injuries Mehdi K. Mazaheri, MD PC 8:30 Rapid Fire Best Practice Abstract Presentations 9:00 Prevention and Treatment of Pain in Pediatric Trauma Patients Stefan J. Friedrichsdorf, MD FAAP 9:30 Abstract Award Presentations and Next Year’s Conference Preview 9:45 Break with the exhibitors 10:15 The Brain: Operating System 1.0 - How We Respond to Crisis Shari Rybak, MBA RN CEN CPEN TCRN 10:45 Extremity Compartment Syndrome: 2017 Update David L. Rothberg, MD 11:15 Disaster and Mass Casualty Training at a Community Hospital in Israel Jonathan I. Groner, MD 11:45 Incorporating Simulation Into a Trauma Teamwork Model Aaron R. Jensen, MD MEd 12:15-12:30 p.m. Evaluation, Wrap-up and Adjourn 11:30

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General SessionsBallroom A&B

Exhibit Hall,Poster Session &

BreaksBallroom C

Level 1

Facility Map

Director’s Lounge

Green Room

Foyer

Screening Room

Elevator

Proje

ction

Room

W

MBallroom

Foyer

Veranda

BA C

Terrace

Director’s Lounge & Bacara Ballroom

BallroomBA C

Director’s Lounge

Registration/Sign-InDirector’s Lounge

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ObjectivesUpon completion of this course, participants should be able to:• Apply newly acquired knowledge in the management of pediatric trauma patients.• Formulate resuscitation strategies using evidence-based guidelines.• Select appropriate diagnostic and therapeutic algorithms for specifi c injury types.• Assess the evidence supporting diagnostic algorithms and clinical pathways.

Continuing Education CreditA certifi cate of attendance will be available upon completion of the online evaluation. Claim only those hours you attend (7/12: 6.5 hours, 7/13: 6 hours, 7/14: 4 hours).

Physicians: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the providership of Phoenix Children’s Hospital.

Phoenix Children’s Hospital is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Phoenix Children’s Hospital designates this live activity for a maximum of 16.5 AMA PRA Category 1 Credits TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing: Phoenix Children’s Hospital is an approved provider of continuing nursing education by the Western Multi-State Division, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

Arizona, Colorado, Idaho, and Utah Nurses Association are members of the Western Multi-State Division of the American Nurses Association.

This educational activity offers 16.5 nursing contact hours.

Successful completion is attendance at all presentations. Credit is awarded for the number of sessions fully attended.

EMS: Santa Barbara Cottage Hospital is an approved provider of EMS Continuing Education credit by the state of California

Other: If requested, a general certifi cate of attendance will be provided for all other healthcare providers.

General

Information

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Faculty

P. David Adelson, MD FACS FAAPProfessor of NeurosurgeryUniversity of ArizonaAdjunct Professor of Biological and Health SystemsArizona State UniversityMedical Director, Barrow Neurological InstituteChief, Pediatric NeurosurgeryPhoenix Children’s Hospital Phoenix, Arizona

Jonathan I. Groner, MDProfessor of SurgeryOhio State UniversityMedical Director, Trauma ProgramMedical DirectorCenter Pediatric Trauma ResearchAttending Physician, Burn ProgramNationwide Children’s HospitalColumbus, Ohio

Stephen J. Fenton, MD FACSAssistant Professor of SurgeryAdjunct Assistant Professor of PediatricsUniversity of UtahMedical Director, Trauma ProgramPrimary Children’s HospitalSalt Lake City, Utah

Stefan J. Friedrichsdorf, MD FAAPAssociate Professor of PediatricsUniversity of MinnesotaMedical DirectorDepartment of Pain MedicinePalliative Care and Intergrative MedicineChildren’s Hospital and Clinics of MinnesotaMinneapolis, Minnesota

Paul B. Harrison, MD FACSClinical Professor of SurgeryUniversity of KansasMedical Director, Trauma CareWesley Medical CenterWichita, Kansas

Jared W. Henricksen, MDAssociate Professor of Critical Care MedicineUniversity of UtahMedical Director, SimulationPrimary Children’s HospitalSalt Lake City, Utah

Aaron R. Jensen, MD MEdAssistant Professor of SurgeryUniversity of Southern CaliforniaAttending Physician, Pediatric SurgeryChildren’s Hospital Los AngelesLos Angeles, California

Sigmund J. Kharasch, MDAssistant Professor of Pediatrics Harvard UniversityAttending PhysicianPediatric Emergency MedicineMassachusetts General HospitalBoston, Massachusetts

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Nathan Kuppermann, MD MPHProfessor of Emergency Medicine and PediatricsUniversity of California San FranciscoChair, Executive CommitteeGlobal Pediatric Emergency Resreach NetworkChair, Council of ChairsBo Tomas Brofeldt Endowed Chair,Department of Emergency MedicineUC Davis Health SystemSacramento, California

Lillian F. Liao, MD MPHAssistant Professor of SurgeryUniversity of TexasMedical DirectorPediatric Trauma and Burn ProgramUniversity Children’s HealthSan Antonio, TexasR. Todd Maxson, MD FACSProfessor of SurgeryUniversity of ArkansasMedical Director, Trauma and Burn ServicesArkansas Children’s HospitalLittle Rock, Arkansas

Mehdi K. Mazaheri, MD PCAttending Physician, Pediatric Plastic SurgeryPhoenix Children’s Hospital Phoenix, Arizona

Craig A. Press, MD PhDAssistant Professor of Pediatrics and NeurologyDirector, Pediatric Neurocritical CareUniversity of ColoradoAttending Physician, Pediatric-NeurologyChildren’s Hospital ColoradoAurora, Colorado

David L. Rothberg, MDAssistant Professor of OrthopedicsUniversity of UtahAttending Physician, OrthopedicsPrimary Children’s HospitalSalt Lake City, Utah

Shari Rybak, MBA RN CEN CPEN TCRNClinical Manager, Emergency Servicesand Pediatric LiaisonBanner Health SystemsAdjunct Faculty - Pediatric and LeadershipArizona State UniversityPhoenix, Arizona

Ronald M. Stewart, MD FACSProfessor of SurgeryUniversity of TexasDr. Witten B. Russ ChairVice Chair, Governor’s Emergency Medical Service and Trauma Advisory CouncilChair, American College of SurgeonsCommittee on TraumaSan Antonio, Texas

Jason Stoneback, MDAssistant Professor of OrthopedicsDirector, Limb Restoration ProgramDirector, Orthopedic Trauma and Fracture SurgeryUniversity of ColoradoDirector, Orthopedic Trauma ProgramChildren’s Hospital ColoradoAurora, Colorado

Faculty

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Faculty &

Certificates

David W. Tellez, MD FCCMAssociate Professor of Clinical Medicine, Department of Clinical HealthUniversity of ArizonaPediatric IntensivistPhoenix Children’s HospitalMedical Director, Pediatric Services Air EvacMajor Liaison, Pediatric Acute Lung Injury and Sepsis NetworkPhoenix, Arizona

Jeffrey Upperman, MD FAAP FACSAssociate Professor of SurgeryAssociate Dean for Faculty DiversityUniversity of Southern CaliforniaMedical Director, Trauma ProgramAssociate Chief of Pediatric SurgeryChildren’s Hospital Los AngelesLos Angeles, California

Certifi cates & EvaluationsIn order to receive your certifi cate of attendance and education credit you must complete the online conference evaluation by August 15, 2017.

Physicians, Advanced Practice, Nurses and Pre-hospital providers:Please go to https://www.surveymonkey.com/r/2017_WPTC_eval

Physicians – To obtain Maintenance of Certifi cation credit:Please go to https://www.surveymonkey.com/r/2017_WPTC_MOC

For any questions or issues obtaining credit, or to receive a certifi cate of attendance, please contact Phoenix Children’s Hospital Trauma Services at [email protected].

15


Objectives

Wednesday, July 12, 2017The Evidence-based Evaluation of Children with Abdominal TraumaNathan Kuppermann, MD MPHObjectives:• Review current concepts on the inital evaluation and management of children with

blunt abdominal trauma.• Describe a state-of-the-art CT prediction rule to decide which children do and do not

need CT imaging.• Discuss the role of the bedside FAST examination in the evaluation of children with

blunt abdominal trauma.

Firearm Injury Prevention: The Approach of the American College of Surgeons Committee on TraumaRonald M. Stewart, MD FACSObjectives:• Explain the history of fi rearm injury occurrences and current trends.• Analyze the prevalence of fi rearm injury versus other mechanisms of injury.• Discuss prevention strategies to decrease the number of fi rearm related injuries.• Report the American College of Surgeons, Committee on Trauma stance on fi rearm

injury and prevention efforts.

Re-imaging After Blunt Abdominal Trauma: What Have We Learned in 20 Years?David M. Notrica, MD FACSObjectives:• Discuss the current recommendations for reimaging children after blunt liver, spleen,

or kidney injury.• Review imaging options in light of changing technology.• Understand the natural course of traumatic pseudoaneursyms.

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Objectives

Neuroprognostication after Traumatic Brain InjuryCraig Press, MD PhDObjectives:• Identify known factors associated with outcomes after acute brain injury.• Discuss the role of EEG and MRI in prognostication.• Discuss the role of a self-fulfi lling prophecy in prognostication.

