Pediatric Trauma Research

CHILD group

The CHILD group is a collaboration between UCSF Benioff Children's Hospital Oakland and the psychology department at the University of California, Berkeley. The CHILD group helps to coordinate research efforts for children, specifically those with neurologic or psychological issues, such as concussion or post-traumatic stress disorder (PTSD).

Affiliation with UCSF

UCSF Benioff Children's Hospital Oakland is affiliated with the University of California, San Francisco. This close association brings an additional level of support to the research and academic efforts at the Trauma Center and the entire hospital.

Research studies

Assessing the Standard Approach for the Pediatric Focused Assessment with Sonography for Trauma (ASAP FAST)

Principal Investigator: Aaron Kornblith, MD

Synopsis: The study objectives are to further characterize test characteristics of the three abdominal Focused Assessment with Sonography for Trauma (FAST) views for hemopertineoum in children with blunt abdominal trauma.

Specifically, this study will determine the sensitivity of each sonographic window of the abdominal FAST. Secondary objectives will be to characterize association with a variety of predicator variables and most sensitive FAST window.

Summary: This is a retrospective study of diagnostic test to evaluate the association of age and the relative sensitivity for each of the three sonographic windows for the Focused Assessment Sonography for Trauma (FAST): the right upper quadrant, left upper quadrant, and suprapubic locations. We will examine children less than 15 year of age presenting for traumatic injury to a Level 1 pediatric emergency department with blunt abdominal trauma. Our outcome, positive FAST location, will be examined for a relationship to our predictor variables including subjects estimated age, estimated weight, Glasgow Coma Scale, Injury Severity Score, injury location/intervention and disposition. This retrospective review will serve as pilot study for further evaluation of test characteristics of the FAST exam for optimal use of this test in pediatric patients presenting with blunt abdominal trauma.

Excessive Endotracheal Cuff Pressure in Pediatric Patients Flown By Helicopter: Is This a Problem?

(Supported by funds from American Academy of Pediatrics)

Research Question: Do differently sized endotracheal tubes in intubated patients reach different ETTCPs at comparable altitudes?

Principal Investigator: Michael Long, MD PL2
Co-investigators: Christopher Newton, MD; Gary McCalla, MD; Augusta Saulys, MD; Heidi Flori, MD; Ward Hagar, MD; Lynne Neumayr, MD

Hypothesis: Pediatric patients who are intubated with pediatric sized cuffed endotracheal tubes and transported via helicopter experience excessive endotracheal cuff pressures at a typical flight altitude.

Specific Aims: We aim to define the endotracheal cuff pressures (ETTCP) experienced by pediatric patients who are flown by helicopter. We hope to demonstrate the range of ETTCP reached at key points during flight. As a secondary outcome, we will assess if different sized endotracheal cuffs react differently with altitude change. Ultimately this data may influence the standard of care for endotracheal tube management in critically ill pediatric patients flown by helicopter. Our study is unique in that it will be one of the few existing prospective studies in all the air medical transport field-- including adult studies. Our study is special in that it represents a unique collaboration between REACH Air Medical Services and Children’s Hospital and Research Center Oakland. We hope this study may be a model for future prospective medical transport research and collaboration with air medical services. Our findings could make in flight ETTCP manometry a standard of care.

Penetrating Tracheal Injuries in Children

Principal Investigator: Christopher Newton, MD

Synopsis: In adults, the care of penetrating neck wounds has evolved significantly over the past two decades. However, penetrating injuries to the neck are extremely uncommon in children, and have rarely been discussed in detail in the literature. There is no clear standard of care or consensus on how children should be managed with these injuries. We have identified numerous children that had such injuries treated in our institution. We intend to review these cases in detail to identify patterns of injury, common treatment practices, and correlative outcomes that may all be able to define standard recommendations for care.

Specific Aims:
1. To review practice patterns related to the diagnosis, initial treatment, and definitive management of penetrating tracheal injuries in children at CHRCO.

