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Purpose: Shock Index is used to predict injury severity and adverse outcomes in trauma patients, but pediatric age-adjusted shock index (SIPA) has superior performance in pediatric patients older than 1 year. Pediatric age-adjusted shock index scores younger than 1 year have not been well studied. This project aimed to establish and evaluate SIPA cut point data points for patients younger than 1 year., Methods: Using age-based vital signs, we developed cut point values for patients younger than 1 year using our institutional trauma data. All trauma patients younger than 12 months were included, and clinical outcomes were recorded. Pediatric age-adjusted shock index cut points were defined using age-specific vital sign limits (SIPA-VS) and tested against optimal cut points defined by receiver operating characteristic analysis (SIPA-ROC) and a cut point of 1.2 (SIPA-Nordin), which is used for patients aged 1 to 4 years. Student's t test, χ 2 tests, analysis of variance, and test characteristics were used to analyze groups., Results: A total of 609 pediatric trauma patients younger than 12 months were identified from 2018 to 2022. Pediatric age-adjusted shock index scores were calculated for 483 patients. There were 406 patients with blunt trauma and 17 with penetrating. SIPA-Nordin was elevated in 81.6% (n = 397) of patients, compared with SIPA-VS 21% (n = 101) and SIPA-ROC 31% (n = 150). In comparison with SIPA-Nordin, both SIPA-VS and SIPA-ROC score exhibited superior specificity and negative predictive values for multiple outcomes. Elevated SIPA-ROC scores had statistically significant associations with intensive care unit admission, mechanical ventilation, severe anemia, transfusion during hospital admission, and in-hospital mortality., Conclusion: Pediatric age-adjusted shock index is a useful tool in identifying patients at risk for several complications of severe traumatic injury. Pediatric age-adjusted shock index cut points had high negative predictive value and specificity for many outcomes. This study proposes cut point values that may aid in clinical decision making for trauma patients younger than 1 year., Level of Evidence: Diagnostic Test/Criteria; Level IV., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Pheochromocytomas (PHEO) are neuroendocrine tumors rarely diagnosed in children. We are reporting on the management challenges of three adolescent patients who present with hereditary PHEO., Case Presentation: The index patient and his male sibling presented with bilateral PHEO, while a third patient presented with a unilateral PHEO, all associated with von Hippel-Lindau (VHL) syndrome. The patients were treated with computed tomography (CT)-guided percutaneous cryoablation (CRA) of the adrenal lesions, with varying degrees of success., Conclusions: CT-guided percutaneous CRA of hereditary PHEO has not been reported in the pediatric population and may represent a novel treatment strategy that reduces the risk of intraprocedural complications and adrenal insufficiency (AI)., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Outcomes of pediatric patients who received extracorporeal life support (ECLS) for COVID-19 remain poorly described. The aim of this multi-institutional retrospective observational study was to evaluate these outcomes and assess for prognostic factors associated with in-hospital mortality. Seventy-nine patients at 14 pediatric centers across the United States who received ECLS support for COVID-19 infections between January 2020 and July 2022 were included for analysis. Data were extracted from the electronic medical record. The median age was 14.5 years (interquartile range [IQR]: 2-17 years). Most patients were female (54.4%) and had at least one pre-existing comorbidity (84.8%), such as obesity (44.3%, median body mass index percentile: 97% [IQR: 67.5-99.0%]). Venovenous (VV) ECLS was initiated in 50.6% of patients. Median duration of ECLS was 12 days (IQR: 6.0-22.5 days) with a mean duration from admission to ECLS initiation of 5.2 ± 6.3 days. Survival to hospital discharge was 54.4%. Neurological deficits were reported in 16.3% of survivors. Nonsurvivors were of older age (13.3 ± 6.2 years vs. 9.3 ± 7.7 years, p  = 0.012), more likely to receive renal replacement therapy (63.9% vs. 30.2%, p  = 0.003), demonstrated longer durations from admission to ECLS initiation (7.0 ± 8.1 days vs. 3.7 ± 3.8 days, p  = 0.030), and had higher rates of ECLS-related complications (91.7% vs. 69.8%, p  = 0.016) than survivors. Pediatric patients with COVID-19 who received ECLS demonstrated substantial morbidity and further investigation is warranted to optimize management strategies., Competing Interests: Disclosure: The authors have no funding and conflicts of interest to report., (Copyright © ASAIO 2023.)

