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Biomedical subjects

M R Eichelberger

Publications and source records attributed to M R Eichelberger.

At least 19 recordsLinked to original sources
PubMed2004

The performance of various rear facing child restraint systems in a frontal crash.

Current forward facing (FF) child restraint designs use LATCH and ISOFIX systems to couple the restraint to the vehicle. Rear facing (RF) child restraints, however, have multiple coupling methods that vary by manufacturer and country of origin. Sled tests were performed with the CRABI 12 month dummy in six different RF attachment conditions. The performance of the rear facing child restraints (restraint kinematics, head accelerations, and neck loads) was highly dependent on the coupling method used. The results were also compared to a FF LATCH restraint.

Acceleration↗
PubMed2003

Prediction of cervical spine injury risk for the 6-year-old child in frontal crashes.

This article presents a series of 49 km/h sled tests using the Hybrid III 6-year-old dummy in a high-back booster, a low-back booster, and a three-point belt. Although a 10-year review at a level I trauma center showed that noncontact cervical spine injuries are rare in correctly restrained booster-age children, dummy neck loads exceeded published injury thresholds in all tests. The dummy underwent extreme neck flexion during the test, causing full-face contact with the dummy's chest. These dummy kinematics were compared to the kinematics of a 12-year-old cadaver tested in a similar impact environment. The cadaver test showed neck flexion, but also significant thoracic spinal flexion which was nonexistent in the dummy. This comparison was expanded using MADYMO simulations in which the thoracic spinal stiffness of the dummy model was decreased to give a more biofidelic kinematic response. We conclude that the stiff thoracic spine of the dummy results in high neck forces and moments that are not representative of the true injury potential.

Accidents, Traffic↗
PubMed2002

Prediction of cervical spine injury risk for the 6-year-old child in frontal crashes.

This paper presents a series of 49 km/h sled tests using the Hybrid III 6-year-old dummy in a high-back booster, a low-back booster, and a three-point belt. Although it is shown that non-contact cervical spine injuries are rare in correctly restrained children in this age group, neck loads exceeded published injury thresholds in all tests. The dummy kinematics were compared to the kinematics of a 12-year-old cadaver tested in a similar impact environment. This comparison was expanded using MADYMO simulations. It is concluded that the stiff thoracic spine of the dummy results in high neck forces and moments that are not representative of the true injury potential.

Accidents, Traffic↗
PubMed2001

The use of a bioactive skin substitute decreases length of stay for pediatric burn patients.

BACKGROUND: To optimize burn care for children, the authors introduced a protocol incorporating the use of a bioactive skin substitute, TransCyte (Advanced Tissue Sciences, La Jolla, CA). This study was designed to determine whether this management plan was safe, efficacious, and decreased hospital inpatient length of stay (LOS) compared with conventional burn management in children. METHODS: All pediatric burns greater than 7% total body surface area (TBSA) that occurred after October 1999 underwent wound closure with TransCyte (n = 20). These cases were compared with the previous 20 consecutive burn cases greater than 7% TBSA that received standard therapy. Standard therapy consisted of application of antimicrobial ointments and hydrodebridement. The following information was obtained: burn mechanism, age, size of burn, requirement of autograft, and LOS. Data were analyzed using the student's t test. RESULTS: Data for age, percent TBSA burn and LOS are reported as means +/- SEM. The children who received standard therapy were 2.99 +/- 0.7 years compared with those receiving TransCyte were 3.1 +/- 0.8 years. There was no difference between the treatment groups with regard to percent TBSA burn: standard therapy, 14.3 +/- 1.4% TBSA versus TransCyte, 12.7 +/- 1.3% TBSA. There was no difference in the type of burns in each group, the majority were liquid scald type, 70% in the standard therapy group versus 90% in the TransCyte group. Only 1 child in the TransCyte group required autografting (5%) compared with 7 children in the standard therapy group (35%). Children treated with TransCyte had a statistically 6 significant decreaed LOS compared with those receiving standard therapy, 5.9 +/- 0.9 days versus 13.8 +/- 2.2 days, respectively (P =.002). CONCLUSIONS: This is the first study using TransCyte in children. The authors found that this protocol of burn care was safe, effective, and significantly reduced the LOS. This new approach to pediatric burn care is effective and improves the quality of care for children with burns.

