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  1. Article ; Online: Invited Commentary.

    Gaines, Barbara A

    Journal of the American College of Surgeons

    2021  Volume 232, Issue 4, Page(s) 655

    Language English
    Publishing date 2021-03-26
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1016/j.jamcollsurg.2020.12.029
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  2. Article ; Online: Use of whole blood in pediatric trauma: a narrative review.

    Abou Khalil, Elissa / Morgan, Katrina M / Gaines, Barbara A / Spinella, Philip C / Leeper, Christine M

    Trauma surgery & acute care open

    2024  Volume 9, Issue Suppl 1, Page(s) e001127

    Abstract: Balanced hemostatic resuscitation has been associated with improved outcomes in patients with both pediatric and adult trauma. Cold-stored, low-titer group O whole blood (LTOWB) has been increasingly used as a primary resuscitation product in trauma in ... ...

    Abstract Balanced hemostatic resuscitation has been associated with improved outcomes in patients with both pediatric and adult trauma. Cold-stored, low-titer group O whole blood (LTOWB) has been increasingly used as a primary resuscitation product in trauma in recent years. Benefits of LTOWB include rapid, balanced resuscitation in one product, platelets stored at 4°C, fewer additives and fewer donor exposures. The major theoretical risk of LTOWB transfusion is hemolysis, however this has not been shown in the literature. LTOWB use in injured pediatric populations is increasing but is not yet widespread. Seven studies to date have described the use of LTOWB in pediatric trauma cohorts. Safety of LTOWB use in both group O and non-group O pediatric patients has been shown in several studies, as indicated by the absence of hemolysis and acute transfusion reactions, and comparable risk of organ failure. Reported benefits of LTOWB included faster resolution of shock and coagulopathy, lower volumes of transfused blood products, and an independent association with increased survival in massively transfused patients. Overall, pediatric data are limited by small sample sizes and mostly single center cohorts. Multicenter randomized controlled trials are needed.
    Language English
    Publishing date 2024-01-05
    Publishing country England
    Document type Journal Article ; Review
    ISSN 2397-5776
    ISSN (online) 2397-5776
    DOI 10.1136/tsaco-2023-001127
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  3. Article ; Online: Whole blood: total blood product ratio impacts survival in injured children.

    Feeney, Erin / Morgan, Katrina M / Spinella, Philip C / Gaines, Barbara A / Leeper, Christine M

    The journal of trauma and acute care surgery

    2024  

    Abstract: Introduction: Some studies in both children and adults have shown a mortality benefit for the use of low titer group O whole blood (LTOWB) compared to component therapy for traumatic resuscitation. Although LTOWB is not widely available at pediatric ... ...

    Abstract Introduction: Some studies in both children and adults have shown a mortality benefit for the use of low titer group O whole blood (LTOWB) compared to component therapy for traumatic resuscitation. Although LTOWB is not widely available at pediatric trauma centers, its use is increasing. We hypothesized that in children who received whole blood after injury, the proportion of whole blood in relation to the total blood product resuscitation volume would impact survival.
    Methods: The trauma database from a single academic pediatric level 1 trauma center was queried for pediatric (age < 18 years) recipients of LTOWB after injury (years 2015-2022). Weight-based blood product (LTOWB, red blood cells, plasma and platelet) transfusion volumes during the first 24 hours of admission were recorded. The ratio of LTOWB to total transfusion volume was calculated. The primary outcome was in-hospital mortality. Multivariable logistic regression model adjusted for the following variables: age, sex, mechanism of injury, injury severity score, shock index, and Glasgow Coma Scale (GCS) score. Adjusted odds ratio representing the change in the odds of mortality by a 10% increase in the LTOWB:total transfusion volume ratio was reported.
    Results: There were 95 pediatric LTOWB recipients included in the analysis, with median (IQR) age of 10 years (5-14), 58% male, median (IQR) injury severity score of 26 (17-35), 25% penetrating mechanism. The median(IQR) volume of LTOWB transfused was 17 (15-35) mL/kg. LTOWB comprised a median (IQR) of 59% (33-100) of the total blood product resuscitation. Among patients who received LTOWB, there was a 38% decrease in in-hospital mortality for each 10% increase in the proportion of WB within total transfusion volume (p < 0.001) after adjusting for age, sex, mechanism of injury, injury severity score, shock index, and GCS score.
    Conclusion: Increased proportions of LTOWB within the total blood product resuscitation was independently associated with survival in injured children. Based on existing data that suggests safety and improved outcomes with whole blood, consideration may be given to increasing the use of LTOWB over CT resuscitation in pediatric trauma resuscitation.
    Article type: Level 3 Evidence; Observational Cohort Study.
    Language English
    Publishing date 2024-04-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000004362
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  4. Article ; Online: Pediatric trauma and the Pediatric Trauma Society: Our time has come.