Objective: Helicopter emergency medical services (HEMS) play a crucial role in providing timely transport for pediatric trauma patients. This service carries the highest risk of any mode of medical transport and a high financial burden, and patient outcomes are seldom investigated. This study evaluated the characteristics of pediatric trauma patients discharged within 24 hours after transport by HEMS., Methods: This was a single-center, retrospective analysis on pediatric trauma patients transported by HEMS from 2019 to 2022. Analyses were performed to identify factors associated with discharge within 24 hours. Factors analyzed included vital signs, Shock Index, Pediatric Age-Adjusted scores, management details, and clinical outcomes., Results: A total of 466 pediatric trauma patients were transported by HEMS, including 171 patients (36.7%) who were discharged within 24 hours. There were no differences in the rates of blunt and penetrating injury (P = .583). Patients discharged within 24 hours were more likely to have a higher Glasgow Coma Scale score (14 vs. 11, P < .001) and a lower Injury Severity Score (4.9 vs. 14.7, P < .001), required less prehospital fluid resuscitation (5.5 vs. 11.7 mL/kg, P = .039), and had higher levels of serum calcium (9.3 vs. 8.9 mg/dL, P < .001). They were also less likely to meet criteria for level 1 trauma activation (13.0% vs. 40%, P < .001) or to require prehospital respiratory support of any kind (4.1% vs. 31.1%, P < .001). After arrival at the hospital, they were less likely to require blood transfusions (2.9% vs. 29.8%, P < .001) or tranexamic acid (2.9% vs. 11.5%, P = .001)., Conclusion: Trauma patients with a high Glasgow Coma Scale score and a low Injury Severity Score who do not require critical care or meet the criteria for high-level trauma activation may be suitable for transportation with lower acuity. Further studies aimed at improving triage and implementing improved criteria for the use of HEMS are paramount., Competing Interests: Declaration of Competing Interest The author(s) have no relevant disclosures. There was no grant funding or financial support for this manuscript., (Copyright © 2023 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Background: Gun-related injury is now the number one cause of death in pediatric trauma patients. Many hospitals lack dedicated forensic nurses or updated protocols for handling ballistic evidence. Evidence not collected, handled improperly, or misplaced may deny a victim the basic human right to justice., Objective: This article aims to describe an initiative to highlight the importance of proper management of ballistic evidence and to educate medical providers on best practices for the documentation, handling, removal, and transfer of ballistic evidence., Methods: After discovering 24 "orphaned" bullets and bullet fragments in our hospital that had not been turned over to law enforcement, we sought to turn in evidence to the proper authorities and implement protocols to prevent this error in the future. New protocols were written by forensic staff, and education on new protocols was provided via in-person training, grand rounds, emails, and other collaborative initiatives., Results: Evidence was matched to police reports using the patient name and date of birth on evidence labels. The median (interquartile range [IQR]) time of lost ballistic evidence was 1,397 (903, 1604) days, with the oldest bullet removed in 2015. All bullets were successfully returned to law enforcement with a median (IQR) time from bullet discovery to collection of 78 (78, 174) days., Conclusions: Ballistic evidence handling protocols are essential for all hospitals. Dedicated, trained forensic staff should be employed to ensure proper evidence handling., Competing Interests: The authors declare no conflict of interest including financial, consultant, institutional, and other relationships that might lead to bias or a conflict of interest., (Copyright © 2024 Society of Trauma Nurses.)

Background: Injuries, the leading cause of death in children 1-17 years old, are often preventable. Injury patterns are impacted by changes in the child's environment, shifts in supervision, and caregiver stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic., Methods: This multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children < 18 years old. Injury was defined by at least one International Classification of Disease-10th revision (ICD-10) code for bodily injury (S00-T78). The main study outcomes were total and proportion of PED injury-related visits compared to all visits in March through December 2020 and to the same months in 2019. Weekly injury visits as a percentage of total PED visits were calculated for all weeks between January 2019 and December 2020., Results: The study included 741,418 PED visits for injuries pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). Overall PED visits from all causes decreased 27.4% in March to December 2020 compared to the same time frame in 2019; however, the proportion of injury-related PED visits in 2020 increased by 37.7%. In 2020, injured children were younger (median age 6.31 years vs 7.31 in 2019), more commonly White (54% vs 50%, p < 0.001), non-Hispanic (72% vs 69%, p < 0.001) and had private insurance (35% vs 32%, p < 0.001). Injury hospitalizations increased 2.2% (p < 0.001) and deaths increased 0.03% (p < 0.001) in 2020 compared to 2019. Mean injury severity score increased (2.2 to 2.4, p < 0.001) between 2019 and 2020. Injuries declined for struck by/against (- 4.9%) and overexertion (- 1.2%) mechanisms. Injuries proportionally increased for pedal cycles (2.8%), cut/pierce (1.5%), motor vehicle occupant (0.9%), other transportation (0.6%), fire/burn (0.5%) and firearms (0.3%) compared to all injuries in 2020 versus 2019., Conclusions: The proportion of PED injury-related visits in March through December 2020 increased compared to the same months in 2019. Racial and payor differences were noted. Mechanisms of injury seen in the PED during 2020 changed compared to 2019, and this can inform injury prevention initiatives., (© 2023. The Author(s).)