Burn Units↗
PubMed1999

Prevalence and distribution of extraperitoneal hemorrhage associated with splenic injury in infants and children.

OBJECTIVE: The purpose of this study was to evaluate the prevalence and distribution of associated extraperitoneal hemorrhage in infants and children with splenic injury. CONCLUSION: Splenic injury occasionally resulted in extraperitoneal hemorrhage that tracked into the anterior pararenal space. Extraperitoneal hemorrhage always occurred in association with intraperitoneal hemorrhage. In addition, blood tracking into the anterior pararenal space after splenic injury dissected the splenic vein and pancreas in two (25%) of eight patients.

Adolescent↗
PubMed1997

Blunt abdominal trauma in children: impact of CT on operative and nonoperative management.

OBJECTIVE: The purpose of this study was to evaluate the impact of CT on operative management of children examined after blunt abdominal trauma. SUBJECTS AND METHODS: Fifteen-hundred consecutive children who sustained blunt abdominal trauma were prospectively examined with CT. CT findings and the decision for operative or nonoperative management were recorded prospectively. In the children who underwent laparotomy, indications for operative intervention as determined by the attending trauma surgeon and surgical findings were also recorded. RESULTS: Three hundred eighty-eight (26%) of the CT scans had abnormal findings: solid viscus injury, 286; other CT abnormality, 102. Twenty (7%) of 286 children with a solid viscus injury and 25 (83%) of 30 children with a hollow viscus injury underwent therapeutic laparotomy. Abnormalities seen on CT were noted in all 20 children with solid viscus injury and 24 of 25 children with hollow viscus injury who underwent therapeutic laparotomy. The decision for laparotomy was based on CT findings in five (25%) of 20 children with solid viscus injury and 17 (68%) of 25 children with hollow viscus injury. Eleven hundred twelve children (74%) had normal findings on CT. Only one of these children later required laparotomy. CONCLUSION: CT rarely influenced the decision for operative intervention in children who sustained blunt abdominal trauma. CT findings affected the decision for operative intervention in most children with hollow viscus injury; however, CT findings affected such a decision in only a small subset of children with solid viscus injury. Normal abdominal CT findings strongly predicted a lack of subsequent deterioration requiring operative intervention.

Abdominal Injuries↗
PubMed1996

Helicopter transport of injured children: system effectiveness and triage criteria.

The authors compared air and ground transport to a level I pediatric trauma center to assess the effectiveness of helicopter transport of injured children. They also performed a retrospective assessment of triage criteria and utilization patterns for helicopter transports. The sample comprised 3,861 children who were admitted (consecutively) to an urban level I pediatric trauma center during a 4-year period and who were transported by emergency medical services. TRISS probability of survival (P2),z, and W scores were used to compare outcomes of ground and air transports. An absolute value of z greater than 1.96 indicates a statistically significant difference in mortality rate; the W statistic represents the number of survivors more than expected per 100 patients treated. Receiver operator characteristic (ROC) curves were used to identify optimal triage criteria, using P6 < .95 to define children who potentially could benefit from air transport. The triage criteria were applied to the air transport group to determine overtriage rates. Nearly 75% of the children arrived directly from the scene of injury. Those transported by air were more severely injured, as shown by significant differences in the mean Glasgow Coma Scale (GCS), P6, Injury Severity Score, and mortality rate. The better survival rate for children transported by helicopter was indicated by a TRISS z score of 2.81, compared with a z score of 0.31 for those transported by ambulance. The W statistic for the children transported by air was 1.11. ROC analysis identified GCS < 12 and heart rate > 160 beats per minute as optimal air triage criteria; these yielded 99% sensitivity and 90% specificity. Using these criteria, approximately 85% of air transports would be considered overtriage. The authors conclude that (1) helicopter transport was associated with better survival rates among urban injured children; (2) pediatric helicopter triage criteria based on GCS and heart rate may improve helicopter resource utilization without compromising care; and (3) current air triage practices result in overuse of helicopters in approximately 85% of flights.