    Gaines, Barbara A

    The journal of trauma and acute care surgery

    2015  Volume 78, Issue 6, Page(s) 1111–1116

    MeSH term(s) Humans ; Pediatrics ; Societies, Medical ; Traumatology
    Language English
    Publishing date 2015-06
    Publishing country United States
    Document type Addresses ; Journal Article ; Portraits
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000000709
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  5. Article ; Online: Endotheliopathy of trauma in children: The association of syndecan-1 with injury and poor outcomes.

    Morgan, Katrina M / Abou-Khalil, Elissa / Gaines, Barbara A / Leeper, Christine M

    The journal of trauma and acute care surgery

    2023  Volume 96, Issue 4, Page(s) 566–572

    Abstract: Background: The contribution of the endothelium to trauma-induced coagulopathy has not been thoroughly investigated in injured children.: Methods: This is a prospective cohort study of children (younger than 18 years) who presented with a potentially ...

    Abstract Background: The contribution of the endothelium to trauma-induced coagulopathy has not been thoroughly investigated in injured children.
    Methods: This is a prospective cohort study of children (younger than 18 years) who presented with a potentially severe injury to an academic pediatric trauma center. Syndecan-1 level was collected on arrival and 24 hours following hospital arrival. Children were categorized as injured versus uninjured based on results of trauma evaluation. Demographics, injury characteristics, vital signs, and clinical laboratories were recorded. A composite clinical outcome was defined as death or blood product transfusion within 24 hours of hospital arrival. Statistical tests determined the impact of injury characteristics and therapeutics on syndecan-1 levels and assessed for associations between syndecan-1 level and outcomes.
    Results: A total of 121 subjects were included in the analysis: 96 injured (79%) and 25 uninjured (21%). There were no differences between groups in age (median [interquartile range (IQR)], 11 [4-14] years), sex, or race. The injured cohort had a median (IQR) Injury Severity Score of 16 (9-21), 75% had blunt mechanism, 26% were transfused within 6 hours, 3% had 24-hour mortality, and 6% had in-hospital mortality. Median (IQR) syndecan-1 level on admission was significantly higher in injured versus uninjured cohort (44 [21-75] vs. 25 [17-42]; p = 0.04). Admission base deficit was significantly correlated with syndecan-1 level ( r = 0.8, p < 0.001); no association with traumatic brain injury or injury mechanism was seen. Children with elevated syndecan-1 on admission had significantly increased odds of poor outcome; every 10 ng/mL increase in syndecan-1 was associated with 10% increased odds of death or transfusion ( p < 0.001). Transfusion with any blood product was associated with a significant decrease in syndecan-1 from arrival to 24 hours (Δ syndecan-1, -17 [-64 to -5] vs. -8 [-19 to +2]; p < 0001).
    Conclusion: Elevated admission syndecan-1 level, suggestive of endotheliopathy, was associated with shock and poor outcomes in pediatric trauma. Larger cohort studies are required to fully describe the complexities of trauma-induced coagulopathy and investigate the benefit of therapies targeting endotheliopathy in children.
    Level of evidence: Prognostic and Epidemiological; Level III.
    MeSH term(s) Humans ; Child ; Prospective Studies ; Syndecan-1 ; Prognosis ; Brain Injuries, Traumatic ; Cohort Studies ; Injury Severity Score ; Wounds and Injuries/complications ; Wounds and Injuries/therapy
    Chemical Substances Syndecan-1
    Language English
    Publishing date 2023-12-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000004229
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  6. Article ; Online: The Efficacy of Low-Titer Group O Whole Blood Compared With Component Therapy in Civilian Trauma Patients: A Meta-Analysis.

    Morgan, Katrina M / Abou Khalil, Elissa / Feeney, Erin V / Spinella, Philip C / Lucisano, Amelia C / Gaines, Barbara A / Leeper, Christine M

    Critical care medicine

    2024  

    Abstract: Objectives: To assess if transfusion with low-titer group O whole blood (LTOWB) is associated with improved early and/or late survival compared with component blood product therapy (CT) in bleeding trauma patients.: Data sources: A systematic search ... ...

