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Pediatric Trauma and Critical Illness Branch (PTCIB)
Overview/Mission
PTCIB focuses on leading causes of morbidity and mortality among children, including physical and psychological trauma, violence-related and unintentional injuries, and pediatric critical illness. The Branch supports research and training to prevent, assess, diagnose, treat, and reduce the impact of childhood traumatic injury and critical illness across the continuum of care. In addition, the Branch recognizes that the psychological and physiologic needs of children who have experienced psychological trauma, physical trauma, or critical illness differ from the needs of adults who have experienced the same. Thus, a major priority of the Branch is to support research elucidating these differences, thereby increasing our understanding of the pathophysiology and psychology of trauma and critical illness to optimize treatment outcomes and prevent future difficulties in children. Because childhood is such a crucial time in human development, the Branch deems research that sheds light on factors that both promote and threaten health and well-being a high priority. Toward that end, its scientific programs support studies of the biobehavioral, psychosocial, physiological, and pathophysiological aspects of trauma and critical illness, as well as research to improve emergency, hospital and trauma-informed care of infants, children, adolescents, and young adults and to reduce secondary injury and related comorbidities.
Pediatric Trauma Research and Training: Programs in this scientific area advance the science of trauma and injury prevention and care for pediatric populations, with the goal of reducing morbidity and mortality in children. Priorities address the full continuum of care—from prevention and emergency response, through treatment, acute rehabilitation, to interventions to improve clinical, behavioral, and psychosocial outcomes in children. The Programs support research on both inflicted (violence and violence-related injuries) and unintentional injuries, and on the diagnosis and treatment of all forms of child abuse and neglect and co-morbid conditions. Priorities also include examinations of the ways in which physical and psychological trauma interact to affect children’s health outcomes and overall well-being, thereby elucidating the role of resilience in ameliorating the impacts of trauma exposure. The specific program areas are:
Pediatric Unintentional Injuries/Trauma Program
Emergency Medical Services Program
Violence affecting Children Program
Psychological Trauma, Recovery, Resilience and Wellbeing Program
Pediatric Disaster Science Program
Pediatric Critical Care Research and Training: Programs in this scientific area focus on investigating the safety and effectiveness of treatment and management strategies for pediatric critical illness and injury including, but not limited to, sepsis (blood infection), multiple organ dysfunction syndrome, acute lung injury, and traumatic brain injury (TBI). The Programs support research that informs the practice of healthcare providers who stabilize, diagnose, and manage the care of critically ill and severely injured children of all ages. In addition, the Programs support research focused on the care of critically ill children with complex chronic health problems and the toll that such illness takes on the family. The specific program areas are:
Pediatric Critical Care Medicine, Pathophysiology, and Management of Critical Illness Program
Ethical, Translational, and Applied Research in Pediatric Critical Care Practice Program
Acute Care of the Hospitalization Child Program
Pediatric Palliative Care in the Hospitalized Child Program
Collaborative Pediatric Critical Care Research Network: Supports efforts 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
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
Community Level Interventions for Firearm and Related Violence, Injury, and Mortality Prevention Network: Supports research projects to develop, implement, and evaluate innovative interventions that modify characteristics of organizations, environments, and/or settings to address higher order, “root” causes of firearm mortality and injury
Pediatric Critical Care and Trauma Scientist Development Program (K12): Trains scholars and junior-level faculty candidates to be pediatric critical care and pediatric trauma physician-scientists
Career Development Award (K01) in Child Abuse and Neglect: Provides protected time for mentored research and training in novel or highly promising interdisciplinary approaches to the study of child abuse and neglect.
Action Collaborative on Disaster Research: Co-chaired by PTCIB staff, provides subject matter experts with a space for discussing strategies to improve the quality of disaster research used to inform the U.S. response to health threats affecting children and other populations. In 2022, the collaborative convened a symposium on pediatric disaster science that focused on scientific needs related to disasters affecting children.