Air Ambulances↗
PubMed1996

Nonoperative management of blunt hepatic and splenic injury in children.

OBJECTIVE: The authors assessed the risks of nonoperative management of solid visceral injuries in children (age range, 4 months-14 years) who were consecutively admitted to a level I pediatric trauma center during a 6-year period ending in 1991. METHOD: One hundred seventy-nine children (5.0%) sustained injury to the liver or spleen. Nineteen children (11.2%) died. Of the 160 children who survived, 4 received emergency laparotomies; 156 underwent diagnostic computer tomography and were managed nonoperatively. The percentage of children who were successfully treated nonoperatively was 97.4%. Delayed diagnosis of enteric perforations occurred in two children. Fifty-three children (34.0%) received transfusions (mean volume 16.7 mL/kg); however, transfusion rates during the latter half of the study decreased from 50% to 19% in children with hepatic injuries, despite increasing grade of injury, and decreased from 57% to 23% in the splenic group with similar injury grade (p < 0.005, chi square test and Student's t test). CONCLUSION: Pediatric blunt hepatic and splenic trauma is associated with significant mortality. Nonoperative management based on physiologic parameters, rather than on computed tomography grading of organ injury, was highly successful, with few missed injuries and a low transfusion rate.

Adolescent↗
PubMed1995

Blunt hepatic and splenic trauma in children: correlation of a CT injury severity scale with clinical outcome.

The purpose of this report is to compare a computed tomography (CT) injury severity scale for hepatic and splenic injury with the following outcome measures: requirement for surgical hemostasis, requirement for blood transfusion and late complications. Sixty-nine children with isolated hepatic injury and 53 with isolated splenic injury were prospectively classified at CT according to extent of parenchymal involvement. Clinical records were reviewed to determine clinical outcome. Ninety-seven children (80%) were managed non-operatively without transfusion. One child with hepatic injury required surgical hemostasis, and 17 (25%) required transfusion of blood. Increasing severity of hepatic injury at CT was associated with progressively greater frequency of transfusion (P = 0.002 by chi 2-test). One child with splenic injury underwent surgery and eight (15%) required transfusion of blood. Splenic injury grade at CT did not correlate with frequency (P = 0.41 by chi 2-test) or amount (P = 0.35 by factorial analysis of variance) of transfusion. There was one late complication in the nonsurgical group. A majority of children with hepatic and splenic injury were managed non-operatively without requiring blood transfusion. The severity of injury by CT scan did not correlate with need for surgery. Increasing grade of hepatic injury at CT was associated with increasing frequency of blood transfusion. CT staging was not discriminatory in predicting transfusion requirement in splenic injury.

Adolescent↗
PubMed1995

Evaluation of early enteral feeding in children less than 3 years old with smaller burns (8-25 per cent TBSA).

Early enteral feeding and high protein nutrition have been advocated for burned patients. The safety and efficacy of early high protein nasogastric feeding (NG) have not been evaluated in very young children. The present study evaluated such feeding in children less than 3 years old with smaller burns (8-25 per cent of total body surface area). Children (n = 10) were able to tolerate high protein intake without detrimental effects. The incidences of gastrointestinal complications related to NG feeding were low. The children needed approximately 2 weeks of supplemental NG feeding which provided two-thirds of total energy intake and three-fourths of protein intake. In spite of smaller burns, the mean measured resting metabolic expenditure (REE) was 1.3 x predicted REE. The mean energy intake of 92 per cent of recommended daily allowances (RDA) for energy or 1.7 x predicted REE was able to maintain body weight. The mean protein intake was 4.3 g/kg/day with a non-protein calorie ratio of 114:1. During the first week postburn, plasma concentrations of prealbumin, albumin and transferrin were low. The high protein intake was able to raise these visceral proteins to normal ranges. These results indicate that early NG feeding is safe and efficacious for achieving increased energy intake and improved protein status in very young children.

Anthropometry↗
PubMed1995

Comparison of three measures of injury severity in children with traumatic brain injury.

