Background

Progressive scoliosis often requires deformity correction. Intraoperative neuromonitoring (IONM) using motor evoked potentials (MEP) and sensory evoked potentials (SEP) is the method of standard to evaluate the integrity of the spinal cord during the procedure. Thus, IONM may detect iatrogenic spinal cord injuries with excellent sensitivity. But there are multiple factors that influence the IONM results.

Objectives

Aim of the study was to identify origins of occurring IONM alarms.

Methods

A total of 54 operative procedures from 2014 to 2017 in 34 children and 18 adults (m:w = 17:35, age 16 +/- 5) were analyzed retrospectively. All patients suffered from scoliosis, underwent spinal deformity surgery and were monitored by MEP and SEP performance intraoperatively.

Anesthesia was generated with propofol, sufentanil and remifentanil. MEP alarms were defined as an amplitudal decrement > 90%. SEP alarms were defined as any extension of latency. According to our algorithm, alarms were categorized in 3 different origins: anestetical, surgical and technical.

Results

In 48 (88,9%) out of 54 procedures reliable MEP and SEP could be generated. 17 alarms were detected. 15 alarms (88,2%) were associated with anesthetic agents. 2 alarms (11,8%) had technical causes. None could be assigned to the surgical procedure.

Conclusion

IONM is state of the art to evaluate spinal cord integrity changes during deformity correction. Dosage and selection of anesthetic agents are the major causes of IONM alarms during scoliosis surgery.

Background

Red Cross-Vorarlberg and Christophorus Flugrettungsverein, operating the helicopter C8, cover emergency medical transports in Vorarlberg and the surrounding area with a population of 450,000 inhabitants among which are 80,000 children and adolescents.

Objectives

The aim of this thesis is to investigate pediatric emergency medical transports in Vorarlberg-Austria from 2013 to 2017, with its focus placed on patients who suffered trauma.

Methods

Patients from the age of 28 days to 18 years were included.

Results

We report about a total of 2,633 transports, 2,170 on ground and 463 by helicopter, which results in a prevalence of 1:140 children per year. Main age groups were infants (from 1 to 5 years) and schoolchildren (from 6 to 14 years) and 61.4% of them were male, and more than 50% of all transports came from a city or village bigger than 1,000 inhabitants; the main destination was the reference Children’s Hospital Feldkirch with a PICU. The three most common diagnoses were febrile seizures, cerebral concussion and epilepsy.

Transports by helicopter were mostly due to traumatic injuries, amongst which a closed fracture of the lower extremities was the most frequent diagnosis.

The mean mission time with helicopter (43±18.6 minutes) was non-significantly higher compared to the one for ground-based missions (37±19.7 minutes).

Conclusion

This high prevalence of transports of ill children in our study may be due to the highly developed alpine tourism in our region. This result is reflected by the larger amount of trauma patients rescued by the helicopter compared to ground-based transports.

Background

Mild head injury is a common cause for paediatric emergency department visits. Cranial computer tomography (CCT) is the diagnostic standard for radiologic investigations, though the risk of radiation. Paediatric Emergency care applied research network (PECARN) clinical prediction rules have been invented to reduce CCT scans. They provide a guideline for outpatient care, or short-term observation for patients with moderate risk.

Objectives

To evaluate the impact of the implementation of PECARN rules in children with mild head injury on hospitalisation and CCT rate, patient management before and after rule implementation was recorded

Methods

In this retrospective study, children with mild head injury presenting in the paediatric emergency department between 2012 and 2016 were examined. We compared two groups, before and after implementation of PECARN criteria in clinical routine and the second group afterwards. Changes in hospitalisation rates and CT rates were calculated using Chi² test.

Results

Of 742 included patients (age ± 5.6 years; 317 female and 425 male), 388 were seen prior to the implementation of PECARN rules, compared to 354 patients afterwards. The amount of admissions to the ward decreased significantly from 325/388 (84%) to 254/354 (71%), whereas the number of discharges rose (p<0.05). Based on all paediatric admissions, the rate of patients with mild head injury fell from 5.9% to 4.2%.

The baseline CCT rate was low in the first group 64/388 (16%), with no significant reduction in the second group 51/363 (14%)(p<0.44).

Conclusion

PECARN rules help to reduce hospitalisation rates. Hospitals with low CCT rates do not experience significant reduction.

Background

Red Cross-Vorarlberg and Christophorus Flugrettungsverein, operating the helicopter C8, cover emergency medical transports in Vorarlberg and the surrounding area with a population of 450,000 inhabitants among which are 80,000 children and adolescents.

Objectives

The aim of this thesis is to investigate pediatric emergency medical transports in Vorarlberg-Austria from 2013 to 2017, with its focus placed on patients who suffered trauma.

Methods

Patients from the age of 28 days to 18 years were included.

Results

We report about a total of 2,633 transports, 2,170 on ground and 463 by helicopter, which results in a prevalence of 1:140 children per year. Main age groups were infants (from 1 to 5 years) and schoolchildren (from 6 to 14 years) and 61.4% of them were male, and more than 50% of all transports came from a city or village bigger than 1,000 inhabitants; the main destination was the reference Children’s Hospital Feldkirch with a PICU. The three most common diagnoses were febrile seizures, cerebral concussion and epilepsy.

Transports by helicopter were mostly due to traumatic injuries, amongst which a closed fracture of the lower extremities was the most frequent diagnosis.

The mean mission time with helicopter (43±18.6 minutes) was non-significantly higher compared to the one for ground-based missions (37±19.7 minutes).

Conclusion

This high prevalence of transports of ill children in our study may be due to the highly developed alpine tourism in our region. This result is reflected by the larger amount of trauma patients rescued by the helicopter compared to ground-based transports.

Background

Mild head injury is a common cause for paediatric emergency department visits. Cranial computer tomography (CCT) is the diagnostic standard for radiologic investigations, though the risk of radiation. Paediatric Emergency care applied research network (PECARN) clinical prediction rules have been invented to reduce CCT scans. They provide a guideline for outpatient care, or short-term observation for patients with moderate risk.

Objectives

To evaluate the impact of the implementation of PECARN rules in children with mild head injury on hospitalisation and CCT rate, patient management before and after rule implementation was recorded

Methods

In this retrospective study, children with mild head injury presenting in the paediatric emergency department between 2012 and 2016 were examined. We compared two groups, before and after implementation of PECARN criteria in clinical routine and the second group afterwards. Changes in hospitalisation rates and CT rates were calculated using Chi² test.

Results

Of 742 included patients (age ± 5.6 years; 317 female and 425 male), 388 were seen prior to the implementation of PECARN rules, compared to 354 patients afterwards. The amount of admissions to the ward decreased significantly from 325/388 (84%) to 254/354 (71%), whereas the number of discharges rose (p<0.05). Based on all paediatric admissions, the rate of patients with mild head injury fell from 5.9% to 4.2%.

The baseline CCT rate was low in the first group 64/388 (16%), with no significant reduction in the second group 51/363 (14%)(p<0.44).

Conclusion

PECARN rules help to reduce hospitalisation rates. Hospitals with low CCT rates do not experience significant reduction.