Pediatric Trauma and Critical Illness Branch (PTCIB)

Care and Treatment of Trauma and Critical Illness for Pediatric Populations

Gap: Trauma and critical illness in children are underrecognized but major public health problems. They are particularly concerning because children's psychological and physiological responses to trauma and critical illness differ from those of adults, yet treatment is still often based on studies involving adults.

Priorities:

• Support research that specifically examines the epidemiology, pathophysiology, diagnosis, prevention, treatment, and outcomes of all forms of critical illness and life-threatening injury in infants, children, and adolescents. Conditions of interest include, but are not limited to, multiple organ dysfunction syndrome, acute respiratory distress syndrome and other forms of respiratory failure, severe brain injury (traumatic and non-traumatic), and all forms of shock and cardiovascular collapse. 
• Support research that develops a better understanding of the psychological responses to trauma and critical illness for children and their families.

Collaborative Multidisciplinary Research across the Continuum of Care

Gap: The current approach to studying pediatric trauma, injury prevention, and critical illness is often compartmentalized, with each discipline operating independently. This approach is insufficient to advance the science and inform clinical practice in these fields.

Priority: Support research that fosters collaborations among multidisciplinary teams of research scientists and allied health professionals to address research gaps and disparities in health outcomes among traumatized, injured, and critically ill children.  

Ethical and Psychosocial Issues Related to the Care of Critically Ill Children and Their Families

Gap: Ethical questions and challenges are inherent in many aspects of the care of critically ill and injured children, yet there are relatively few well-developed empirical studies on the topic. Similarly, critical illness creates multiple levels of stress for both the child and family and remains understudied.

Priorities: Support research focused on ethical and psychosocial issues in the following areas of pediatric critical care practice: family/caregiver/healthcare provider burden and distress; foregoing life-sustaining therapies, end-of-life care, organ donation, palliative care, and bereavement; decision-making/communication in the pediatric intensive care unit; and morbidities and functional outcomes related to pediatric intensive care unit treatment modalities. 

Interplay of Physical and Psychological Trauma in Children

Gap: Little is known about the independent and combined effects of physical and psychological trauma in injured children, or how these forms of trauma affect children's recovery and well-being.

Priority: Support research that examines the distinctive aspects of psychological and physical trauma, the complex interplay of those traumas, and how they interact in care and treatment.

Prevention and Treatment of Traumatic Injuries in Children

Gap: Childhood injury is a serious and understudied public health problem in the United States and around the world. Many injuries require hospitalization or result in disabling conditions that may have a significant effect on a child's long-term health and well-being.

Priority: Support research on the pathophysiology of trauma, including the prevention of injury, secondary injury, and comorbidities. Of particular interest are injuries most likely to cause death or disability, including motor vehicle crashes, sports, firearms, poisonings, drowning, self-injurious behavior, fires, burns, and injuries from all forms of violence against children.

• Pediatric Critical Care Research and Training Program: Informs the practice of healthcare providers who stabilize, diagnose, and manage the care of critically ill and severely injured children of all ages
• Pediatric Trauma Research and Training Program: Advances the science of trauma and injury prevention and care for pediatric populations, with the goal of reducing morbidity and mortality in children
• Collaborative Pediatric Critical Care Research Network: Seeks to reduce morbidity and mortality in pediatric critical illness and injury, and to provide a framework for the development of the scientific basis of pediatric critical care practice
• Pediatric Clinical Care and Trauma Scientist Development Program: Develops successful pediatric critical care and pediatric trauma physician scientists

