Factors associated with patient exposure and environmental control during pediatric trauma resuscitation.
BACKGROUND
Exposure and environmental control are essential components of the advanced trauma life support primary survey, especially during the resuscitation of pediatric patients. Proper exposure aids in early recognition of injuries in patients unable to communicate their injuries, while warming techniques, such as the use of blankets, assist in maintaining normothermia. The purpose of this study was to identify factors associated with exposure compliance and duration during pediatric trauma resuscitation.


METHODS
All pediatric trauma resuscitations over a 4-month period were reviewed for compliance and time to completion of clothing removal and warm blanket placement. Video review data were then linked with clinical data obtained from the trauma registry. Univariate and multivariate analyses were used to determine the associations of patient characteristics, injury mechanism, and clinical factors on exposure compliance and duration.


RESULTS
Of 145 patients, 65 (52%) were never exposed. Lower exposure compliance was associated with increasing age (odds ratio, [OR], 0.90; 95% confidence interval [CI], 0.83-0.98), Glasgow Coma Scale (GCS) score of 14 or greater (OR, 0.16; 95% CI, 0.03-0.76), Injury Severity Score (ISS) of 15 or less (OR, 0.27; 95% CI, 0.09-0.82), and the absence of head injury (OR, 0.26; 95% CI, 0.08-0.87). Among those exposed, the duration of exposure was longer among children with GCS score of less than 14 (4.3 [1.6], p = 0.009), head injuries (3.33 [1.6], p = 0.04), and the need for intubation (8.4 [2.2], p < 0.001). In multivariate analyses, older age and ISS of 15 or less were associated with a decreased odds of exposure (p = 0.009, p = 0.04, respectively), while intubation was associated with increased exposure duration (p = 0.007).


CONCLUSIONS
Despite the importance of exposure and environmental control during pediatric trauma resuscitation, compliance with these tasks was low, even among severely injured patients. Interventions are needed to promote the proper exposure of patients during the initial evaluation, while also limiting the duration of exposure during examinations and procedures in the trauma bay.


METHODS
Epidemiologic study, level III.
Division of Trauma and Burns, Children's National Medical Center, Washington, District of Columbia 20010, USA.
Deirdre C
DC
Kelleher
Lauren J
LJ
Waterhouse
Samantha E
SE
Parsons
Jennifer L
JL
Fritzeen
Randall S
RS
Burd
Elizabeth A
EA
Carter
D000293:Adolescent; D061906:Advanced Trauma Life Support Care / Q000379:methods / Q000592:standards; D001831:Body Temperature; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards; D003020:Clothing; D004780:Environment, Controlled; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D010808:Physical Examination / Q000379:methods / Q000592:standards; D012151:Resuscitation / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D014193:Trauma Centers / Q000592:standards; D014741:Video Recording; D014947:Wounds and Injuries / Q000628:therapy*