    Abstract Objectives: To assess if transfusion with low-titer group O whole blood (LTOWB) is associated with improved early and/or late survival compared with component blood product therapy (CT) in bleeding trauma patients.
    Data sources: A systematic search of PubMed, CINAHL, and Web of Science was performed from their inception through December 1, 2023. Key terms included injury, hemorrhage, bleeding, blood transfusion, and whole blood.
    Study selection: All studies comparing outcomes in injured civilian adults and children who received LTOWB versus CT were included.
    Data extraction: Data including author, publication year, sample size, total blood volumes, and clinical outcomes were extracted from each article and reported following the Meta-analysis Of Observational Studies in Epidemiology guidelines. Main outcomes were 24-hour (early) and combined 28-day, 30-day, and in-hospital (late) mortality rates between recipients of LTOWB versus CT, which were pooled using random-effects models.
    Data synthesis: Of 1297 studies reviewed, 24 were appropriate for analysis. Total subjects numbered 58,717 of whom 5,164 received LTOWB. Eleven studies included adults-only, seven included both adults and adolescents, and six only included children. The median (interquartile range) age for patients who received LTOWB and CT was 35 years (24-39) and 35.5 years (23-39), respectively. Overall, 14 studies reported early mortality and 22 studies reported late mortality. LTOWB was associated with improved 24-hour survival (risk ratios [RRs] [95% CI] = 1.07 [1.03-1.12]) and late (RR [95% CI] = 1.05 [1.01-1.09]) survival compared with component therapy. There was no evidence of small study bias and all studies were graded as a moderate level of bias.
    Conclusions: These data suggest hemostatic resuscitation with LTOWB compared with CT improves early and late survival outcomes in bleeding civilian trauma patients. The majority of subjects were injured adults; multicenter randomized controlled studies in injured adults and children are underway to confirm these findings.
    Language English
    Publishing date 2024-03-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000006244
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    Zs.A 1261: Show issues Location:
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  7. Article ; Online: Impact of hypocalcemia on mortality in pediatric trauma patients who require transfusion.

    Abou Khalil, Elissa / Feeney, Erin / Morgan, Katrina M / Spinella, Philip C / Gaines, Barbara A / Leeper, Christine M

    The journal of trauma and acute care surgery

    2024  

    Abstract: Introduction: Admission hypocalcemia has been associated with poor outcomes in injured adults. The impact of hypocalcemia on mortality has not been widely studied in pediatric trauma.: Methods: A pediatric trauma center database was queried ... ...

    Abstract Introduction: Admission hypocalcemia has been associated with poor outcomes in injured adults. The impact of hypocalcemia on mortality has not been widely studied in pediatric trauma.
    Methods: A pediatric trauma center database was queried retrospectively (2013-2022) for children age < 18 years who received blood transfusion within 24 hours of injury and had ionized calcium (iCal) level on admission. Children who received massive transfusion (>40 mL/kg) prior to hospital arrival or calcium prior to laboratory testing were excluded. Hypocalcemia was defined by the laboratory lower limit (iCal <1.00). Main outcomes were in-hospital mortality and 24-hour blood product requirements. Logistic regression analysis was performed to adjust for injury severity score (ISS), admission shock index, Glasgow Coma Score (GCS) and weight-adjusted total transfusion volume.
    Results: In total, 331 children with median (IQR) age of 7 years (2-13) and median (IQR) ISS 25 (14-33) were included, 32 (10%) of whom were hypocalcemic on arrival to the hospital. The hypocalcemic cohort had higher ISS (median (IQR) 30(24-36) vs 22(13-30)) and lower admission GCS (median (IQR) 3 (3-12) vs 8 (3-15)). Age, sex, race, and mechanism were not significantly different between groups. On univariate analysis, hypocalcemia was associated with increased in-hospital (56% vs 18%; p < 0.001) and 24-hour (28% vs 5%; p < 0.001) mortality. Children who were hypocalcemic received a median (IQR) of 22 mL/kg (7-38) more in total weight-adjusted 24-hour blood product transfusion following admission compared to the normocalcemic cohort (p = 0.005). After adjusting for ISS, shock index, GCS, and total transfusion volume, hypocalcemia remained independently associated with increased 24-hour (Odds Ratio(OR) 95% Confidence Interval(CI) = 4.93(1.77-13.77); p = 0.002) and in-hospital mortality (OR 95% CI =3.41(1.22-9.51); p = 0.019).
    Conclusion: Hypocalcemia is independently associated with mortality and receipt of greater weight-adjusted volumes of blood product transfusion after injury in children. The benefit of timely calcium administration in pediatric trauma needs further exploration.
    Level of evidence: III; prognostic/epidemiological.
    Language English
    Publishing date 2024-04-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000004330
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  8. Article ; Online: Kids, cameras, and acute care: Minimally invasive management in pediatric emergency general surgery.

