Addressing Teamwork Delays during Life-Saving Interventions through an Activity Theory-Informed Analysis.

Hemorrhage, or severe blood loss due to injury, is a leading cause of preventable deaths after injury. This study uses and extends activity theory to understand the dynamics of team-based hemorrhage control during trauma resuscitation and to explore potential computerized mechanisms to support this time- and safety-critical process. We reviewed videos of 25 resuscitation cases and analyzed hemorrhage control activities using nine activity theory prompts, including a new prompt-speech intention-a critical but underexplored dimension of teamwork in prior activity theory analyses.

ProcessGAN: Generating Privacy-Preserving Time-Aware Process Data with Conditional Generative Adversarial Nets.

Process data constructed from event logs provides valuable insights into procedural dynamics over time. The confidential information in process data, together with the data's intricate nature, makes the datasets not sharable and challenging to collect. Consequently, research is limited using process data and analytics in the process mining domain.

Development of an algorithm for adjudicating actionable hemorrhage in pediatric trauma patients.

Background: Bleeding is the leading cause of preventable death in trauma. Early identification of hemorrhage improves patient outcomes. Current triage tools for predicting hemorrhage rely on transfusion receipt as a surrogate outcome, indicating that blood was needed.

Development and Validation of a Bayesian Network Predicting Intubation Following Hospital Arrival Among Injured Children.

Background: Inadequate airway management can contribute to preventable trauma deaths. Current machine learning tools for predicting intubation in trauma are limited to adult populations and include predictors not readily available at the time of patient arrival. We developed a Bayesian network to predict intubation in injured children and adolescents using observable data available upon or immediately after patient arrival.

Strategies to Obtain and Deliver Blood Products Into Critically Injured Children: A Survey of Pediatric Trauma Society Members.

Objectives: Timely transfusion is associated with improved survival and a reduction in in-hospital morbidity. The benefits of early hemorrhagic shock recognition may be limited by barriers to accessing blood products and their timely administration. We examined how pediatric trauma programs obtain blood products, the types of rapid infusion models used, and the metrics tracked to improve transfusion process efficiency in their emergency department (ED).

Analysis of Task Attributes Associated with Crisis Checklist Compliance in Pediatric Trauma Resuscitation.

Although checklists can improve overall team performance during medical crises, non-compliant checklist use poses risks to patient safety. We examined how task attributes affected checklist compliance by studying the use of a digital checklist during trauma resuscitation. We first determined task attributes and checklist compliance behaviors for 3,131 resuscitation tasks.

Survival bias in pediatric hemorrhagic shock: Are we misrepresenting the data?

Background: Studies of hemorrhage following pediatric injury often use the occurrence of transfusion as a surrogate definition for the clinical need for a transfusion. Using this approach, patients who are bleeding but die before receiving a transfusion are misclassified as not needing a transfusion. In this study, we aimed to evaluate the potential for this survival bias and to estimate its presence among a retrospective observational cohort of children and adolescents who died from injury.

Injury Patterns and Outcomes at a Single Pediatric Trauma Center During the Coronavirus Disease 19 Pandemic.

Introduction: The coronavirus disease 19 (COVID-19) pandemic is reported to have changed injury patterns, prevalence, and outcomes across multiple institutions in the United States. Interpretation of aggregate data is difficult because injury patterns vary between urban and rural hospitals and the implementation of locoregional public health policies and guidelines in response to COVID-19 differed. To prepare our trauma system for future societal shutdowns, we compared injury patterns and outcomes of injured children and adolescents at a single pediatric trauma center before and during the first 2 y of the COVID-19 pandemic.

Supporting Awareness of Dynamic Data: Approaches to Designing and Capturing Data within Interactive Clinical Checklists.

Automatically integrating data within interactive clinical checklists allows for enhanced dynamic displays, while also providing information needed for checklist adaptation to the context of the medical event. In this mixed-methods study, we used user-centered design sessions with clinicians to design a checklist interface that automatically captures and displays dynamic patient data. We compared the manual and automatic checklist versions during video-guided simulation sessions, evaluating the effects of automatic capture on clinicians' interactions with dynamic data and their situation awareness.