Control the Chaos - Automated Compression DevicesDavid W. Tellez, MD FCCMObjectives:• Describe the physiology of chest compressions in code victims.• Discuss the most common automated chest compression devices on the market.• Discuss the most recent literature and evaluations of the effi cacy of these devices.

Bandidos de Bacara Point-Counterpoint: Pediatric Trauma Activation CriteriaSigmund J. Kharasch, MD and Lillian F. Liao, MD MPHObjectives:• Review the current physiologic criteria for trauma team activation.• Identify the current mechanistic criteria for trauma team activation.• Discuss recommendations for improvement in both the above criteria for trauma team

activation.• Describe triage using TAC.

ECMO in Environmental HypothermiaStephen J. Fenton, MD FACSObjectives:• Discuss the role of ECMO in the treatment of environmental hypothermia.• Discuss management priorities for patients receiving ECMO.

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Objectives

Refi ning Pediatric Trauma ResuscitationR. Todd Maxson, MD FACSObjectives:• Defi ne trauma induced coagulopathy.• Discuss management strategies of trauma induced coagulopathy.• Determine the role of a massive transfusion protocol in trauma induced

coagulopathy.

Thursday, July 13, 2017Screening Practices for Non-Accidental Trauma – A Surgeon’s PerspectiveJonathan I. Groner, MDObjectives:• Identify patients who have increased risk for non-accidental trauma.• Integrate strategies to combat implicit bias in non-accidental trauma.• Integrate knowledge of non-accidental trauma into a usable screening practice.

American College of Surgeons Committee on Trauma Update and FutureDirection - Stop the BleedRonald M. Stewart, MD FACSObjectives:• Discuss new initiatives for Best Practice Guidelines for patient care.• Describe the benefi ts of PI taxonomy as an engine to quality improvement.• Provide participants with the schedule of educational activities such as webinars

and online tutorials to help centers understand the criteria in the Optimal Care of the Injured Patient manual.

• Provide participants with a dashboard for quality outcomes and best practices.

18


Objectives

Developing a Pediatric Trauma Program in an Adult Trauma CenterPaul B. Harrison, MD FACSObjectives:• Describe the evolution of pediatric trauma care.• Identify factors related to access to care for pediatric trauma.• Discuss the process of growing a pediatric trauma center.

Key Principles of Pediatric Genitourinary and Anorectal TraumaLillian F. Liao, MD MPHObjectives:• Discuss management of blunt and penetrating GU and anorectal trauma.• Discuss non-accidental trauma related to anorectal trauma considerations.

Skeletal Maturity Implications for the Fixation of Long Bone FracturesJason Stoneback, MDObjectives:• Discuss pediatric considerations for fracture fi xation.• Describe management priorities for pediatric fracture fi xation.

Traumatic Bronchus Avulsion Case ReportEric R. Scaife, MD FACSObjectives:• Discuss the principles involved in major airway trauma.• Discuss management priorities in major airway trauma.

The Science of TeamworkJared W. Henricksen, MDObjectives:• Defi ne the intricacies of the science of teamwork. • Implement the science of teamwork into your trauma program.

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Objectives

Shark Attack Point-Counterpoint: Neurotrauma Resuscitation Monitoring: High Tech vs. Low TechP. David Adelson, MD FACS FAAP and Craig Press, MD PhDObjectives:• Apply a practical application model to managing TBI in children.• Contrast high and low tech methods for managing TBI in children.• Evaluate low tech methods and their applicability for use in TBI management.

Traumatic Brain Injury Prediction Rules in Children: Generating/Validating theEvidence, Translation to Practice, and Shared Decision MakingNathan Kuppermann, MD MPHObjectives:• Describe the generation and validation of CT decision rules for children with

blunt head trauma.• Discuss the implementation of the decision rules into practice using the electronic

health record.• Indentify concepts of shared decision-making when the use of CT is unclear.

Pediatric Neurotrauma and Neurocritical Care ManagementP. David Adelson, MD FACS FAAPObjectives:• Discuss current strategies in pediatric neurocritical care.• Describe management priorities for pediatric patients with neurotrauma.

Disaster Preparedness, Response, and Recovery Considerations for ChildrenJeffrey Upperman, MD FAAP FACSObjectives:• Describe recent federal policy for children in disasters.• Discuss innovative pediatric preparedness tools.• Determine barriers to pediatric disaster planning.

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Objectives

Friday, July 14, 2017Pediatric Peripheral Vascular InjuriesR. Todd Maxson, MD FACSObjectives:• Contrast hard and soft signs of vascular injury.• Identify when to perform fasciotomy. • Recommend appropriate management strategies and follow up after vascular repair.

Considerations in Complex Facial Dog Bite InjuriesMehdi K. Mazaheri, MD PCObjectives:• Discuss pediatric considerations in the repair of complex facial dog bite injuries.• Describe the management priorities for pediatric patients with dog bite injuries.

New Strategies for Acute Pediatric Pain ManagementStefan J. Friedrichsdorf, MD FAAPObjectives:• Critically review risks and safety of analgesic under-treatment versus over-treatment

in hospitalized infants and children with trauma pain.• Evaluate differences in treatment approach for acute, visceral, neuropathic,

procedural, psycho-social, and/or chronic-persistent pain.• Discuss how multiple agents, interventions, rehabilitation, psychological and

integrative (“non-pharmacological”) therapies act synergistically for more effective pediatric pain control with fewer side effects than a single analgesic or modality.

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Objectives

The Brain: Operating System 1.0 - How We Respond to CrisisShari Rybak, MBA RN CEN CPEN TCRNObjectives:• Describe the two pathways the thalamus sends signals to the cerebral cortex and

the amygdala.• Demonstrate three ways to intervene with a family in crisis to decrease the

amygdala hijacking.• Recognize two programs currently in place to assist the trauma team in times of

amygdala stimulus.

Extremity Compartment Syndrome: 2017 UpdateDavid L. Rothberg, MDObjectives:• Discuss current strategies in the care of pediatric patients with extremity

compartment syndrome.• Describe management priorities for the treatment of extremity compartment

syndrome.

Disaster and Mass Casualty Training at a Community Hospital in IsraelJonathan I. Groner, MDObjectives:• Identify level of security at learner’s institution.• Create a low cost disaster/mass casualty scenario.

Incorporating Simulation Into a Trauma Teamwork ModelAaron R. Jensen, MD MEdObjectives:• Discuss the role of simulation in trauma teamwork training.• Describe strategies for implementing simulation training in trauma team

development.

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Disclosure of Relevant Financial RelationshipsPhoenix Children’s Hospital fully complies with the ACCME Standards for Commercial SupportSM

Standards to Ensure Independence in CME Activities. The following disclosures meet SCS 6.0: Disclosures Relevant to Potential Commercial Bias (6.1-6.5).

The following speakers and planning committee members have had no relevant fi nancial relationships in the last 12 months with a commercial interest that manufactures products or provides services that will be discussed during this Live CME Activity:

Aaron Jensen, MDCraig Press, MD, PhDChristina Roberts, BSDavid Adelson, MDDavid Notrica, MDDavid Rothberg, MDDavid Tellez, MDEric Scaife, MDGena Topping, RNHale Wills, MDHilary Hewes, MDJared Henricksen, MDJason Stoneback, MD

Jeffrey Upperman, MDJenny Oliver, RNJohn Recicar, RNJon Groner, MDKari Hayes, MDKris Hansen, RNLillian Liao, MDLilly Bayouth, MDLisa Runyon, RNMaggie Leyendecker, RNMehdi Mazaheri, MDNathan Kuppermann, MDPaul Harrison, MD

Ray CuellarRobert Vanderwalle, MDRonald Stewart, MDShari Rybak, RNSharon Chow, RNSig Karasch, MDStefan Friedrichsdorf, MDStephen Fenton, MDStephen Kaminski, MDSue Fortier, RNSummer Magoteaux, RNTammy Kopelman, MDTodd Nickoles, RN

The following speakers have relevant fi nancial relationships with commercial interests to disclose:

Todd Maxson, MDCompany Received Role American College of Surgeons Honorarium ConsultantArkansas Trauma Society Fee ATLS Instruction

Disclosures

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SAVE THE DATE

July 18-20, 2018Grand Summit Hotel | Canyon Resort


Bring the familyfor fun and education

RELAXATION | SHOPS ADVENTURES | GOLF


RESEARCH ABSTRACTSPODIUM

Date Time Title Presentor7/12/17 10:00 APPROPRIATE NEEDLE LENGTH FOR EMERGENT

PEDIATRIC NEEDLE THORACOSTOMY UTILIZING COMPUTED TOMOGRAPHY

Hayes, Kari

7/12/17 10:11 CT IMAGING IN THE PEDIATRIC PATIENT WITH A SEATBELT SIGN: STILL NOT GOOD ENOUGH

Kopelman, Tammy

7/12/17 10:21 WHAT IS THE INCIDENCE OF DELAYED SPLENIC BLEEDING? DOES IT REALLY EXIST?

