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 differ from those of adults, yet, treatment is still often based on studies involving adults.

Priorities:

• Support research that increases the understanding of the pathophysiology of psychological trauma, injury, and critical illness and associated pain to optimize treatment outcomes and prevent future difficulties in child populations.
• Support research that specifically examines the ways in which treatments in the pediatric intensive care unit or emergency department for adults can be modified to address the unique needs of children.

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.

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:  Very little quality empirical research has been published in this scientific area as it relates to pediatric critical care practice.  

Priorities: Focus on ethical and psychosocial issues in the following areas: family/caregiver/health care 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 and critically ill children, or how these forms of trauma affect children's recovery and well-being.

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

Multiple Organ Dysfunction Syndrome (MODS) in Critically Ill Children

Gap: MODS is the simultaneous dysfunction of two or more organ systems and is responsible for substantial morbidity and mortality among critically ill children. However, because it is not related to a single organ system, this topic is understudied and poorly understood.

Priority: Research the state of the science pertaining to MODS and its pathophysiologic process, treatment, etiology, and unique phenotypes.

Prevention and Treatment of Life-Threatening Traumatic Injuries in Children

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

Priority:  Support general and cause-specific prevention and intervention research studies on areas most likely to cause death or disability,including motor vehicle crashes, 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 health care providers who stabilize, diagnose, and manage the care of critically ill 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 (CPCCRN): 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 Award (PCCTSDP): 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
• Tool for Researchers: Functional Status Scale for Pediatric Hospitalization Outcomes: 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 judgements 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:
  • Web-based Injury Statistics Query and Reporting System (WISQARS)
  • Youth Violence (PDF - 95 KB)
  • Motor Vehicle Injury
  • FastStats: Injuries
  • Child Maltreatment
• PedsCCM.org  : Provides news on courses and conferences, clinical research, and clinical resources for all members of the health care 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

• 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
• Tiffany Ferguson, Extramural Staff Assistant