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Just Like Adults? Evaluating the Impact of Fluid Resuscitation in Pediatric Trauma
Paulette I. Abbas, MD1,2, Kyle Carpenter2, Fariha Sheikh1,2, Michelle L. Peterson1,2, Mirko Kljajic1, Bindi Naik-Mathuria1,2; 1Texas Children's Hospital, Division of Pediatric Surgery, Houston, Texas; 2Baylor College of Medicine, Houston, Texas

Abstract:
Purpose:
While adult trauma management emphasizes restricted crystalloid resuscitation, limited literature is available in pediatric trauma. We sought to evaluate outcomes in children treated at our institution. Methods: The trauma registry of a level 1pediatric trauma center was queried from 9/2011 to 7/2014. Data collected included demographics, vitals, injury type, injury severity score (ISS), and 24-hour crystalloid administration. Patients requiring blood transfusions were excluded. Outcomes included ileus (>3 days), coagulopathy (INR >1.5), and need for mechanical ventilation within 24 hours. Statistical analyses included ?2, Mann-Whitney-U, and ROC analyses. Results: Of the 603 patients, 94% had blunt trauma (mean age 8.45.3 years). Median ISS was 9 (IQR 5-14). 10% of patients had ileus, 3% had coagulopathy, and 11% required intubation. Higher median crystalloid volume was associated with ileus (3.0 cc/kg/hr vs 1.5 cc/kg/hr, p50 cc/kg/day) leads to prolonged ileus and need for mechanical ventilation. This may help guide providers in initial resuscitation of pediatric trauma patients.
Objective:
At the end of this activity, the learner will be able to discuss the potential adverse outcomes related to excess early crystalloid resuscitation.
Objective Content: Adult literature suggests that crystalloid resuscitation should be limited during trauma resuscitation; however, current ATLS protocols still indicate initial crystalloid resuscitation in pediatric patients. Our study suggests that higher crystalloid administration predicted prolonged ileus and need for mechanical ventilation in pediatric trauma patients.


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