Notrica, David

7/12/17 10:31 IN-VIVO SIMULATION-BASED EDUCATIONAL OUTREACH PROJECT FOR PEDIATRIC TRAUMA CARE IN A RURAL TRAUMA SYSTEM

Bayouth, Lilly

7/12/17 10:41 TRENDS IN PEDIATRIC ADJUSTED SHOCK INDEX PREDICT MORBIDITY AND MORTALITY IN CHILDREN WITH SEVERE BLUNT INJURIES

Vandewalle, Robert

7/12/17 10:51 A NATIONAL TRAUMA DATABANK ANALYSIS OF TIMING OF DEATH IN PEDIATRIC TRAUMA:CHILDREN HAVE EARLIER MORTALITY THAN ADULTS

Jensen, Aaron R.

POSTERDate Time Title Presentor

7/12/17 2:30 SECURING A DEFINITIVE AIRWAY AFTER PRE-HOSPITAL SUPRAGLOTTIC RESCUE AIRWAY INSERTION

Antiel, Ryan

7/12/17 2:35 EPIDEMIOLOGY OF PEDIATRIC FOREIGN BODY INJURIES PRESENTING TO THE SOUTH KOREAN EMERGENCY DEPARTMENTS

Park, Joon Wan

7/12/17 2:40 UNIFORMITY OF CRANIOCERVICAL JUNCTION ASSESMENT AMONG PEDIATRIC RADIOLOGISTS IN THE INTERPRETATION OF CERVICAL SPINE CT

Bamgartner, Michele

Abstracts26


7/12/17 2:45 SUBDURAL HEMORRHAGE OF AN INFANT WHO PRESENT WITH REPEATED SEIZURE ATTACKS AT THE EMERGENCY DEPARTMENT

Seo, Hyo Yeon

7/12/17 2:50 USE OF LAPAROSCOPY IN PEDIATRIC BLUNT LIVER AND SPLEEN INJURY: AN UNEXPECTEDLY COMMON PROCEDURE AFTER CESSATION OF BLEEDING

Notrica, David

7/12/17 2:55 LEVETIRACETAM VERSUS (FOS)PHENYTOIN FOR EARLY ONSET POST-TRAUMATIC SEIZURE PROPHYLAXIS IN PEDIATRIC PATIENTS

Neff, Luke

7/12/17 3:00 BROKEN BONE? HERE'S YOUR TICKET TO RIDE; ORGANIZING HIGH VOLUME FRACTURE CARE AT A LEVEL 1 PEDIATRIC TRAUMA CENTER

Stoneback, Jason

7/12/17 3:05 OUTCOMES OF COMPLEX PANCREATICODUODENAL INJURIES IN CHILDREN: REVIEW OF A SINGLE LEVEL 1 PEDIATRIC TRAUMA CENTER

Short, Scott

7/12/17 3:10 DEVELOPMENT, IMPLEMENTATION, & USE OF LENGTH-BASED STANDARDIZED PEDIATRIC RESUSCIATION REFERENCE CARDS ACROSS EMS SYSTEM

Woods, Brandon

7/12/17 3:15 CHARACTERISTICS OF PEDIATRIC FROSTBITE INJURIES AND THEIR MANAGEMENT

Badru, Faidah

7/12/17 3:20 AMERICAN COLLEGE OF SURGEONS PEDIATRIC TRAUMA CENTER VERIFICATION IS ASSOCIATED WITH IMPROVED SURVIVAL FOR LEVEL 1 AND 2

Lombardo, Sarah

7/12/17 3:25 PERIOPERATIVE USE OF EXTRACORPOREAL MEMBRANE OXYGENATION IN TRAUMATIC BRONCHIAL AVULSION IN CHILDREN

Bennett, Erin

Abstracts2727


BEST PRACTICE ABSTRACTSPODIUM

Date Time Title Presentor7/14/17 8:30 BROKEN BONE" HERE'S YOUR TICKET TO RIDE;

ORGANIZING HIGH VOLUME FRACTURE CARE AT A LEVEL 1 PTC

Leyendecker, Maggie

7/14/17 8:30 DEVELOPMENT AND IMPLEMENTATION OF A PEDIATRIC TRAUMA TELEMEDICINE SIMULATION COURSE

Runyon, Lisa

7/14/17 8:30 BEAR IN MIND: GUIDELINES FOR OPTIMAL CARE OF PEDATRIC HEAD INJURED PATIENTS

Roberts, Christina

7/14/17 8:30 MANAGEMENT OF THE UNSTABLE, ACTIVELY HEMORRHAGING CHILD WITH A SUSPECTED VASCURLAR INJURY FROM BUTTON BATTER INGESTION

Recicar, John

POSTERDate Time Title Presentor

7/12/17 2:30 IMPROVING COLLECTIVE MINDFULNESS IN THE TREATMENT OF RARE INJURIES IN THE PICU

McRoberts, Christina

7/12/17 2:30 PED THORACOLUMBAR SPINE CLEARANCE GUIDELINE FOLLOWING TRAUMTIC INJURY

Bolinger, Carol

7/12/17 2:30 VENOUS THROMBOEMBOLISM PROPHYLAXIS Bolinger, Carol

7/12/17 2:30 PEDIATRIC BLUNT CEREBROVASCULAR INJURY Bolinger, Carol

7/12/17 2:30 PEDIATRIC BLUNT ABDOMINAL INJURY Bolinger, Carol

Abstracts28


Abstract Title: APPROPRIATE NEEDLE LENGTH FOR EMERGENT PEDIATRIC NEEDLE THORACOSTOMY UTILIZING COMPUTED TOMOGRAPHY

Author(s): Maria J. Mandt, Kathleen Adelgais, Kari Hayes, Fred Severyn, MD

Introduction: Needle thoracostomy is a life-saving procedure. Advanced Trauma Life Support guidelines recommend insertion of a 5cm, 14-gauge needle for pneumothorax decompression. High-risk complications can arise if utilizing an inappropriate needle size. No study exists evaluating appropriate needle length in pediatric patients. Utilizing computed tomography (CT), we determined the needle length required to access the pleural cavity in children matched to Broselow™ Pediatric Emergency Tape color.

Methods: Three investigators reviewed chest CTs of children < 13 years of age obtained between 2010-2015. Patient exclusions included those with a chest wall mass, muscle disease, pectus deformity, anasarca, prior open thoracotomy, inadequate imaging, or missing height documentation. We established four groups based upon Broselow™ color as determined by recorded height. Investigators, trained by a pediatric board-certifi ed radiologist, obtained standardized CT measurements of chest wall thickness at four points: right/left second intercostal space at the midclavicular line (ICS-MCL) and right/left fourth intercostal space in the anterior axillary line (ICS-AAL). Our outcome was the median chest wall thickness and interquartile ranges (IQR) for each Broselow grouping and anatomic site.

Results: To date, 72 chest CTs have been reviewed. Median patient age was 5 years and 56.1% were male. Children measuring Broselow Gray/Pink (<68cm), had a median chest wall thickness at the right ICS-MCL of 1.5cm (IQR 1.3cm, 1.9cm), left ICS-MCL 1.7cm (IQR 1.6cm, 1.9cm), right ICS-AAL 1.4cm (IQR 1.3cm, 1.6cm), left ICS-AAL 1.4cm (IQR 1.2cm, 1.5cm). Children measuring Broselow Red/Purple (68.1-90cm): right ICS-MCL 1.8cm (IQR 1.5cm, 1.9cm), left ICS-MCL 2cm (IQR 1.7cm, 2.1cm), right ICS-AAL 1.8cm (IQR 1.6cm, 2.2cm), left ICS-AAL 1.9cm (IQR 1.6cm, 2.2cm). Children measuring Broselow Yellow/White (90.1-115cm): right ICS-MCL 1.9cm (IQR 1.7cm, 2.5cm), left ICS-MCL 1.9cm (IQR 1.6cm, 2.3cm), right ICS-AAL 1.7cm (IQR 1.6cm, 2.1cm), left ICS-AAL 1.7cm (IQR 1.5cm, 2.1cm). Children measuring Broselow Blue/Orange/Green (>115.1cm): right ICS-MCL 2.4cm (IQR 2.1cm, 2.9cm), left ICS-MCL 2.4cm (IQR 2.1cm, 2.9cm), right ICS-AAL 2cm (IQR 1.5cm, 2.9cm), left ICS-AAL 2cm (IQR 1.5cm, 2.9cm).

Conclusion: Median chest wall thickness varies little by height or location in children < 13 years of age. The standard 5-cm needle is twice the chest wall thickness of most children.

Abstracts

29

Podium


Abstract Title: CT IMAGING IN THE PEDIATRIC PATIENT WITH A SEATBELT SIGN: STILL NOT GOOD ENOUGH

Author(s): Tammy R. Kopelman, Ramin Jamshidi, Paola G. Pieri, Karole Davis, James Bogert, Sydney J. Vail

Introduction: Reliability of computed tomography (CT) to identify hollow viscus injury (HVI) in patients with blunt abdominal trauma (BAT) is uncertain. The 2002 Eastern Association for the Surgery of Trauma guideline on BAT stated that patients with a seatbelt sign (SBS) required hospital admission despite normal radiographic evaluation (presumably due to concern for missed HVI). Considering the improvements in CT resolution over the past decade, this study aimed to determine whether CT can reliably diagnose HVI in pediatric trauma patients with SBS.