Pediatric Intensive Care Core Outcomes Set: A guide to ensure that outcomes most important to all stakeholders are considered in pediatric intensive care unit (PICU) clinical research programs
Long-Term Ventilation Information and Decision-Making Support: Outlines the risks, benefits, and impact of long-term ventilation for families with a child who has or is at risk for chronic respiratory failure. Available in English and Spanish. Created as part of a PTCIB grant, the booklet addresses both invasive ventilation, such as a tracheostomy, and noninvasive ventilation, such as a continuous positive airway pressure machine.
American Academy of Pediatrics Reports and Resources: Selected reports that provide information regarding the state of the science and best practices in the following areas related to PTCIB priorities:
Centers for Disease Control and Prevention Fact Sheets and Resources: Selected data sources that provide data tables and information in the following areas related to PTCIB priorities:
Federal Interagency TBI Research: Informatics system developed to share data across the entire TBI research field and to facilitate collaboration between laboratories as well as interconnectivity with other informatics platforms
Substance Abuse and Mental Health Services Administration (SAMHSA)
National Child Traumatic Stress Initiative (NCTSI): Transforms mental health care for children and adolescents affected by trauma by improving the quality of community-based trauma treatment and services and increasing access to effective trauma-focused interventions
National Child Traumatic Stress Network: Funded through SAMHSA/NCTSI to raise the standard of care and improve access to services for traumatized children, their families, and communities
Disaster Preparedness, Response, and Recovery
Child Welfare Information Gateway: A service of the Children’s Bureau, Administration for Children and Families that promotes the safety, permanency, and well-being of children, youth, and families by connecting child welfare, adoption, and related professionals as well as the public to information, resources, and tools covering topics on child welfare, child abuse and neglect, out-of-home care, adoption, and more
Healthy People 2030 Objectives: Data-driven national objectives to improve health and well-being throughout the next decade that include topics on health behaviors such as injury and violence prevention and emergency preparedness, and settings and systems such as hospital and emergency services
Office on Trafficking in Persons (OTIP): Addresses human trafficking, which often focuses on children and adolescents, by supporting and leading systems that prevent trafficking and protect survivors and help them rebuild their lives.
Human Trafficking Prevention Month: Every January, OTIP works to raise awareness about human trafficking and empower the public to take action to prevent and respond to it. From this site, access events and activities, a prevention toolkit, and other useful resources related to educating the public on how to stop human trafficking.
U.S. Fire Administration: Provides data, prevention, and training resources for fire prevention, mitigation, and response
U.S. Consumer Product Safety Commission: Includes resources, statistics, and regulations about consumer products, including safety education and prevention resources for homes, indoor/outdoor activities, and recreation
Ready.gov: Provides disaster and emergency resources for individuals, families, and businesses, including household preparedness research data
World Health Organization: Selected data sources and reports that provide data and information in the following areas related to PTCIB priorities:
Valerie Maholmes,Ph.D., CAS Branch Chief Main Research Areas: Childhood adversity, child traumatic stress, violence and violence-related injury, child maltreatment; psychological services to children affected by trauma; trauma-informed care and systems; child protection; child welfare
Leah Gilbert, M.D., Deputy Branch Chief, Medical Officer Main Research Areas: Pediatric trauma (diagnosis, treatment, prevention); childhood adversity, child traumatic stress, violence and violence-related injury, abuse, neglect, and maltreatment; training (child maltreatment, violence); emergency medical and psychological response/services to children
Cinnamon Dixon, D.O., M.P.H., Medical Officer Main Research Areas: Emergency medical services for children (EMSC) (prevention, diagnostics, interventions, treatment, utilization, quality); pediatric disaster science (preparedness, mitigation, response, acute recovery); pediatric unintentional injury prevention and trauma care; global health advancements in EMSC and pediatric disasters; education and training (unintentional injury prevention, EMSC and trauma care, disaster science)
Tammara Jenkins, M.S.N., R.N., PCNS-BC, FCCM Program Official/Nurse Consultant Main Research Areas: Pediatric critical care and injury (general, diagnosis, treatment, prevention, ethics, end-of-life issues, environment of care, and psychosocial aspects of critical care); palliative care in the hospitalized child; acute care in the hospitalized child; training and career development (pediatric critical care, and acute care)
Vesna Kutlesic, Ph.D., LCP., Senior Advisor, Program Officer Main Research Areas: Psychological trauma , recovery, resilience and wellbeing; psychological processes that co-occur with physical trauma and long-term sequelae that affect assessment, treatment, recovery, and well-being; trauma-informed care and systems of care (child welfare, juvenile justice, and health systems); contexts for studying the effectiveness of trauma-informed efforts in real time may include natural disasters, humanitarian crises, and mass casualties; early intervention strategies to mitigate risk among vulnerable child populations; resilience, coping, well-being, adaptive outcomes, and protective factors in children exposed to adverse/traumatic events; intergenerational trauma; effects on community, family, child health and wellbeing including collective grief, loss and bereavement.
