TY - JOUR
T1 - THAM Administration to Pediatric Trauma Patients in a Combat Zone
AU - Naylor, Jason F.
AU - April, Michael D.
AU - Hill, Guyon J.
AU - Kempski, Kelley M.
AU - Arana, Allyson A.
AU - Schauer, Steven G.
N1 - Publisher Copyright:
© 2018 Lippincott Williams & Wilkins.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Objectives Pediatric casualties made up a significant proportion of patients during the recent military conflicts in Iraq and Afghanistan. Damage control resuscitation strategies used by military physicians included rapid reversal of metabolic acidosis to mitigate its pathophysiologic consequences, primarily through hemorrhage control and volume restoration. Alkalizing agents, including tris(hydroxymethyl)aminomethane (THAM), are potential therapeutic adjuncts to treat significant acidosis. There is, however, limited published data on THAM administration in the pediatric trauma population. We compared demographics and outcomes among pediatric trauma patients in Afghanistan and Iraq receiving THAM versus those not receiving THAM. Methods We queried the Department of Defense Trauma Registry for all of the pediatric patients admitted to US and Coalition fixed-facility hospitals in Afghanistan and Iraq from January 2007 to January 2016. We retrieved data on age, sex, location, mechanism of injury, Injury Severity Scores, ventilator days, days in the intensive care unit, days of total hospitalization, and survival to hospital discharge. We excluded subjects if they were dead on arrival to the emergency department. Results From January 2007 to January 2016, there were 3386 pediatric subjects that met our inclusion criteria. Of these, 15 received THAM. The youngest subject receiving THAM was a 2-month-old burn victim. Subjects receiving THAM were more likely to be injured by submersion or burn (P < 0.001), had higher composite Injury Severity Scores (17 vs 10; P < 0.001) and Abbreviated Injury Scores for the thorax and abdomen (P = 0.004 and P = 0.019, respectively), and longer ventilator days/intensive care unit stays/hospital lengths of stay (P < 0.001/P < 0.001/P = 0.013). In addition, subjects receiving THAM had a lower survival rate than subjects not receiving THAM (73.3% vs 91.7%; P = 0.011). Conclusions THAM was administered rarely to pediatric trauma casualties during the conflicts in Afghanistan and Iraq. Subjects receiving THAM were more critically injured than the baseline population.
AB - Objectives Pediatric casualties made up a significant proportion of patients during the recent military conflicts in Iraq and Afghanistan. Damage control resuscitation strategies used by military physicians included rapid reversal of metabolic acidosis to mitigate its pathophysiologic consequences, primarily through hemorrhage control and volume restoration. Alkalizing agents, including tris(hydroxymethyl)aminomethane (THAM), are potential therapeutic adjuncts to treat significant acidosis. There is, however, limited published data on THAM administration in the pediatric trauma population. We compared demographics and outcomes among pediatric trauma patients in Afghanistan and Iraq receiving THAM versus those not receiving THAM. Methods We queried the Department of Defense Trauma Registry for all of the pediatric patients admitted to US and Coalition fixed-facility hospitals in Afghanistan and Iraq from January 2007 to January 2016. We retrieved data on age, sex, location, mechanism of injury, Injury Severity Scores, ventilator days, days in the intensive care unit, days of total hospitalization, and survival to hospital discharge. We excluded subjects if they were dead on arrival to the emergency department. Results From January 2007 to January 2016, there were 3386 pediatric subjects that met our inclusion criteria. Of these, 15 received THAM. The youngest subject receiving THAM was a 2-month-old burn victim. Subjects receiving THAM were more likely to be injured by submersion or burn (P < 0.001), had higher composite Injury Severity Scores (17 vs 10; P < 0.001) and Abbreviated Injury Scores for the thorax and abdomen (P = 0.004 and P = 0.019, respectively), and longer ventilator days/intensive care unit stays/hospital lengths of stay (P < 0.001/P < 0.001/P = 0.013). In addition, subjects receiving THAM had a lower survival rate than subjects not receiving THAM (73.3% vs 91.7%; P = 0.011). Conclusions THAM was administered rarely to pediatric trauma casualties during the conflicts in Afghanistan and Iraq. Subjects receiving THAM were more critically injured than the baseline population.
KW - acidemia
KW - pediatrics
KW - resuscitation
KW - trauma
KW - tris(hydroxymethyl)aminomethane
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U2 - 10.14423/SMJ.0000000000000843
DO - 10.14423/SMJ.0000000000000843
M3 - Article
C2 - 30075467
AN - SCOPUS:85051055550
SN - 0038-4348
VL - 111
SP - 453
EP - 456
JO - Southern medical journal
JF - Southern medical journal
IS - 8
ER -