Methods: With IRB approval, we identifi ed pediatric patients (<15 years) with SBS after motor vehicle collision who had abdominopelvic CT performed on initial evaluation at our ACS-verifi ed dual adult/pediatric trauma center. This was a retrospective review of patients identifi ed within the trauma database over a 5-1/2 year period. Abnormal CT was defi ned by attending radiologist identifi cation of any intra-abdominal abnormality possibly related to trauma.

Results: 120 patients met inclusion criteria (ages 3-14 years). CT was abnormal in 38/120 (32%) patients: 32 concerning for isolated HVI; 2 suspicious for HVI and solid organ injury (SOI); and 4 with isolated solid organ injury (SOI). Of the 34 patients with suspicion for isolated HVI, 15 (44 %) had a small amount of isolated pelvic free fl uid as the only abnormal CT fi nding; none of these 15 required intervention. Ultimately, 16/120 (13%) patients suffered HVI and underwent celiotomy. Collectively, these patients underwent thirteen bowel resections, 8 bowel repairs and 3 mesenteric repairs. Three of the 16 HVI patients had a normal initial CT but ultimately required celiotomy for clinical deterioration within 20 hours of presentation. False negative CT rate was thus 3.6% (3/82). Overall, the sensitivity, specifi city and accuracy of CT to diagnose signifi cant HVI in the presence of a SBS were 81%, 80%, and 80%, respectively.

Conclusion: Despite improvements in CT technology, pediatric patients with seatbelt signs may have hollow viscus injury not evident on initial CT. This study confi rms the need to consider hospital admission and observation of such patients for delayed manifestation of hollow viscus injury.

Abstracts

303030

Podium


Abstract Title: WHAT IS THE INCIDENCE OF DELAYED SPLENIC BLEEDING? DOES IT REALLY EXIST?

Author(s): David M. Notrica, Crystal S. Langlais, Amina Bhatia, Robert W. Letton, Adam Alder, Shawn St. Peter, Todd A Ponsky, James W. Eubanks III, Karla A Lawson, Daniel J. Ostlie, David W. Tuggle, Nilda M. Garcia, R. Todd Maxson, Charles Leys

Introduction: One of the concerns associated with nonoperative management of splenic injury has been delayed bleeding after a period of hemostasis. The incidence of delayed bleeding is unknown.

Methods: A 3-year prospective study was done to evaluate nonoperative management of pediatric (≤18 years) blunt liver and spleen injuries (BLSI) presenting to one of 10 pediatric trauma centers. Each institution previously adopted the ATOMAC guideline for nonoperative management of BLSI. Patients with blunt spleen injury with or without concurrent liver injury were included in this planned secondary analysis to describe the frequency of delayed splenic bleeding. Follow-up was done at 2 weeks and 2 months.

Results: 509 children with splenic injury presented to one of ten hospitals. Median age was 11.6 [IQR: 7.0, 14.8]; median splenic injury grade was 3 [IQR: 2, 4]. 18 patients underwent splenectomy, all within 34 hours of injury (median: 3 hours [IQR:1.9, 5.0]). An additional 3 had splenorrhaphy, all within 5 hours of injury. 118 patients underwent transfusion; 90 patients were fi rst transfused within 24 hours of injury, 17 after, and 11 had unknown time of injury. For the 17 patients with fi rst transfusion after 24 hours, 12 had additional injuries including: 5 traumatic brain injuries, 10 lung injuries, 4 pelvic fractures, 4 kidney injuries, 5 femur fractures, and 3 liver injuries. Follow-up was available on 373 (73%) of patients. No patient developed a delayed splenic bleed.

Conclusion: The incidence of delayed splenic bleeding appears to be extremely low, if it exists at all.

Abstracts

31

Podium


Abstract Title: IN-VIVO SIMULATION-BASED EDUCATIONAL OUTREACH PROJECT FOR PEDIATRIC TRAUMA CARE IN A RURAL TRAUMA SYSTEM

Author(s): Shannon W. Longshore, Lilly A. Bayouth, Sarah Ashley, Jackie Brady, Bryan Lake, Morgan Keeter, David Schiller, Walter C. Robey III, Eric A. Toschlog

Introduction: Despite regionalization of trauma systems and advances in care of the injured, outcome disparities between urban and rural pediatric trauma patients persist. Rural pediatric trauma patients are often taken to the nearest emergency department (ED) for initial workup and stabilization, where pediatric emergency care is a low-frequency event. Existing resuscitation courses offer minimal education in pediatric trauma care. The aim of this study was to identify targets for educational intervention and increase provider experience via pediatric trauma simulation.

Methods: A prospective study of simulations-based pediatric trauma resuscitation, was performed at three of the highest volume referral community EDs. Consent was obtained for video recording of the simulations. Pre and post-test surveys with a fi ve-point Likert scale assessed provider comfort performing 13 specifi c skills. Independent t-tests were performed comparing mean survey responses pre- and post-simulation. An assessment tool was utilized to score each simulation on tasks essential to successful initial trauma stabilization care. Providers from the level 1 trauma center visited each ED to facilitate simulation, provide feedback and educate in real time. A second visit for reassessment was completed at a later date. Primary outcomes were: 1) improved comfort performing skills and 2) team performance during resuscitation.

Results: Ninety-nine providers, 19 MDs, 65 RNs, 5 RRTs, and 10 other, participated. Comfort performing the following skills showed statistically signifi cant improvement with p-values <0.05: infant airway, infant IV, blood administration, infant C-spine immobilization, pediatric chest tube placement, obtaining radiographic images, initiating transport, and use of the Broselow tape. The mean number of tasks that needed improvement per simulation was 15.2 initially, improving to 9.7 during a second visit. Defi ciencies most common among all simulations were: failure to obtain additional history (75%), beginning secondary survey exam (58.33%), log rolling appropriately and examining the back (66.67%), calling for transport within 5 minutes (50%), calculating appropriate medication dosages (50%).

Conclusion: This study used simulation to identify and correct defi ciencies in stabilization of children presenting to referring rural EDs. Simulation-based education improves both provider comfort and performance. Follow up study comparing patient outcomes pre- and post-simulation is warranted.

Abstracts

32

Podium


Abstract Title: TRENDS IN PEDIATRIC ADJUSTED SHOCK INDEX PREDICT MORBIDITY AND MORTALITY IN CHILDREN WITH SEVERE BLUNT INJURIES

Author(s): Robert J. Vandewalle, Julia K. Peceny, Scott C. Dolejs, Jodi L. Hackworth, Thomas M. Rouse,

Introduction: The utility of measuring the pediatric adjusted shock index (SIPA) at admission for predicting severity of blunt injury in pediatric patients has been previously reported. However, the utility of following SIPA after admission is not well described.

Methods: The trauma registry from a level-one pediatric trauma center was queried from January 1, 2010 to December 31, 2015. Patients were included if they were less than 17 years old at the time of admission, sustained a blunt injury with an Injury Severity Score > 15, and were admitted less than 12 hours after their injury (n=286). Each patient’s SIPA was then calculated at admission and at 12, 24, 36, and 48 hours after admission. SIPA scores were then categorized as elevated or normal at each time frame based upon previously reported values. Trends in outcome variables as a function of time from admission for patients with an abnormal SIPA to normalize as well as patients with a normal admission SIPA to abnormal were analyzed.

Results: In patients with an elevated SIPA at arrival, 90.8% of those that normalized their SIPA within 12 hours survived to discharge, where 72.2% survived if they required 13-24 hours to normalize (p=0.05). In patients with a normal SIPA at arrival, 24.1% of patients with an elevated SIPA at 12 hours after admission died, whereas 3% of patients with a normal SIPA throughout the fi rst 48 hours of admission died (p<0.01). Need for early transfusion, incidence of ventilator associated pneumonia, and length of stay showed similar signifi cant trends on statistical analysis.

Conclusion: Time to normalize an elevated admission SIPA appears to directly correlate with severity of injury across a mixed blunt trauma population. Similarly, patients with a normal SIPA at time of arrival who then have an elevated SIPA in the fi rst 24 hours of admission are at increased risk for morbidity and mortality compared to those whose SIPA remains normal throughout the fi rst 48 hours of admission. Whether trending SIPA early in the hospital course serves only as a marker for injury severity or if it has utility as a resuscitation metric has not yet been determined.

Abstracts

33

Podium


Abstract Title: A NATIONAL TRAUMA DATABANK ANALYSIS OF TIMING OF DEATH IN PEDIATRIC TRAUMA: CHILDREN HAVE EARLIER MORTALITY THAN ADULTS

Author(s): Jensen, Aaron

Introduction: Trauma remains the leading cause of mortality in children in the United States. The classic “trimodal” distribution of death has been described in adult patients, but the distribution of mortality timing in injured children is not well understood. The purpose of this study was to defi ne the temporal distribution of mortality in pediatric trauma patients in an effort to inform research priorities.

Methods: A retrospective analysis of the National Trauma Databank from 2007-2014 was analyzed for deaths pronounced at Trauma Centers. Transfer patients were excluded. Categorical comparison of Dead on Arrival (DOA), Death in the Emergency Department (DIED), and early (<24h) or late (>24h) inpatient deaths was performed. Secondary analyses included mortality by pediatric age strata, predictors of early mortality, and late complication rates.