    Behr, Christopher A / Gaines, Barbara A / Scholz, Stefan

    The journal of trauma and acute care surgery

    2020  Volume 88, Issue 6, Page(s) e142–e145

    MeSH term(s) Adolescent ; Age Factors ; Child ; Emergency Treatment/instrumentation ; Emergency Treatment/methods ; Humans ; Laparoscopy/instrumentation ; Laparoscopy/methods ; United States
    Language English
    Publishing date 2020-03-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000002656
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  9. Article ; Online: Trauma-Induced Coagulopathy in Children.

    Lucisano, Amelia C / Leeper, Christine M / Gaines, Barbara A

    Seminars in thrombosis and hemostasis

    2020  Volume 46, Issue 2, Page(s) 147–154

    Abstract: Trauma-induced coagulopathy (TIC) is well documented in injured children. However, many important features of pediatric hemostasis are still in development in early childhood and may impact TIC. Certain pediatric subgroups are at a higher risk. Traumatic ...

    Abstract Trauma-induced coagulopathy (TIC) is well documented in injured children. However, many important features of pediatric hemostasis are still in development in early childhood and may impact TIC. Certain pediatric subgroups are at a higher risk. Traumatic brain injury, which occurs with a higher rate in children, and physical child abuse are known risk factors for TIC that deserve special consideration. Resuscitation of a pediatric trauma patient follows many of the same goals as in the injured adult trauma, although some key aspects of pediatric resuscitation require ongoing investigation. Venous thromboembolism occurs with higher rates in certain high-risk groups of pediatric trauma patients, although overall it is considerably less frequent in children as compared with adults.
    MeSH term(s) Adolescent ; Blood Coagulation Disorders/etiology ; Child ; Child, Preschool ; Female ; Humans ; Male ; Wounds and Injuries/blood ; Wounds and Injuries/complications
    Language English
    Publishing date 2020-03-11
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 196901-8
    ISSN 1098-9064 ; 0094-6176
    ISSN (online) 1098-9064
    ISSN 0094-6176
    DOI 10.1055/s-0040-1702203
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  10. Article ; Online: Evaluation of a mobile safety center's impact on pediatric home safety behaviors.

    Furman, Leah / Strotmeyer, Stephen / Vitale, Christine / Gaines, Barbara A

    BMC public health

    2021  Volume 21, Issue 1, Page(s) 1095

    Abstract: Background: A Mobile Safety Center (MSC) provides safety resources to families to prevent pediatric injury. The primary objective of this study was to assess the impact of an MSC on home safety behaviors.: Methods: We conducted a prospective ... ...

    Abstract Background: A Mobile Safety Center (MSC) provides safety resources to families to prevent pediatric injury. The primary objective of this study was to assess the impact of an MSC on home safety behaviors.
    Methods: We conducted a prospective observational study with 50 parents and guardians recruited at community events attended by an MSC. Participants completed a pre-test assessing demographics and home safety behaviors prior to participating in the MSC's home safety educational program. We conducted follow-up with participants 4 weeks (follow-up 1) and 6 months (follow-up 2) after their visit to the MSC to reassess home safety behaviors. We used descriptive statistics in addition to Friedman, Wilcoxon sum-rank, and Fisher's exact testing to analyze respondent demographics and changes in home safety practices. Friedman and Wilcoxon sum-rank testing was performed only for participants who completed all surveys.
    Results: Of our 50 participants, 29 (58%) completed follow-up 1, 30 (60%) completed follow-up 2, and 26 (52%) completed both. Participants were more likely to have a fire-escape plan at follow-up 1 than on the pre-test (p = 0.014). They were also more likely to have the Poison Control Hotline number accessible in their cellphone or near a home phone at follow-up 1 compared to the pre-test (p = 0.002) and follow-up 2 compared to the pre-test (p < 0.001). Families with at least one household member who smoked or used e-cigarettes at any point during the study (n = 16 for the total population, n = 9 for those who completed both surveys) were less likely to have more than two smoke detectors installed at home during the pre-test (p = 0.049). However, this significantly changed across timepoints (p = 0.018), and while 44.4% reported more than two detectors during the pre-test, 88.9% reported this at both follow-ups.
    Conclusions: Home safety education through an MSC positively changed some reported safety behaviors and maintained these changes at long-term follow-up. By encouraging the adoption of better home safety practices, education at an MSC may decrease pediatric injury rates.
    MeSH term(s) Accidents, Home/prevention & control ; Child ; Electronic Nicotine Delivery Systems ; Fires ; Health Education ; Humans ; Protective Devices ; Safety
    Language English
    Publishing date 2021-06-08
    Publishing country England
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ISSN 1471-2458
    ISSN (online) 1471-2458
    DOI 10.1186/s12889-021-11073-4
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