Eighty-six traumatically brain-injured children aged 6 to 15 years who were consecutively admitted to a pediatric Level I trauma center were recruited for participation in the study. A comprehensive battery of behavioral, cognitive, communicative, social, motoric, and neurological tests was administered to the children from 12 to 36 months postinjury. The performance of three severity indices, the Glasgow Coma Scale (GCS), the ASCOT probability of survival, and the head injury component of the Anatomic Profile, was compared with respect to their association with long-term outcomes in five neurological domains, as assessed by linear regression models. The ASCOT probability of survival was correlated to test scores in all five domains. The GCS and the head injury component of the Anatomic Profile were each correlated to outcome in only one domain. The ASCOT probability of survival, which includes coded variables for the GCS, systolic blood pressure, and respiratory rates on admission, as well as a measure of multisystem anatomic injury, was the most sensitive indicator of head injury severity and was associated with outcomes beyond survival and death in this population. Probability of survival is a promising brain injury severity index that may be useful in efforts to assess new medical and rehabilitative therapies for children with traumatic brain injury.

Adolescent↗
PubMed1995

Splenic injury from blunt abdominal trauma in children: follow-up evaluation with CT.

PURPOSE: To assess if the initial grade of splenic injury depicted at computed tomography (CT) in children could help predict rate of healing. MATERIALS AND METHODS: Thirty-seven children with splenic injury graded at emergent CT were prospectively followed up with non-enhanced and contrast material-enhanced CT performed 2 weeks to 11 months after injury. RESULTS: In all 15 grade 1 and 2 splenic injuries, healing was seen at follow-up, including eight injuries that occurred in patients who underwent follow-up CT within 4 months. In 10 of 11 grade 3 splenic injuries, healing was seen within 6 months. In all 11 grade 4 injuries, residual lesions were seen within 4 months and healing took up to 11 months. Five of nine residual splenic injuries were more clearly visualized with contrast material enhancement. No splenic complications occurred. CONCLUSION: CT grade of splenic injury is related to rate of healing. Grade 1 and 2 injuries typically heal within 4 months, whereas grade 3 injuries take up to 6 months to heal and grade 4 injuries take up to 11 months.

Abdominal Injuries↗
PubMed1995

CT diagnosis and localization of rupture of the bladder in children with blunt abdominal trauma: significance of contrast material extravasation in the pelvis.

OBJECTIVE: The purpose of this study was to determine the utility of CT performed with maximal bladder distension in showing extravasation of IV contrast material as a means of detecting and localizing bladder rupture in children after blunt trauma. MATERIALS AND METHODS: Seven of 1500 consecutive children who had IV contrast-enhanced CT of the abdomen after blunt trauma had a rupture of the bladder proved at surgery (five patients) or by clinical and imaging findings (two patients). The scanning protocol in all patients included occlusion of the Foley catheter if present and a 5-min delay after IV injection of contrast material prior to scanning the pelvis. The CT scans of all 1500 children were prospectively evaluated for the presence and location of extravasated contrast material in the pelvis. RESULTS: Extravasated IV contrast material in the pelvis was noted in all seven children with bladder rupture (intraperitoneal in four, extraperitoneal in three) and two of 1493 children without bladder rupture (extraperitoneal in both). Both children with contrast material extravasation who did not have bladder rupture had a renal injury. The location of the rupture (intraperitoneal or extraperitoneal) could be determined from the distribution of extravasated contrast material in the pelvis seen on CT scans. CONCLUSION: The use of a scanning delay at CT prior to imaging the pelvis showed extravasation of IV contrast material in all seven children with bladder rupture. Intraperitoneal and extraperitoneal bladder rupture could be differentiated on the basis of the distribution of extravasated contrast material seen on CT scans.

Abdominal Injuries↗
PubMed1995

CT diagnosis of pancreatic injury in children: significance of fluid separating the splenic vein and the pancreas.