Results: Pediatric patients (N=5,463 deaths) had an earlier temporal distribution of death compared to adults (n=104,225 deaths), with 51% of children DOA or DIED compared to 44% of adults (Figure 1). For patients surviving ED resuscitation, children and adolescents had a shorter median time to death than adults (1.2 and 0.8 days versus 1.6 days, p<0.001, Figure 2). Older age, penetrating mechanism, bradycardia, hypotension, thoracostomy placement, and thoracotomy were associated with early mortality.

Conclusion: Children demonstrate a slight but signifi cant preponderance toward earlier mortality after trauma as compared to adults, with children surviving an ED resuscitation having lower proportion of late mortality than their adult counterparts. These results suggest that, in addition to injury prevention efforts, strategies to improve early ED resuscitation of injured children may have the greatest impact.

AbstractsPodium

34


Abstract Title: SECURING A DEFINITIVE AIRWAY AFTER PRE-HOSPITAL SUPRAGLOTTIC RESCUE AIRWAY INSERTION

Author(s): Ryan M. Antiel, Matthew C. Hernandez, Terri Elsbernd, Denise B. Klinkner, Karthik Balakrishnan

Introduction: Historically, endotracheal intubation (ETI) has been the accepted standard for obtaining prehospital airway control in pediatric trauma patients. However, supraglottic rescue devices have been increasingly used as an alternative to ETI. Complications may result from the placement of these devices. Currently, there is no consensus for the ideal subsequent defi nitive airway management. In this study, we aimed to evaluate defi nitive airway management in pediatric patients with multisystem trauma who had a prehospital supraglottic rescue airway inserted.

Methods: Retrospective review of pediatric patients with multisystem trauma and prehospital rescue airway insertion referred to our level 1 trauma center from 2005 to 2016. We evaluated baseline demographics as well as the number and type of fi eld airway insertion attempts, defi nitive airway techniques and attempts, and complications. Main outcome measures were 24-hour mortality and need for tracheostomy versus endotracheal tube exchange for defi nitive airway management.

Results: A total of 17 patients (76% male, median age 16 years [IQR 10-17 years]) had multisystem trauma and prehospital rescue airway insertion. Table 1. The most common mechanisms of injury were motor vehicle accidents (47%), drowning (18%), and asphyxiation (12%). Median ISS was 26 [IQR 25-43], median head AIS was 5 [IQR 4-5], facial 0 [IQR 0-2] and cervical spine 0 [IQR 0-0]. Median number of prehospital endotracheal intubation attempts was 2 [IQR 1-3]. Complications included facial instability, bleeding, emesis, and inability to suction. Twelve patients (71%) required direct laryngoscopy and endotracheal tube exchange, while 5 patients (29%) required tracheostomy for defi nitive airway management. Overall, twenty-four hour mortality was 35%. Patients who required a tracheostomy compared to those who only underwent endotracheal tube exchange demonstrated higher median facial AIS (2 versus 0, p=0.04), increased prehospital complication rates (80% versus 17%, p=0.01) and median number of attempts at endotracheal tube intubation (3 versus 1, p=0.01). However, there was not a signifi cant difference in 24-hour mortality rate (42% versus 20%, p=0.6).

Conclusion: Defi nitive airway management after prehospital temporary airway is a diffi cult challenge in the pediatric trauma patient. The presence of a complicated prehospital airway and the number of prehospital endotracheal tube attempts may predict need for tracheostomy.

AbstractsPoster

35


Abstract Title: EPIDEMIOLOGY OF PEDIATRIC FOREIGN BODY INJURIES PRESENTING TO THE SOUTH KOREAN EMERGENCY DEPARTMENTS

Author(s): Joong Wan Park, Soyun Hwang, Ikwan Jang, Jae Yun Jung

Introduction: Foreign body (FB) injuries mainly occur in young children and may cause serious complications. The aim of the study was to investigate the epidemiology and clinical characteristics of pediatric FB injuries in South Korea

Methods: Using data from the National Emergency Department Information System (NEDIS) in Korea, we analyzed FB injury-related emergency department (ED) visits among children < 19 years of age between January 2010 and December 2013. The epidemiological characteristics and the anatomical site of the FB injury were analyzed by age and gender. A multivariable logistic regression model was used to obtain the odds ratios for the factors associated with hospital admission.

Results: In total, 54,416 pediatric FB injuries occurred during the study period. The pediatric FB injuries occurred most frequently in infants and young children aged 0-4 years (61.48%). The FB injuries occurred more frequently in boys, except for nasal FB injuries. The overall hospital admission rate was 1.77%, and children with airway FB injuries had the highest hospital admission rate (24.18%). Five deaths were caused by FB aspiration. The prominent factors that were associated with hospitalization were having an FB in the lower airway (odd ratio (OR)=40.35, 95% confi dence intervals (CI); 28.15-57.84) or intestine (OR=31.37, 95% CI; 21.95-44.84) and being transferred or referred patients (OR=5.65, 95% CI; 4.82-6.61).

Conclusion: FB injuries are more common in infants and young children, and FB aspiration can be fatal. Patients with the prominent factors associated with hospitalization require more attention for the management and prevention of pediatric FB injuries.

AbstractsPoster

36


Abstract Title: UNIFORMITY OF CRANIOCERVICAL JUNCTION ASSESMENT AMONG PEDIATRIC RADIOLOGISTS IN THE INTERPRETATION OF CERVICAL SPINE CT

Author(s): Michele Bamgartner, David Dansie, Nadia Van Der Watt, Stephen J. Fenton

Introduction: Traumatic craniocervical junction (CCJ) injuries are uncommon but potentially devastating. Computed tomography (CT) has become the primary imaging modality to evaluate the CCJ at our institution, a level 1 pediatric trauma center. The objective of this study was to compare the reproducibility and accuracy of CCJ interpretation on cervical spine CT scans of injured children amongst radiologists.

Methods: A protocol for reporting all clinically salient measurements of the CCJ was developed between the neurosurgeons and radiologists. The process and thresholds of normal measurements were established within the pediatric radiology group. Over a 6-month period, children who underwent cervical spine CT in the setting of signifi cant trauma had their exam over-read by another radiologist within 24-hours to verify the original fi ndings.

Results: During this period, 99 patients underwent cervical spine CT imaging following trauma activation. Five patients had imaging from another institution and were excluded. The remaining 94 children underwent review using the CCJ protocol. Thirty CT exams were over-read for a provider compliance rate of 32%. Of the exams that were originally interpreted by a general pediatric radiologist, 11% were over-read. Additionally, 42% of the exams originally read by a pediatric neuroradiologist were over-read. There was a 100% agreement between radiologists in all of the over-read CT exams.

Conclusion: This study did not demonstrate a difference in the radiographic interpretation of the CCJ between pediatric radiologists. Development of multispecialty CCJ report template may result in uniformity of measurement and fi ndings from cervical spine CT evaluation.

AbstractsPoster

37


Abstract Title: SUBDURAL HEMORRHAGE OF AN INFANT WHO PRESENT WITH REPEATED SEIZURE ATTACKS AT THE EMERGENCY DEPARTMENT

Author(s): Ji Sook Lee, Hyo Yeon Seo, Woo Chan Jeon, Seung Ah Chung

Abstract: Abusive head trauma (AHT) is the leading cause of death from trauma in infants. These patients may be present with severe and nonspecifi c symptoms to the emergency department.

An 8-month-old infant presented with repeated seizure attack at emergency department. At the time of visit, his father stated his child fell on the matted fl oor from 50 cm-height couch. The infant was stupor mental state at presentation but has no external wound. Computerized tomography (CT) of the brain revealed an acute subdural hematoma (SDH) in the right cranial convexity and diffuse cerebral edema, leading to midline shift to the left and effacement of right lateral ventricle and basal cistern (Figure 1). He had no bone fracture including skull on radiographic skeletal series. The patient underwent an emergently decompressive craniectomy, hematoma removal, and duraplasty. After surgery, he was sent to intensive care unit. We suspected child abuse, because SDH is rare in infant, what is more it may be extremely rare with the history father stated and without external sign of trauma. We referred him for the department of ophthalmology. Fundus examination revealed bilateral numerous superficial and intra-retinal hemorrhages in the posterior pole, extending to the periphery. He also had white retinal ridges with cherry hemorrhages in the both eyes. The optic discs appeared unremarkable (Figure 2). Despite of continued treatments, he expired the 20th hospital days. After all, his father confessed that he shook his child and missed him on the fl oor.

AHT, also known as shaken baby syndrome is a constellation of a triad: subdural hematoma, retinal bleeding, and diffuse brain injury without a reasonable explanation for severe trauma. In infants, SDH without obvious mechanisms is very rare. Also severe brain damage with inconsistent history taken from caregivers requires immediate work-ups for AHT. The physician must maintain a high index of suspicion in cases similar to ours.