OTA-25-001: Post-Crash EMS Data Science Initiative (PDF 244 KB)
Now Available: HEAL KIDS (Knowledge, Innovation, and Discovery Studies) Pain Program. NICHD is leading activities for the KIDS Pain Program, part of NIH's Helping to End Addiction Long-term Initiative® (NIH HEAL Initiative®), through two Requests for Application (RFAs), RFA-HD-24-011 and RFA-HD-24-012. Check out these newly posted Frequently Asked Questions and the recording from a technical assistance webinar related to the KIDS Pain Program and the RFAs on the HEAL Initiative website.
PTCIB leads and participates in NICHD’s activities related to COVID-19, which includes co-sponsoring NOT-HD-21-026: Notice of Special Interest (NOSI): Research on the Impact of the Covid 19 Pandemic and Risks for Abuse and Injury Among Vulnerable Children and Youth
PTCIB also co-sponsors NOT-HD-21-048: NOSI: Research on Drowning Prevention
Highlights from selected branch-funded research:
Lurie Children’s Hospital Launches App to Help Screen Bruises in Young Children for Potential Abuse. Lurie Emergency Medical Physician Mary Clyde Pierce, M.D., used the evidence she and colleagues helped gather for an NICHD-funded study on the prevalence of bruising among infants in pediatric emergency departments (EDs) (PMID: 26233923) to develop the Lurie Children’s Child Injury Plausibility Assessment Support Tool (LCAST) app. According to the study, many cases of physical child abuse (PCA) are missed initially because early signs of abuse go unrecognized. Bruising is one of the most common signs of PCA and is missed as an early warning sign in up to 44% of fatal and near-fatal cases. Dr. Clyde Pierce and colleagues based LCAST on the study’s research that derived, refined, and validated a bruising clinical decision rule that specifies body regions on which bruising is likely due to abuse in infants and young children. Learn more about LCAST from this CBS News Chicago interview with Dr. Clyde Pierce .
ED Pediatric Readiness and Short-Term and Long-Term Mortality Among Children Receiving Emergency Care. This cohort study of nearly 800,000 children who received care in close to 1,000 U.S. EDs demonstrated significantly lower odds of in-hospital death among children who received care at EDs with a high readiness to care for children. Additionally, for children followed beyond hospitalization, the benefit of high-readiness ED care continued for up to 1 year. (PMID: 36637819)
Licensing Examination and Crash Outcomes Postlicensure in Young Drivers. This cohort study of more than 130,000 adolescents and young adults (16 to 24 years old) revealed that driver license applicants between the ages of 16 to 17 who underwent comprehensive licensing requirements (including graduated driver licensing, driver education, and behind-the-wheel practice) performed better on licensing exams than their older counterparts who were not subject to these requirements. Moreover, this younger population with comprehensive licensing requirements had lower crash rates 1 year postlicensure. (PMID: 35467733)
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