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Background Aims Methods Results Conclusions Trauma‐induced coagulopathy (TIC) is associated with negative outcomes. Pediatric TIC has been described most often in older children. Children undergo normal developmental hemostasis, but it is unknown how this process impacts the risk of TIC across childhood.To understand variations in coagulation testing and TIC across pediatric age groups.We evaluated testing patterns of coagulation studies at presentation and over the first 72 h of hospitalization by pediatric age group at a large, Level I trauma center, 2015–2020. The frequency of TIC was determined using published, age‐specific reference ranges and controlling for injury severity. We performed subgroup analyses of those with isolated severe traumatic brain injury (TBI) and those who presented directly from the scene of injury.Data from 2409 pediatric patients were available; 333 patients had isolated severe TBI. Children <1 year were least likely to be tested for TIC at presentation and over the first 72 h, even among the most injured. Fibrinogen testing was uncommon, regardless of injury severity. TIC was common: 22% of patients had TIC at presentation and 35% by 72 h. Greater injury severity was associated with TIC. Children 1–4 and 5–9 years had a higher frequency of TIC at presentation and over 72 h compared to older children in the least injured cohort. We saw no difference in frequency of TIC between age groups in the subset with isolated severe TBI. Using age‐specific criteria, patients most often met TIC criteria by INR/PT, followed by platelet count, and least commonly by aPTT. The presence of TIC was associated with in‐hospital mortality (OR 4.10, 95% CI 2.06–8.17).Significant sampling bias exists in clinical data collection among injured children and adolescents. Contrary to previous reports and using age‐specific TIC criteria, younger children are not at lower risk of TIC than older children when controlling for injury severity. [ABSTRACT FROM AUTHOR]

Background: The Translational Science Benefit Model (TSBM) was developed to broadly capture systematic measures of health and societal benefits from scientific research, beyond traditional outcome measures. We aimed to develop a systematic process for the application of the TSBM and to then provide an example of a novel application of the TSBM to an ongoing Return-to-Learn (RTL) after youth concussion project involving partnerships with community stakeholders. Methods: We invited investigators, project advisory board, and participants of the RTL project to participate in a modified Delphi process. We first generated a list of potential translational benefits using the indicators of the TSBM as guideposts. We then prioritized the benefits on an adapted Eisenhower matrix. Results: We invited 35 concussion care or research experts to participate, yielding 20 ranked translational benefits. Six of these recommendations were ranked high priority, six were regarded as investments, and eight were ranked as either low yield or low priority. Discussion: This study found that activities such as education and training of stakeholders, development of policy and consensus statements, and innovation in dissemination, were perceived as higher priority than other activities. Our approach using a modified Delphi process and incorporating the TSBM can be replicated to generate and prioritize potential benefits to society from research studies. [ABSTRACT FROM AUTHOR]

Background: To understand provider perceptions of the COVID-19 pandemic on priorities of severe pediatric traumatic brain injury (TBI) care across hospitals in South America. Methods: Site principal investigators (PIs) from 17 hospitals in South America enrolled in the PEGASUS-Argentina randomized controlled trial completed questionnaires regarding order of tasks performed in the care of a typical pediatric patient with severe TBI before (2019) and during (2021) the COVID-19 pandemic. Acute care processes were examined by quintiles to identify early, mid, and late actions and were categorized and compared. Associations of hospital volume and subspecialty resource availability with prioritization of key process actions were examined. Finding: Site PIs from 15 and 16 hospitals completed the surveys in 2019 and 2021, respectively, including 14 who completed both. Action category order was stable between 2019 and 2021 and were ranked in priorities as: initial encounter, primary survey, interventions and invasive monitors, diagnostics, medications, staff communication, then disposition (in 2019) or nutrition (in 2021). There was variation in specific action order between hospitals at both timepoints, with only a few initial encounter and disposition actions limited to a single quintile. There was no reported association between hospital volume or subspecialty resource availability with prioritization of key process actions. Interpretation: Despite novel healthcare challenges presented by the COVID-19 pandemic, providers in South America perceived maintaining standard severe pediatric TBI care consistent with BTF guidelines. There was large variability in specific action order between individual hospitals reported. [ABSTRACT FROM AUTHOR]