AbstractsPoster

38


Abstract Title: USE OF LAPAROSCOPY IN PEDIATRIC BLUNT LIVER AND SPLEEN INJURY: AN UNEXPECTEDLY COMMON PROCEDURE AFTER CESSATION OF BLEEDING

Author(s): David M. Notrica, Crystal S. Langlais, Charles Leys, R. Todd Maxson, Nilda M. Garcia, Karla A. Lawson, Robert W. Letton, James W. Eubanks III, Todd A. Ponsky, Shawn D. St. Peter, David W. Tuggle, Adam C. Alder, Amina Bhatia, Daniel J. Ostlie

Introduction: Several series have reported the use of laparoscopy in pediatric trauma, most commonly for bowel and pancreatic injury. A recent multicenter trial found many centers using laparoscopy in children with blunt liver or spleen injury (BLSI). A secondary analysis was done to describe the frequency and application to pediatric BLSI.

Methods: Prospective data was collected on all children ≤18 years of age with BLSI presenting to one of 10 Pediatric Trauma Centers. An unplanned secondary analysis of children who underwent laparoscopy was done.

Results: Of 1,007 children with BLSI, 59 initially underwent a laparotomy, but 11 underwent a laparoscopic procedure during their index admission; 1 of these was 22 hours post laparotomy while 2 others were eventually converted to laparotomy. Median age of patients undergoing laparoscopic procedure was 11.5 [IQR: 5.8, 16.4]. Laparoscopy was performed at 7 of the 10 centers. Median time to surgery was 42 hours [IQR: 8, 96]. Most patients had a liver (n=6) injury; 4 had spleen and 1 had both. Procedures and frequencies performed are presented in table 1. Two of three bowel injuries were to the appendix. None of the patients with laparoscopy indicated a missed intra-abdominal injury or missed bowel injury. There were no deaths.

Conclusion: Laparoscopy was utilized in 1% of children after BLSI. Uses included diagnosis, drain placement, pancreatectomy, and washout of hematoma.

AbstractsPoster

39


Abstract Title: LEVETIRACETAM VERSUS (FOS)PHENYTOIN FOR EARLY ONSET POST-TRAUMATIC SEIZURE PROPHYLAXIS IN PEDIATRIC PATIENTS

Author(s): Luke A. Neff, Colleen Barthol, Nicole Greene, Kay Green, Darrel Hughes

Introduction: Current pediatric traumatic brain injury (TBI) guidelines recommend prophylactic treatment with (fos)phenytoin for the prevention of early post traumatic seizures (PTS), defi ned as seizure activity within the fi rst seven days after TBI. Levetiracetam is commonly used in clinical practice for these patients, despite the lack of evidence. The objective of this study is to compare the effi cacy and safety of levetiracetam to (fos)phenytoin for use in early PTS prophylaxis in pediatric patients with TBI.

Methods: In this retrospective chart review, electronic medical and pharmacy billing records were used to identify patients younger than 18 years who were admitted with TBI. Data points collected included patient demographics; mechanism of injury; Glasgow Coma Scores; time to fi rst seizure determined by electroencephalogram (EEG) or direct observation; neurosurgical interventions performed or hyperosmolar therapy initiated; and adverse medication events.

Results: 198 patients were included for evaluation, with 137 patients in the (fos)phenytoin group and 61 patients in the levetiracetam group. Overall, 7.1% (14/198) of patients experienced early PTS. By treatment group, early PTS occurred in 8.8% (12/137) of the (fos)phenytoin group and 3.3% (2/61) of the levetiracetam group (p = 0.16). In patients with early PTS, seizure activity was confi rmed by EEG in 41.7% (5/12) of patients receiving (fos)phenytoin and 50% (1/2) of patients receiving levetiracetam. The median time to fi rst seizure was similar between the fos(PHT) and LEV groups (85 vs 84 hours, respectively). In the (fos)phenytoin group, there were three (2.2%) reported adverse medication events that led to discontinuation of the drug. There were no reported adverse medication events that led to discontinuation of levetiracetam.

Conclusion: In pediatric patients with TBI, there was no statistically signifi cant difference in early PTS activity or adverse medication events between (fos)phenytoin and levetiracetam.

AbstractsPoster

40


Abstract Title: BROKEN BONE? HERE’S YOUR TICKET TO RIDE; ORGANIZING HIGH VOLUME FRACTURE CARE AT A LEVEL 1 PEDIATRIC TRAUMA CENTER

Author(s): Leyendecker, Soucie, Carry, Trizno, Stoneback

Introduction: Children’s Hospital Colorado manages thousands of orthopedic trauma patients every year in a dedicated orthopedic trauma/urgent room. Timing of ambulatory surgeries fl uctuates to appropriately triage cases making effective communication important to avoid extended wait times and minimize parental/staff frustration. Historically, this communication has been inconsistent. The urgent room ticket was developed to address this problem and is given to families when their case is scheduled. The ticket provides a phone number for the families to call the morning of surgery to obtain an up to date operative time. The aims of this study were to compare average patient wait time, nursing staff satisfaction, and patient/family satisfaction before and after implementation of the urgent room ticket system.

Methods: Patients that underwent ambulatory operative treatment in the urgent room by a single surgeon before (summer of 2015) and after implementation (summer of 2016). Surgical wait time (time between hospital check in and operative start) was retrospectively collected. Patient/family satisfaction was determined based on a phone survey. Nursing satisfaction was assessed based on an electronic survey assessing perception of patient/family and nursing satisfaction. Multiple linear regression analysis was used to compare average wait time in the two study groups. Chi-square tests were used to compare staff and parental satisfaction before and after ticket implementation.

Results: Surveys competed by nurses indicated the proportion of nurses that perceived parents to be often/always frustrated with communication between families and surgical staff decreased from 50% to 33% after implementation of the ticket system [p=0.4715]. Perceptions of families that were often/always frustrated with surgery timing remained unchanged. Nurses were less likely to be very unsatisfi ed or unsatisfi ed with the urgent room post- (33%) as compared to pre-ticket (58%) implementation [p=0.1515]. Parent/family surveys who indicated their overall hospital experience was excellent increased between the pre- (40%) and post-ticket (74%) implementation time periods [p=0.2885]. Median wait time was 140.5 minutes [Interquartile Range: 109-193] compared to 125.0 minutes [Interquartile Range: 103-183] after implementation of the ticket system. After adjusting for month, the average wait time decreased by 8% [95% CI: 24% decrease to 11% increase, p = 0.3907] after ticket implementation.

Conclusion: The urgent room ticket system represents an innovative and effective solution for maintaining effi cient communication between surgeons, operative staff, and patient families. The ticket system was associated improvements in nurse and parent satisfaction.

AbstractsPoster

Best Practice - Podium

41


Abstract Title: OUTCOMES OF COMPLEX PANCREATICODUODENAL INJURIES IN CHILDREN: REVIEW OF A SINGLE LEVEL 1 PEDIATRIC TRAUMA CENTER

Author(s): Scott Short, Micah Katz, Stephen J. Fenton, Eric R. Scaife

Introduction: Complex pancreaticoduodenal injury requiring pancreaticoduodenectomy are uncommon in children and the literature describing the management and outcomes of these injuries are sparse. Aim: To report management and outcomes from complex pancreaticoduodenal injuries in children.

Methods: We performed a single center retrospective review of all children (< 18 years) identifi ed from the institution’s prospectively collected trauma database from 2002 to 2016. All patients who underwent operative exploration for grade V pancreatric or duodenal injuries were included. Relevant clinical factors were collected.

Results: One hundred eleven children presented with a pancreas or pancreatiocoduodenal injury with 38 (34%) underwent operative exploration. Of these 5 children (4.5%) presented with an AAST grade V pancreatoduodenal injury. All fi ve underwent a staged approach with damage control laparotomy as the initial step. Two children underwent pancreaticoduodenectomy, two underwent duodenectomy, and one underwent subtotal pancreatectomy with partial duodenectomy. Of those undergoing duodenectomy, one did not undergo resection of the pancreas due to hemodynamic instability and the other was reconstructed with roux-en-y duodenojejunostomy. Median age at time of injury was 4.2 yrs (1.3 to 10.7 yrs) and median length of stay was 34 days (29 to 52 days). The mortality rate for grade V injuries was 40%. The remaining three children recovered without signifi cant morbidity and none experienced a pancreatic or anastomotic leak.

Conclusion: Severe pancreaticoduodenal injury is uncommon in children and is associated with a high mortality rate. Some children may be salvaged by a damage control approach.

AbstractsPoster

42


Abstract Title: DEVELOPMENT, IMPLEMENTATION, & USE OF LENGTH-BASED STANDARDIZED PEDIATRIC RESUSCIATION REFERENCE CARDS ACROSS EMS SYSTEM

Author(s): Brandon Woods, Mary King, Lila O’Mahony, Carolyn Blayney, Benjamin Lang

Introduction: For paramedics, pediatric resuscitation is a highly stressful, technically challenging, low frequency event. Length-based equipment selection and medication dosing, as well as less familiar scenarios, create high cognitive load. Our project aimed to reduce cognitive load by providing standard pediatric resuscitation reference cards across an entire Emergency Medical Services (EMS) system (6 agencies) in a large geographic urban setting where 200,000 children less than 12 years old reside.

Methods: After 2 years of collaboration between EMS and pediatric subspecialists, we created a novel set of length-based, color-coded cards. The reference cards standardize the approach to common resuscitation scenarios such as rapid sequence intubation and seizure management. We consolidated drug concentrations across all 6 EMS agencies, which allowed volume dosing and removal of medication calculations. Qualitatively, we administered surveys to EMS personnel before and after implementation of our cards to determine EMS personnel satisfaction, utilization, and ease of use.