OBJECTIVE: The purpose of our study was to evaluate the relationship of fluid between the splenic vein and the pancreas to fluid in the anterior pararenal space in children following blunt trauma and to assess the usefulness of detecting fluid separating the splenic vein and the pancreas in the CT diagnosis of pancreatic injury in children. MATERIALS AND METHODS: Twenty-five of 1725 consecutive children who underwent abdominal CT following blunt trauma had surgically or autopsy-proven pancreatic injury or clinical pancreatitis. An additional 29 children who underwent CT for evaluation of blunt trauma did not have pancreatic injury and were prospectively noted to have fluid in the anterior pararenal space. CT findings (visceral injury or intraperitoneal or extraperitoneal fluid) were recorded at the time of initial interpretation in all children. The CT scans of these 54 children were reviewed for the presence of fluid separating the splenic vein and the pancreas. RESULTS: Fluid separating the splenic vein and the pancreas was noted in 15 (60%) of 25 children with pancreatic injury and in 14 (48%) of 29 children who had fluid in the anterior pararenal space without pancreatic injury. In 14 of 15 children with pancreatic injury and fluid between the splenic vein and the pancreas, additional collections of peripancreatic fluid (anterior pararenal space or lesser sac) were also noted. In another four children with pancreatic injury, additional collections of peripancreatic fluid were noted in the absence of fluid between the splenic vein and the pancreas. CONCLUSION: Fluid separating the splenic vein and the pancreas on CT scans is a nonspecific finding usually associated with fluid in the anterior pararenal space. Although it may be seen in conjunction with pancreatic injury, it is rarely the only abnormal CT finding in such an injury.

Adolescent↗
PubMed1995

Resuscitation of the injured child.

Unintentional injury is the leading cause of death for children less than 14 years of age. Optimal injury control includes prevention, acute care, and rehabilitation. When prevention efforts fail, a dedicated well-trained team must be prepared to resuscitate and treat the injured child. This article presents an approach to resuscitation that emphasizes the primary and secondary survey. Early and aggressive airway control with cervical spine protection is stressed, followed by a rapid assessment of ventilatory mechanics and circulatory status. Clinical indicators of inadequate tissue perfusion are described, with priorities concerning intravenous access highlighted. Initial resuscitation steps, complemented by laboratory and radiological assessment, occur before the secondary survey. The secondary survey completes the early resuscitation phase and consists of a systematic and complete physical examination. Resuscitation priorities specific to the multiply-injured child are also discussed. Finally, the importance of rehabilitation and prevention efforts are included.

Abdominal Injuries↗
PubMed1994

Blunt renal trauma in children: healing of renal injuries and recommendations for imaging follow-up.

Initial CT grading of renal injury was correlated with the frequency of complications and the time course of healing in 35 children. All renal contusions (grade 1, 8) and small parenchymal lacerations (grade 2, 8) healed without complications. All lacerations extending to the collecting system (grade 3, 9) resulted in mild to severe loss of renal function with progressive healing over 4 months. One of four segmental infarcts (grade 4A), and five of six vascular pedicle injuries (grade 4B) resulted in severe loss of renal function. Complications, including urinoma (2), sepsis (1), hydronephrosis (1), and persistent hypertension (2), were limited to grade 3 and 4 injuries. Our results suggest that mild renal injuries do not require follow-up imaging. Major renal lacerations and vascular pedicle injuries, however, often result in loss of renal function and should be followed up closely due to the risk of delayed complications. Follow-up examinations should continue for 3-4 months until healing is documented.

Adolescent↗
PubMed1994

The injured child. An approach to care.

Injury is the leading cause of childhood death and disability in this country and has been for over a decade. Examination of the current injury statistics clearly demonstrates the failure of our present prevention strategies. Unless definitive steps are undertaken to initiate a comprehensive national injury prevention program, this tragic impact upon children will continue. To ensure that optimal care for injured children is provided, several criteria must be met. Seriously injured children require skillful assessment by clinicians experienced in pediatric trauma and rapid evacuation to a regional pediatric trauma center when appropriate. Their care is best provided by a multidisciplinary team including intensivists, surgeons, and rehabilitation specialists, all thoroughly familiar with the types of injuries children sustain. In the ICU, careful monitoring of circulatory, respiratory, renal, and neurologic status combined with early intervention for physiologic derangements maximizes the injured child's chances for recovery. Finally, it is important to understand that care for the injured child spans a continuum beginning with prevention, continuing through acute care, and ending only after rehabilitation and reintegration into the community is complete, and that each component is no less important than another. Only through these efforts can the loss of our nation's most precious resource be avoided.

Child↗