2. To identify injury patterns predictive of mortality, early complications, and long term morbidity in children presenting with penetrating tracheal injuries.

3. To correlate diagnostic, resuscitative, and definitive management strategies with short- and long-term outcomes after penetrating tracheal injury in children. 

Advanced Clinical Decision Support for Transport of the Critically Ill Pediatric Patient

Principal Investigator: Heidi Flori, MD

Sponsor: U.S. Army Medical Research and Materiel Command

Synopsis: The overarching goal of this application is to develop and test the efficacy of a comprehensive, interfacility transport system that maximizes clinical decision support (CDS) opportunities available to the transport team. This system will embody both the visual and auditory interface available through telemedical infrastructure combined with a real-time, hand held, electronic medical record (EMR) - compatible and interactive clinical decision support (CDS) tool.

To complete this goal, we will engage our existing ground and air critical care transport infrastructure, as well as our off-site care critical care telemedicine platform and Childrens Hospital and Research Center Oakland (CHRCO) Information Technology specialists. By combining this array of resources, we will create and implement improved and more efficient strategies of communication with pre-hospital and transport personnel to provide more exact and timely interventions while also minimizing transport time to our receiving facility.

Objective 1: To create and test a portable, robust, interactive and hand-held application to allow time-sensitive CDS algorithms to be used in the transport of critically ill children and adolescents from remote hospital locations to our tertiary care facility.

Objective 2: To create and test the added utility of a portable yet high-fidelity visual interface in the management and triage of critically ill children and adolescents at the start of ground- and air- interfacility transports.

Studies in process

1. Assessment of Hb Measurements in Spleen and Liver Trauma
2. Follow Up Patterns for Children with Concussions
3. Evaluation of S-100b Serum Levels in Pediatric Traumatic Brain Injury
4. Medical Management of Common Co-morbidities in Pediatric Trauma Patients
5. Kids Can't Fly Project: Incidence of falls from windows in children in different areas throughout the Bay Area.
   (Study in conjunction with Stanford University Department of Emergency Medicine)
   
   