Results: We surveyed 240 paramedics across all 6 agencies and received a 60% baseline and 58% post-implementation response rate. Baseline and post-implementation paramedic groups were similar in experience and comfort with adult cardiac arrest. After 6 months of implementation, 95% of respondents reported using the new cards as their primary pediatric reference. Paramedic comfort improved with more respondents strongly agreeing in comfort with pediatric arrest management (24 to 33%), rapid sequence intubation medication administration (32 to 43%), and seizure management (41 to 53%).

Conclusion: The new pediatric reference cards were well adopted in a collaborative manner across a large EMS system with improvement in paramedic comfort in managing several pediatric scenarios: cardiac arrest, rapid sequence intubation medication administration, and seizure management. For further evaluation, quantitative data on timing and accuracy of equipment selection and medication administration will be evaluated to determine effi cacy as compared to prior practice.

AbstractsPoster

43


Abstract Title: CHARACTERISTICS OF PEDIATRIC FROSTBITE INJURIES AND THEIR MANAGEMENT

Author(s): Colleen M. Fitzpatrick, Madsen Jorgen, Yana Puckett, Saurabh Saxena, Kaveer Chatoorgoon, Gustavo Adolfo Villalona, Jose Greenspon, Stephen J. Fenton

Introduction: There is very little data about frostbite injuries and their management in pediatric patients. The aim of this study is to evaluate the characteristics of frostbite injuries in the pediatric population as well as current management of these injuries.

Methods: A retrospective review of all patients managed for frostbite at two free-standing level 1 pediatric centers between 1998 and 2015 was performed. Data abstracted included demographics, date of injury, environmental temperature, frostbite grade, management and complications.

Results: Thirty one patients were treated for frostbite injuries during the study period. Nineteen patients were managed at one institution and 12 patients at the other. Mean age was 11.3 years, 71% were female, 55% were African American. and 55% had medicaid as their primary insurance. Mean environmental temperature was 25o F (16.2o F in one institution and 39.4o F in the other) [p = 0.008]. Fifty two percent of the frostbite occurred in January and 22.5% in December. All other injuries were equally distributed throughout the remainder of the year. Most injuries occurred while playing/working in the snow (58%). Mean length of cold exposure was 2.6 hours. There were 20 grade I injuries, 7 grade II, 3 grade III, and 1 grade IV. There were 80.6% extremity injuries. Analgesia was administered in 74.1% of patients, 12.9% underwent imaging, 12.8% received antibiotics and only 13.3% required wound debridement. Average duration of rewarming was 12 minutes and admission was required in 25.8%. Complications such as return to the emergency room for worsening of frost bite or infection occurred in 16.1% of this cohort.

Conclusion: Frostbite injuries, although most common during the winter months, can occur at any time of the year with most patients having a low grade injury which can be managed without procedures, imaging, antibiotics or admissions. When required, rewarming is recommended with analgesia use.

AbstractsPoster

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Abstract Title: AMERICAN COLLEGE OF SURGEONS PEDIATRIC TRAUMA CENTER VERIFICATION IS ASSOCIATED WITH IMPROVED SURVIVAL FOR LEVEL 1 AND 2

Author(s): Sarah Lombardo, Toby Enniss, Raminder Nirula

Introduction: American College of Surgeons (ACS) trauma center verifi cation is associated with improved outcomes in adult trauma patients. Injured children treated at dedicated pediatric trauma centers (TCs) have a survival benefi t when compared to those receiving care at adult or mixed centers. This study sought to compare the mortality between ACS-verifi ed and State-designated pediatric TCs.

Methods: Patients ≤ 15 years admitted to ACS verifi ed or State designated Level 1 and 2 pediatric TCs were identifi ed in the 2010-2012 National Trauma Data Bank (NTDB). A mulitvariate logistic regression model for death was created using demographic and physiologic data. Expected mortality (E) at the facility level was calculated from the probability of death predicted by the model. Observed facility mortality (O) was calculated directly. Observed to expected (O/E) mortality ratios were determined with 90% confi dence intervals (CI). Outcomes of ACS verifi ed and State designated facilities were compared for level 1 and 2 centers. Analysis was repeated for severely injured (ISS>15 ) and very severely injured (ISS>25) patients.

Results: There were 127,296 subjects. Groups were not comparable prior to adjustment, with crude mortality 1.03%, 0.97%, 1.19%, and1.73% at ACS Level 1, ACS Level 2, State Level 1, and State Level 2 TCs, respectively. The model had an area under the receiver curve of 0.9878, and good calibration (Hosmer-Lemeshow c-stat 9.13, p > 0.05). ACS Level 2 TCs had a lower median O/E ratio than ACS Level 1 TCs for all comers and severely injured patients (p=0.020 and 0.017, respectively; Table 1). State Level 2 TCs tended towards higher O/E ratios when compared to ACS Level 2 and State Level 1 TCs, but the differences were not signifi cant.

Conclusion: ACS-verifi cation is not associated with improved O/E mortality for pediatric TCs. Interestingly, superior outcomes were identifi ed in ACS Level 2 TCs, and no signifi cant adverse rates of mortality were found with State designation. Further evaluation of the ACS verifi cation and State designation processes in pediatric TCs may be warranted to identify features likely to improve outcomes.

AbstractsPoster

45


Abstract Title: PERIOPERATIVE USE OF EXTRACORPOREAL MEMBRANE OXYGENATION IN TRAUMATIC BRONCHIAL AVULSION IN CHILDREN

Author(s): Erin Bennett

Abstract: In cases of traumatic bronchial avulsion, the standard approach has been emergent lobectomy versus primary repair. Extracorporeal membrane oxygenation (ECMO) is used to support patients with acute severe pulmonary and/or cardiac failure and could potentially serve as a bridge to allow cardiorespiratory stabilization after surgical intervention or in cases too unstable for immediate surgical intervention. We report two cases of blunt chest trauma resulting in bronchial tears in which venovenous (V-V ECMO) was used peri-operatively to facilitate surgical repair. Case 1 was a 13-month-old male with a large right upper lobe bronchial tear who failed conservative medical management with mechanical ventilation and required complete right upper lobectomy. He was supported on V-V ECMO post-operatively to facilitate lung protection. Case 2 was a 23-month-old male with complete right main stem bronchial avulsion who failed conservative medical management with mechanical ventilation and was supported on V-V ECMO pre-operatively as a bridge to primary surgical repair. Both patients survived with favorable outcomes. ECMO can be used to overcome respiratory failure, facilitate surgical repair, and promote healing in the setting of blunt chest trauma in children.

AbstractsPoster

46


Abstract Title: DEVELOPMENT AND IMPLEMENTATION OF A PEDIATRIC TRAUMA TELEMEDICINE SIMULATION COURSE

Author(s): Lisa Runyon

Introduction: Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. It brings the expertise of an expert to the point of care. Patient medical information is exchanged from one site to another via electronic communication that provides an interactive exchange between the medical provider and remote patient and local medical providers. Our institution has a focus on specialty consultation for pediatric traumatic brain injury. Our goal is to decrease the number of unnecessary patient transfers using our Pediatric Surgery/Trauma resources of our ACS accredited Level One Pediatric Trauma Center and neurosurgical support. The telemedicine connection allows our pediatric trauma surgeons to communicate from a distance during a real time exam and provide clinical direction with a local medical team in a time-sensitive setting. Simulation is a technique that uses a situation or environment created to allow persons to experience a representation of a real event for the purpose of practice, learning, evaluation, testing or to gain understanding of systems or human actions. Our institution has had great success with the use of Trauma Simulation to improve team communication and streamline delivery of care in our trauma bay. Because of this success we developed a telemedicine simulation training to better prepare our team members for our program expansion.

Methods: A four hour, 30 minute pediatric trauma telemedicine course was developed in conjunction with our hospital’s Simulation Lab team. This Simulation team provides training for our health care workers with realistic, interactive training in both cognitive and behavioral skills required for profi cient clinical practice. The sessions were provided in December 2016 through April 2017. The course consisted of didactic sessions and 3 case scenarios where a surgeon and an APC team member would assess and communicate a plan for a remote pediatric trauma patient. The didactic sessions included Communication techniques, Psychological Safety and Diffi cult Communication techniques. The case scenarios focused on use of telemedicine equipment, dealing with a hidden issue/diffi cult provider and review of our Traumatic Brian injury Telemedicine guidelines.

Results: Eight pediatric surgeons, 3 pediatric neurosurgeons and 14 Advanced Practice Clinicians (NP’s and PA’s) completed the course in 5 sessions. At the conclusion of each session time was allowed for each participant to discuss aspects of the course in a group setting. We received overwhelming feedback from the participants that the specifi c simulation training was specifi cally useful to better understand the issues they may face during implementation of the new telemedicine program. Specifi cally, participants were appreciative of being able to use the computers, cameras and equipment in a safe setting to gain a better understanding of remote patient assessment. Participants also identifi ed logistic issues that we were able to streamline prior to program implementation. Our Simulation program focuses on the basic assumption - ‘We believe that everyone participating in simulation is intelligent, skilled, cares about doing their best and wants to improve.’ This assumption helped to enhance communication channels between all providers during both the didactic sessions and during the case scenarios. This led to improved team communication in a non-threatening environment.

