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IntroductionRoutine advanced airway usage by Emergency Medical Services (EMS) has had conflicting reports of being the secure airway of choice in pediatric patients.Hypothesis/ProblemThe primary objective was to describe a pediatric cohort requiring airway management upon their arrival directly from the scene to two pediatric emergency departments (PEDs). A secondary objective included assessing for associations in EMS airway management and patient outcomes., Methods: Retrospective data from the health record were reviewed, including EMS reports, for all arrivals less than 18 years old to two PEDs who required airway support between May 2015 and July 2016. The EMS management was classified as basic (oxygen, continuous positive airway pressure [CPAP], or bag-valve-mask [BVM]) or advanced (supraglottic or endotracheal intubation [ETI]) based on EMS documentation. Outcomes included oxygenation as documented by receiving PED and hospital mortality., Results: In total, 104 patients with an average age 5.9 (SD=5.1) years and median EMS Glasgow Coma Scale (GCS) of nine (IQR 3-14) were enrolled. Basic management was utilized in 70% of patients (passive: n=49; CPAP: n=2; BVM: n=22). Advanced management was utilized in 30% of patients (supraglottic: n=4; ETI: n=27). Proper ETI placement was achieved in 48% of attempted patients, with 41% of patients undergoing multiple attempts. Inadequate oxygenation occurred in 18% of patients, including four percent of ETI attempts, nine percent of BVM patients, and 32% of passively managed patients. Adjusted for EMS GCS, medical patients undergoing advanced airway management experienced higher risk of mortality (risk-ratio [RR] 2.98; 95% CI, 1.18-7.56; P=.021)., Conclusion: With exception to instances where ETI is clearly indicated, BVM management is effective in pediatric patients who required airway support, with ETI providing no definitive protective factors. Most of the patients who exhibited inadequate oxygenation upon arrival to the PED received only passive oxygenation by EMS. TweedJ, GeorgeT, GreenwellC, VinsonL. Prehospital airway management examined at two pediatric emergency centers. Prehosp Disaster Med. 2018;33(5):532-538.

Background: Trauma is the leading cause of death in children, accounting for half of all deaths in patients between birth and 18 years of age, and is the cause of a significant number of hospital admissions. We reviewed our experience at a Level I pediatric trauma center with a 2-level trauma activation (TA) system for mobilization of personnel over a 3-year period. The aim was to assess severity of injury of the trauma patients, resource use, and outcome., Methods: After obtaining institutional review board approval, a retrospective analysis of all trauma patients between January 2006 and December 2008 was performed. Data analyzed included number of admissions, level of TA (STAT vs ALERT), mechanism of injury, intensive care unit (ICU) admission, injury severity score (ISS), need for operative intervention, and survival., Results: In 3 years, there were 4502 patients entered. Trauma activation was initiated in 1315 patients (29.2%), divided between 211 STATs (4.7%) and 1104 ALERTs (24.5%). Mean patient age was 5.9 ± 4.1 years, 65% of the patients were boys, and blunt trauma accounted for 92% of the admissions. An ICU admission was required in 736 (16.3%) of the entire group, whereas 502 (38.2%) patients in the TA group were admitted to the ICU(1). The 154 STAT (21%) and 348 ALERT (47%) patients accounted for 68% of all ICU admissions(1). An ISS listed as severe (16-24) or very severe (>24) was found in 468 (10.4%) and 232 (5.2%) patients, respectively. An ISS listed as 16 or higher was found in 144 (68.2%) of the STATs and 264 (23.9%) of the ALERTs(1). Operative intervention was required in 2118 patients (47%). The overall mortality rate was 1.9%, and this increased to 5.8% in the TA group(1). There were 48 deaths (22.7%) in the STAT group, 29 deaths (2.6%) in the ALERT group, and 9 deaths (0.28%) in patients with no TA(1). When emergency department deaths were excluded, the remaining 60 deaths resulted in a mortality rate of 1.3%., Conclusions: Our Level I pediatric trauma center manages a large volume of patients with significant acuity and, evidenced by a TA in 29% of the patients, a severe or very severe ISS in 16% of the patients, 16% of the patients requiring ICU admission, and 47% requiring operative intervention. The TA patients had markedly higher rates of ICU admission, ISS, and mortality. Deaths in the study were lower by almost an order of magnitude comparing TA STATs with TA ALERTs and TA ALERT patients with patients without TA. The TA criteria are in many ways very helpful and is integral to a Level I trauma center. However, opportunities were identified for improvement because of areas of "overutilization" and discordance between TA and ISS., (Copyright © 2011 Elsevier Inc. All rights reserved.)