Peer reviewed publications

1. Vogel L, Vongsachang H, Pirrotta E, Holmes Jr. J, Sherck J, Newton C, D’Souza P, Spain D, Wang E. Variations in pediatric trauma transfer patterns in Northern California pediatric trauma centers (2001-2009). Acad Emer Med. Submitted
2. Hoshiko S, Smith D, Fan C, Jones CR, McNeel SV, Cohen RA. Trends in CT scan rates in children and pregnant women: teaching, private, public and nonprofit facilities. Pediatr Radiol. 2014 Feb 14.
3. Pandya NK, Upasani VV, Kulkarni VA. The pediatric polytrauma patient: current concepts. J Am Acad Orthop Surg. 2013 Mar;21(3):170-9. PMID: 23457067
4. Pandya NK, Edmonds EW. Immediate intramedullary flexible nailing of open pediatric tibial shaft fractures. J Pediatr Orthop. 2012 Dec;32(8):770-6.
5. Pandya NK, Edmonds EW, Roocroft JH, Mubarak SJ. Tibial Tubercle fractures: complications, classification, and the need for intra-articular assessment. J Pediatr Orthop. 2012 Dec;32(8):749-59.
6. Jenkins JA, Gharabaghian L, Doniger SJ, Bradley S, Crandall S, Spain D, Williams S. Sonographic identification of tube thoracostomy study (SITTS): confirmation of intrathoracic placement. West J Emerg Med. 2012 Sep;13(4):305-311.
7. Boriosi JP, Cohen RA, Summers E, Sapru A, Hanson JH, Gildengorin G, Newman V, Flori HR. Lung aeration changes after lung recruitment in children with acute lung injury: a feasibility study. Pediatr Pulmonol. 2012 Aug;47(8):771-9. DOI: 10.1002/ppul22508. Epub 2012 Feb 1.
8. Pandya NK, Namdari S, Hosalkar HS. Displaced clavicle fractures in adolescents: facts, controversies, and current trends. J Am Acad Orthop Surg. 2012 Aug;20(8):498-505.
9. Pandya NK, Behrends D, Hosalkar HS. Open reduction of proximal humerus fractures in the adolescent population. J Child Orthop. 2012 Jun;6(2):111-8. PMID: 23730341
10. Lamperti M1, Bodenham AR, Pittiruti M, Blaivas M, Augoustides JG, Elbarbary M, Pirotte T, Karakitsos D, Ledonne J, Doniger S, Scoppettuolo G, Feller-Kopman D, Schummer W, Biffi R, Desruennes E, Melniker LA, Verghese ST. International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med. 2012 Jul;38(7):1105-17.
11. Sabatini CS, Skaggs KF, Kay RM, Skaggs DL. Orthopedic surgeons are less likely to see children now for fracture care compared with 10 years ago. J Pediatr. 2012 Mar;160(3):505-7.
12. Frenkel O, Mansour K, Fischer J. Ultrasound-guided femoral nerve block for pain control in an infant with a femur fracture due to nonaccidental trauma. Pediatr Emer Care. 2012 Feb;28(2): 183-184.
13. Pandya NK, Edmonds EW, Mubarak SJ. The incidence of compartment syndrome after flexible nailing of pediatric tibial shaft fractures. J Child Orthop. 2011 Dec;5(6):439-47.
14. Berg C, Zaia B, Doniger SJ, Williams S, Determining the change in intraocular pressure during orbital bedside ultrasonography. Annals Emer Med. 2011 Oct;58(4), Supplement; S205.
15. Boriosi J, Sapru A, Hanson J, Asselin J, Gildengorin G, Newman V, Sabato K, Flori H. Efficacy and safety of lung recruitment in pediatric patients with acute lung injury. Pediatr Crit Care Med. 2011 Jul;12(4):431-6.
16. Srinivasan R, Song Y, Wiener-Kronish J, Flori HR. Plasminogen activation inhibitor concentrations in broncholaveolar lavage fluid distinguishes ventilator-associated pneumonia from colonization in mechanically ventilated pediatric patients. Pediatr Crit Care Med. 2011 Jan;12(1):21-7.
17. Baldwin K, Pandya NK, Wolfgruber H, Drummond DS, Hosalkar HS. Femur fractures in the pediatric population: abuse or accidental trauma? Clin Orthop Relat Res. 2011;469:798-804.
18. Clark A, Auguste K, Sun P: Cervical spine stenosis and sports-related cervical cord neurapraxia. Neurosurg Focus. 2011 Nov;31(5):E7.
19. Flori H, Church G, Liu K, Gildengorin G, Matthay M: Positive fluid balance is associated with higher mortality and prolonged mechanical ventilation in pediatric patients with acute lung injury. Crit Care Res Pract. 2011;2011: 854142.
20. Hosalkar HS, Pandya NK, et al. Intramedullary nailing of pediatric femoral shaft fracture. J AM Acad Orthop Surg. 2011 Aug;19(8): 472-481.
21. Pahlavan S, Baldwin KB, Pandya NK, et al. Proximal humerus fractures in the pediatric population: a systematic review. J Child Orthop. 2011;5:187-194.
22. Pandya NK, Baldwin K, Kamath AF, Wenger DR, Hosalkar HS. Unexplained fractures: child abuse or bone disease? a systematic review. Clin Orthop Relat Res. 2011;469:805-512. PMID: 20878560
23. Rice T, Trent R, Bernacki K, Lovette B, et al. Trauma center-based surveillance of nontraffic pedestrian injury among California children West J Emerg Med. 2012 May;XIII(2):139-145. DOI 10.5811/westjem.2011.7.6594.