02:58am Wednesday 23 October 2019

Research agenda, network needed to study pediatric trauma care

ANN ARBOR, Mich.Pediatric trauma is the leading cause of death and acquired disability among children and young adults in the United States, according to a 2008 report by the World Health Organization.

Despite that, many deficiencies exist in pediatric trauma care, and there is little research nationally to address them, according to a commentary in two academic journals by leading trauma specialists from around the country. Peter F. Ehrlich, M.D., M.H.S., director of Pediatric Trauma at the University of Michigan C. S. Mott Children’s Hospital, is one of the authors in the commentary, which appears in the Journal of Trauma, Injury, Infection, and Critical Care and the Journal of Pediatric Surgery. Ehrlich is also Associate Professor in the Department of Surgery at the U-M Medical School.

“Despite the enormity of this public health problem, there is no comprehensive national pediatric trauma research agenda and no infrastructure to support a pediatric trauma research network,” Ehrlich says. “The development of a research consortium such as a Pediatric Applied Trauma Research Network is the next logical step to address these challenges.”

The types of research conducted would be comprehensive and multi-disciplinary to include improving head injury outcomes, risk-based behavior such as substance abuse, thoracic injury, stem cells and brain injury, mental health, rehabilitation and orthopedic approaches to injured children.

“We’re trying to bridge a gap between a huge pediatric problem and a lack of research by the people who care for these children 90 percent of the time,” he adds. “We’re trying to raise the profile of this problem and the understanding that not one center that can do it. It’s got be a comprehensive, multi-center effort.”

Pediatric trauma affects both genders and all economic, racial, and social backgrounds in the United States. Children are injured in rural, suburban, and urban environments. Childhood injury affects not only the physical well-being of the child but also the child’s mental health, school performance and the well-being of the child’s family.

Pediatric trauma has enormous costs to society: years of productive life are lost and disabilities present additional and significant health care costs. Because trauma is a disease process with identifiable and reproducible patterns, interventions can be developed that reduce and effectively treat its incidence and morbidity.

Some multi-center research has been conducted via the Trauma Committee of the American Pediatric Surgical Association. And while a valuable starting point, more research is needed to validate studies, Ehrlich says.

A busy urban pediatric emergency department may see 50,000 to 70,000 patients per year, of which only 10% are injured, and roughly 10% of the injured group is admitted to the hospital. In a moderate-sized city with a 500,000 population and 125,000 children, 375 children per year are hospitalized for the treatment of any injury, of which only 20 to 40 have sustained a severe injury.

Because the number of seriously injured children treated at a single center is relatively small, a research network is required for studies focused on severe pediatric injury. Individual institutions are also unlikely to have sufficient patient diversity to represent all populations, such as rural, suburban, minority, or low socioeconomic status.

The authors propose that the research network include thought leaders from Level I pediatric trauma centers from across the country working to determine a research agenda, research infrastructure, resources, tools and methodologies for studying pediatric trauma.

The network would create approaches for measuring health care delivery. The network would be developed from a competitive process funded by federal resources. The framework would include the entire continuum from injury prevention to rehabilitation.

Access to injured children in pre-hospital, in-hospital, and post-hospital settings will allow the network to address a range of research issues including the pre-hospital and hospital triage of injured patients, airway management, acute care and rehabilitation of children with traumatic brain injury, the role of blunt and penetrating abdominal trauma, identification and treatment of alcohol and substance abuse, and the development of targeted injury prevention programs.

The National Institutes of Health, Center for Disease Control and Prevention, and Agency for Healthcare Research and Quality are obvious choices to orchestrate and oversee the establishment of a pediatric trauma research framework and appropriations focused solely on pediatric trauma should be directed to these agencies to host planning workshops and recommendations, the authors wrote.

Additional authors: Upperman, J.S., Burd R, Cox C., Ehrlich P., Mooney D., Groner JI

References: J Trauma. 2010 Nov;69(5):1304-1307 and J Pediatr Surg. 2010 Nov;45(11):2278-82.

Media contact: Margarita Wagerson
E-mail: mbauza@med.umich.edu
Phone: 734-764-2220

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