Pediatric trauma�Major adult trauma service or specialised paediatric service?

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Pediatric trauma—Major adult trauma service or specialised paediatric service? Article in Injury · July 2010 DOI: 10.1016/j.injury.2010.01.068

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Abstracts Trauma Melbourne 2009 / Injury 41S (2010) S27–S48

differ from those of a trauma control group. This suggests the importance of addressing these issues in those with persisting problems. doi:10.1016/j.injury.2010.01.066 ORAL-INVITED PLENARY 4-2 Maximal intensive care monitoring and support—Does it improve outcome? J. Rosenfeld 1,2 1 2

Monash University, Melbourne, Victoria, Australia The Alfred Hospital, Melbourne, Victoria, Australia

There is a trend in trauma ICUs toward individualised targeted monitoring and therapy for patients with severe TBI. There is evidence that mortality of patients with severe TBI is improved in an intensive care unit in centres with neurosurgeons (Patel et al. Lancet 2005). It is difficult to prove that ICP monitoring improves outcome but clearly high ICPs are associated with poor outcome but there is recent evidence that aggressive monitoring of ICP does improve outcome (Stein et al. J Neurosurg 2009). Episodes of low brain oxygen (PbtO2 ) may occur ‘silently’, be independent of ICP elevations and are associated with poor outcome. There is evidence that brain oxygen treatment algorithms can reduce episodes of cerebral hypoxia in severe TBI (Adamides Acta Neurochir 2009). There is emerging evidence that brain oxygen monitoring is associated with improved outcomes in severe TBI (McCarthy et al. Surgery 2009) but this requires further substantiation with a randomised controlled trial. Demonstrating improved mortality and outcome on the GOSE is what is usually aimed for in these TBI studies which is fine but in the future we will need to discern quality of outcome functionally and psychologically in more detail to be able to reveal the full and more subtle effects of intensive monitoring. Other newer cerebral protective agents and therapeutic hypothermia treatments are still under investigation and these treatments combined with more aggressive targeted monitoring including microdialysis for ‘metabolic’ monitoring may produce further improvements in outcome.

trauma, different mechanisms of injury and different injuries from similar insults (children suffer severe internal organ injury in the absence of skeletal damage, more commonly suffer single organ trauma usually head or spinal injury). Adequate resuscitation, ongoing intensive care and paediatric surgical skills are required to care for these critically ill children. It is clear that care of critically ill patients improves with increasing numbers of patients; centres of excellence have better results than occasional operators. There is no doubt that the development of regional coordinated trauma systems saves lives and decreases long term morbidity, and that severe or complex paediatric trauma is uncommon at most major children’s hospitals. Most trauma systems compromise and admit small children to paediatric hospitals and older (pubertal) “polytrauma” to adult trauma hospitals. doi:10.1016/j.injury.2010.01.068 ORAL-INVITED PLENARY 4-4 EPO/POLAR—World leading trials in TBI research A. Nichol 1,2 1

Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia 2 Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia Currently, two therapies with great potential to reduce neurological damage and improve outcome after a number of acute cerebral insults is the application of early prophylactic hypothermia and exogenous erythropoeitin (EPO) administration. Many experimental studies have confirmed that moderate hypothermia and EPO confers protection against ischaemic and non-ischaemic brain hypoxia. There is extensive scientific rationale supporting early prophylactic hypothermia and EPO as a treatments for a number of conditions in the critically ill. We will explore the rationale, the practical application of these therapies in the ICU, complications and future studies which will determine the clinical utility of hypothermia in severe traumatic brain injury.

doi:10.1016/j.injury.2010.01.067 doi:10.1016/j.injury.2010.01.069 ORAL-INVITED PLENARY 4-3 Pediatric trauma—Major adult trauma service or specialised paediatric service? W. Butt 1,2 1 Intensive Care Unit, Royal Children’s Hospital, Melbourne, Victoria, Australia 2 Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia

Small children injured after trauma are very different to adults. They have major physiological differences, different responses to