• CAPSTONE Centers for Multidisciplinary Research in Child Abuse and Neglect: Specialized research centers that serve as a national resource for research on child abuse and neglect
• Resource-Related Research Projects in the Epidemiology and Prevention of Pediatric Injury: Collaborative multidisciplinary research focused on the development of research resources for use by the broader scientific community
• The Functional Status Scale for Pediatric Hospitalization Outcomes: A Tool for Researchers: Helps measure functional status of children during hospital admissions
• American Academy of Pediatrics Reports: Selected reports that provide information regarding the state of the science and best practices in areas related to PTCIB priorities:
  • Management of Pediatric Trauma 
  • Inflicted Childhood Neurotrauma 
  • Adverse Childhood Experiences and the Lifelong Consequences of Trauma  (PDF 270 KB)
• Institute of Medicine/National Academies of Medicine Reports: Selected publications and meeting proceedings that provide information regarding the state of the science and best practice in areas related to PTCIB priorities:
  • New Directions in Child Abuse and Neglect Research 
  • Sports-Related Concussions in Youth: Improving the Science, Changing the Culture 
  • Emergency Care for Children: Growing Pains : Examines the challenges associated with providing emergency services to children and families and evaluates progress since the publication of the Institute of Medicine report Emergency Medical Services for Children (1993)
  • When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families : Discusses current knowledge and judgments regarding palliative, end-of-life, and bereavement care for children and their families
• Centers for Disease Control and Prevention Fact Sheets: Selected data sources and fact sheets that provide data tables and information in areas related to PTCIB priorities:
  • National Center for Injury Prevention and Control (NCIPC) 10 Leading Causes of Death and Injury by Age Group
  • NCIPC Web-based Injury Statistics Query and Reporting System
  • Youth Violence: Facts at a Glance (PDF 95 KB)
  • Motor Vehicle Safety
  • National Center for Health Statistics FastStats: All Injuries
  • Child Maltreatment: Facts at a Glance (PDF 79 KB)
• PedsCCM.org  : Provides news on courses and conferences, clinical research, and clinical resources for all members of the healthcare team
• Sports-related Concussion Common Data Elements: Funded by the National Institute of Neurological Disorders and Stroke, provides data standards and accompanying tools to help investigators collect and record standardized clinical data in sports-related concussion and related areas
• The Federal Interagency Traumatic Brain Injury Research: Informatics system developed to share data across the entire traumatic brain injury (TBI) research field and to facilitate collaboration between laboratories as well as interconnectivity with other informatics platforms.
• National Institute of Neurological Disorders and Stroke Common Data Elements (CDEs): Provides several libraries of CDEs for neurological disorders, including pediatric spinal cord injury and TBI. 
• Ray E. Helfer Society : Promotes education and training in the medical aspect of child abuse and neglect; advocates for improved resources for research, clinical practice, and education; strengthens research; promotes high ethical standards for practice and research; and assists in establishing guidelines for clinical practice
• Health Research Services Administration
  • National Emergency Medical Services for Children Data Analysis Resource Center 
  • Pediatric Emergency Care Applied Research Network 
• Healthy People.Gov
  • Healthy People 2020 Injury and Violence Prevention
• National Highway Traffic Safety Administration (NHTSA) Databases: Research and data from NHTSA’s Office of Vehicle Safety Research, Office of Behavioral Safety Research, and National Center for Statistics and Analysis

• Valerie Maholmes,Branch Chief
  Main Research Areas: Pediatric trauma: diagnosis, treatment, prevention; childhood adversity, child traumatic stress, violence and violence-related injury, abuse, neglect, maltreatment; training: child maltreatment, violence, pediatric injury prevention, emergency care; emergency medical and psychological response/services to children
• Tammara Jenkins, Program Official/Nurse Consultant
  Main Research Areas: Pediatric critical care and injury: general, diagnosis, treatment, prevention, ethics, end-of-life issues, palliative care; training: pediatric critical care and pediatric trauma
• Robert Tamburro, Medical Officer
  Main Research Areas: Pediatric critical care and injury: general, diagnosis, treatment, prevention, basic research, medical devices; pediatric injury: diagnosis, treatment, prevention; pediatric traumatic brain injury: diagnosis, treatment, prevention; training: pediatric critical care and pediatric trauma
• Lynne Haverkos, Special Research Volunteer
  Main Research Areas: Pediatric injury prevention and epidemiology, emergency care; emergency medical response/services to children
• Mary Ellen Michel, Special Research Volunteer
  Main Research Areas: Traumatic brain injury, neuroscience, neurological injury
• Tiffany Ferguson, Extramural Staff Assistant