Functional impairment associated with nonfatal pediatric firearm injuries.

Background: Firearm injury is now the leading cause of death for children in the United States. Functional morbidity among survivors also contributes to the public health burden of firearm injury but has not been quantified in children. This study aimed to assess functional impairment among survivors of pediatric firearm injury.

Discovering interpretable medical process models: A case study in trauma resuscitation.

Understanding the actual work (i.e., "work-as-done") rather than theorized work (i.

Development and validation of a Bayesian network predicting neurosurgical intervention after injury in children and adolescents.

Background: Timely surgical decompression improves functional outcomes and survival among children with traumatic brain injury and increased intracranial pressure. Previous scoring systems for identifying the need for surgical decompression after traumatic brain injury in children and adults have had several barriers to use. These barriers include the inability to generate a score with missing data, a requirement for radiographic imaging that may not be immediately available, and limited accuracy.

Postoperative Respiratory Complications in SARS-CoV-2 Positive Pediatric Patients Across 20 United States Hospitals: A Cohort Study.

Introduction: Data examining rates of postoperative complications among SARS-CoV-2 positive children are limited. The purpose of this study was to evaluate the impact of symptomatic and asymptomatic SARS-CoV-2 positive status on postoperative respiratory outcomes for children.

Methods: This retrospective cohort study included SARS-CoV-2 positive pediatric patients across 20 hospitals who underwent general anesthesia from March to October 2020.

Evaluation of Missing Prehospital Physiological Values in Injured Children and Adolescents.

Introduction: Prehospital vital signs and the Glasgow Coma Scale score are often missing in clinical practice and not recorded in trauma databases. Our study aimed to identify factors associated with missing prehospital physiological values, including systolic blood pressure, heart rate, respiratory rate, peripheral oxygen saturation, and Glasgow Coma Scale.

Methods: We used our hospital trauma registry to obtain patient, injury, resuscitation, and transportation characteristics for injured children and adolescents (age <15 y).

Factors Affecting Peripheral Intravenous Catheter Placement During Pediatric Trauma Resuscitation.

Introduction: Intravenous access is required for resuscitation of injured patients but may be delayed in children because of challenges associated with peripheral intravenous (PIV) catheter placement. Early identification of factors predisposing patients to difficult PIV placement can assist in deciding strategies for timely intravenous access.

Methods: We conducted a retrospective, video-based review of injured children and adolescents treated between April 2018 and May 2019.

Time is tissue: Barriers to timely transfusion after pediatric injury.

Strategies to improve outcomes among children and adolescents in hemorrhagic shock have primarily focused on component resuscitation, pharmaceutical coagulation adjuncts, and hemorrhage control techniques. Many of these strategies have been associated with better outcomes in children, but the barriers to their use and the impact of timely use on morbidity and mortality have received little attention. Because transfusion is uncommon in injured children, few studies have identified and described barriers to the processes of using these interventions in bleeding patients, processes that move from the decision to transfuse, to obtaining the necessary blood products and adjuncts, and to delivering them to the patient.

Reducing the Time to Blood Administration after Pediatric Injury: A Quality Improvement Initiative.

Introduction: Hemorrhage is the leading cause of preventable death in pediatric trauma patients. Timely blood administration is associated with improved outcomes in children and adults. This study aimed to identify delays to transfusion and improve the time to blood administration among injured children.

Development and validation of a Bayesian belief network predicting the probability of blood transfusion after pediatric injury.

Background: Early recognition and intervention of hemorrhage are associated with decreased morbidity in children. Triage models have been developed to aid in the recognition of hemorrhagic shock after injury but require complete data and have limited accuracy. To address these limitations, we developed a Bayesian belief network, a machine learning model that represents the joint probability distribution for a set of observed or unobserved independent variables, to predict blood transfusion after injury in children and adolescents.