Conclusion: Use of simulation training as a part of telemedicine program development can provide safe, non-threatening, yet clinically challenging environment that also enhances team communication and ultimately improved delivery of care for pediatric

trauma patients in remote settings.

AbstractsBest Practice - Podium

47


Abstract Title: BEAR IN MIND: GUIDELINES FOR OPTIMAL CARE OF PEDIATRIC HEAD INJURED PATIENTS

Author(s): Christina McRoberts

Introduction: At Level 1 Pediatric Trauma Centers, many patients present with isolated, low acuity head injuries that warrant neurosurgical evaluation but do not require admission to a neurosurgical service. A patient with a head injury and an injury severity score (ISS) of 8 was admitted to the Pediatric Hospitalist service without a surgical consultation which led to the revision of this hospital’s guidelines. The Pediatric Trauma Committee devised a set of Pediatric Head Injury Admission Guidelines (PHIAG) to ensure timely evaluation by the neurosurgery staff, avoid overwhelming limited neurosurgical resources, and comply with guidelines from the American College of Surgeons (ACS) regarding admission of injured children to non-surgical services. The Pediatric Neurosurgery, Pediatric Surgery, and the Pediatric Hospitalist services adopted these guidelines.

Methods: The trauma registry was queried for patients aged 0-17 years, admitted to a non-surgical service. A two month sample of data were collected for pre-implementation (Group 1) and post-implementation (Group 2) of the revised guidelines and evaluated using the Plan, Do, Study, Act (PDSA) cycle. Demographic, mechanism of injury (MOI), ISS, and consultations were compared between the groups. Patients injured in a same-height falls, drownings, poisonings, hangings, or patients with an ISS less than 4 are excluded from the review.

Results: The rate of nonsurgical pediatric admissions that received a surgery consult improved from 78% to 91%. The percentage rate of patients with an Injury Severity Score of >4 without a surgical service consult decreased from 22% to 0% in the post-implementation time period. (Table I)

Conclusion: Pediatric Head Injury Admission Guidelines can achieve a balance between appropriate surgical evaluation and maintaining an appropriate workload with limited neurosurgical resources. Incorporation of mandatory neurosurgical consultation guidance into PHIAG can ensure timely neurosurgical evaluation. Non-Surgical admissions should be monitored closely to ensure that the standard of care meets the needs of isolated pediatric head injured patients.


48


Abstract Title: MANAGEMENT OF THE UNSTABLE, ACTIVELY HEMMORHAGING CHILD WITH A SUSPECTED VASCULAR INJURY FROM BUTTON BATTERY INGESTION

Author(s): John Recicar

Introduction: Button battery ingestions are potentially life threatening for children. Catastrophic and fatal injuries can occur when the battery becomes lodged in the esophagus, where battery induced injury can extend beyond the esophagus to the trachea or aorta. Increased production of larger, more powerful button batteries has coincided with more frequent reporting of fatal hemorrhage secondary to esophageal battery impaction.

Setting: Our trauma activation protocol for button battery ingestions was implemented at an urban regional pediatric trauma center with a 7 state catchment area. The majority of our patients are transferred to us with long transport times from facilities that often do not have surgical capability.

Protocol Development: In 2015 a few cases with delays and a potentially preventable death from attributed delays in assessment and access to the OR revealed the need for additional guidance to ensure these patients were rapidly evaluated, and those with a retained battery were taken to the most appropriate place for removal. A group was convened to include surgeons and nurses to draft, establish and evaluate a care pathway for patients post button battery ingestion in 2016. The group decided to incorporate those patients with active bleeding into the trauma activation criteria to allow for the quickest mobilization of resources.

Outcomes and Evaluation: We evaluated the effi cacy of the protocol by examining the medical records of patients with button battery ingestions from January 1 - December 31, 2016. Additional data were queried from the trauma registry (Traumabase, Conifer, CO) in which trauma registrars abstract data on all trauma admissions. Our state includes foreign bodies that cause damage into the trauma registry. We excluded patients who had the battery removed at a referring facility from the data collection unless they had on-going active bleeding. Outcomes of interest included the identifi cation of initial presenting symptoms, time to chest x-ray, time to gastroenterology or pediatric surgery consult, activation rate, time to OR if the patient had a sentinel bleed, time to OR if patient did not have a sentinel bleed, and length of stay. There were 7 patients transferred in with button battery ingestions during the 12 months’ study period. Five patients met criteria for entry into the pathway and two had batteries removed at a referring facility. Of the 5 patients who met criteria to follow the pathway, there were two patients that did not. One was activated as a high-level trauma activation and had no active bleeding event and the second took 5 hours after identifi cation for the battery to call for a surgical consult. Re-education was performed for both the medical and nursing teams.

Conclusion: Button battery ingestions should prompt immediate medical attention. Known or suspected button battery ingestion in combination with signs and symptoms of gastrointestinal bleeding represents a potentially life-threatening medical emergency and needs to be treated as such to prevent further damage to the esophagus or underlying structures.


49


Abstract Title: IMPROVING COLLECTIVE MINDFULNESS IN THE TREATMENT OF RARE INJURIES IN THE PEDIATRIC INTENSIVE CARE UNIT (PICU), PROACTIVELY ADDRESSING NURSING ENCOUNTERS WITH NEW AND UNFAMILIAR THERAPIES

Author(s): Christina McRoberts, Nie Bohlen

Introduction: Following a patient safety event in the PICU involving a new piece of equipment for a rare injury, process improvement analysis identifi ed a gap between the identifi cation of new equipment and implementation of staff education.

Methods: A multi-disciplinary process improvement committee found opportunities to identify and address concerns about new or unfamiliar equipment and therapies. Twice daily combined medical/nursing “huddles” were held. The existing daily “huddle sheet” was revised to prompt the PICU Nursing Administration to specifi cally query the staff regarding new procedures, equipment, or medications identifi ed for their assigned patients. A just-in-time education process was implemented to develop, disseminate, and assess competency through in-service education. All safety concerns related to new therapies were brought to daily hospital safety briefi ngs. Results: PICU staff report high satisfaction rates with the daily “huddle” and “huddle sheet.” PICU nurses report improved proactive identifi cation of knowledge gaps. In the fi rst two months after implementation, four new equipment issues were identifi ed, resulting in just-in-time education.

Conclusion: Many pediatric injuries are rare, requiring specialized equipment or therapies that may be unfamiliar to PICU nurses. Specifi cally soliciting concerns about new equipment in scheduled daily briefi ngs, coupled with a streamlined process to rapidly address knowledge gaps, improves collective mindfulness, empowers staff nurses to ask questions, and improves staff comfort in caring for rare injuries. The impact on patient safety warrants further study.

AbstractsBest Practice - Poster

50


Abstract Title: PEDIATRIC THORACOLUMBAR SPINE CLEARANCE GUIDELINE FOLLOWING TRAUMATIC INJURY

Author(s): Carol Bolinger

Introduction: The purpose of the algorithm is to provide evidence-based practice and decrease variations in care. While not all patients fi t into an algorithm, it does provide a template for care that is widely applicable. Given the limited pediatric data and concern for radiation exposure to children, our protocol varies signifi cantly from the EAST adult guideline for thoracolumbar spine clearance. Our level 1 pediatric trauma center has had no missed injuries of clinical signifi cance (ie need for intervention) using this algorithm.


51


Abstract Title: VENOUS THROMBOEMBOLISM PROPHYLAXIS: PEDIATRIC TRAUMA SERVICE


Introduction: The purpose of the algorithm is to provide evidence-based practice and decrease variations in care. While not all patients fi t into an algorithm, it does provide a template for care that is widely applicable. The submitted algorithm is titled: Venous Thromboembolism prophylaxis: Pediatric Trauma Service. Over the past few years, a number of pediatric guidelines have been developed which identify pediatric risk for VTE and the decision to implement a prophylactic care. This algorithm provides visual representation to evaluate patient risk and treatment.


52


Abstract Title: PEDIATRIC BLUNT CEREBROVASCULAR INJURY


Introduction: The purpose of the algorithm is to provide evidence-based practice and decrease variations in care. While not all patients fi t into an algorithm, it does provide a template for care that is widely applicable. Our protocol varies from adult guidelines and uses the Utah Score to stratify risk for pediatric blunt cerebrovascular injury and implications for treatment.


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Abstract Title: PEDIATRIC BLUNT ABDOMINAL INJURY


Introduction: The purpose of the algorithm is to provide evidence-based practice and decrease variations in care. While not all patients fi t into an algorithm, it does provide a template for care that is widely applicable. The submitted algorithm is titled: Blunt abdominal injury. This algorithm presents a variation from the recently published ATOMIC algorithm. It is more streamline, in a recently presented poster was shown to decrease admission rate to intensive care, decrease length of stay, decrease period of bed rest without morbidity. We have successfully applied it to liver, spleen, hollow viscous organ and renal injury.


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Documents

· 2017. 11. 22. · Maricopa Integrated Health System Summer Magoteaux, BSN RN Phoenix Children’s Hospital Todd Nickoles, BSN RN MBA Jessica Swietzer David W. Tellez, MD FCCM