Biomedical subjects

R Rintala

Publications and source records attributed to R Rintala.

At least 19 recordsLinked to original sources

PubMed2006

Laparoscopic suture rectopexy in the treatment of persisting rectal prolapse in children: a preliminary report.

BACKGROUND: The repair of choice for persistent rectal prolapse (PRP) in children is disputed. Laparoscopic suture rectopexy (LSRP) is effective in adults, but its usefulness in pediatric PRP is unknown. We compared LSRP with posterosagittal rectopexy (PSRP). METHODS: Sixteen children, with a median age of 6.5 years (range, 0.8-16.8) and duration of symptoms of 2.8 years (range, 0.5-10.2), underwent surgery for PRP. Eight (1991-2000) had PSRP, and eight (2002-2005) had LSRP. Three patients with LSRP were healthy; the others had mental retardation and epilepsy (n = 1), cerebral palsy (n = 1), Aspeger's syndrome (n = 1), meningomyelocele (n = 1), and bladder extrophy (n = 1). Preoperative cologram (n = 6), sigmoideoscopy (n = 3), and anorectal manometry (n = 2) were normal in patients with LSRP. In LSRP, the rectum was mobilized and sutured to the sacral periosteum. RESULTS: Median operation time for LSRP was 80 min (range, 62-90) and for PSRP 40 min (range, 25-70) (p < 0.05); median hospital time was 6 days (range, 3-8) for LSRP and 6 days (range, 3-9) for PSRP (not significant). Six patients with LSRP had a median follow-up of 13 months (range, 4-24). None have had recurrences, and two patients (33%) require laxatives. Of the patients with PSRP, two (25%) had recurrence and underwent abdominal rectopexy with sigmoid resection. CONCLUSION: Medium-term results indicate that LSPR is effective in pediatric PRP. Constipation is the only postoperative problem in a significant proportion of patients.

Adolescent↗

PubMed2004

The Santulli enterostomy in necrotising enterocolitis.

An ideal operation for necrotising enterocolitis (NEC) would be quick and reliable, remove all nonviable bowel, minimise the loss of intestinal length, permit early restoration of intestinal continuity, and minimise the need for secondary operations. No operation currently meets all these needs. In this study we review our experience with the Santulli enterostomy in NEC. From 1992 to 1998, 19 patients (16 males, three females) underwent a Santulli enterostomy for Bell grade III NEC. The median gestational age at birth (GA) was 26 weeks (range 23-30), and the median birth weight 755 g (range 600-1095). The median patient age at operation was 10 days (range 3-59), and the median operative time was 55 min (range 25-90). Sixteen (84%) patients survived. Complications included leakage of the Santulli anastomosis in four cases, stomal necrosis in two cases, additional intestinal necrosis in two cases, leakage of a concurrent intra-abdominal anastomosis in two cases, and intestinal obstruction in four cases. Twelve patients underwent relaparotomy. Enteral feeding was started at a median of 5 days postoperatively (range 2-9), with full oral feeding possible at a median of 21 days (range 10-128). The median time until closure of the enterostomy was 48 days and the median hospital stay 87 days (range 19-197). After stomal closure, obstructive symptoms necessitated a new Santulli enterostomy in two patients and a revision of the anastomosis in one patient. Santulli enterostomy can be used to treat NEC even in very small premature babies. It enables rapid recovery of intestinal continuity and early stomal closure. However, the operation is technically demanding and carries significant morbidity.

Anastomosis, Surgical↗

PubMed2003

T-cell-mediated mucosal immunity is attenuated in experimental necrotizing enterocolitis.

In premature infants with necrotizing enterocolitis (NEC) the gastrointestinal mucosal barrier is immature, but little is known about the immune response of immature bowel. The aim of this study was to evaluate the intestinal mucosal immune response in experimental NEC. In general anaesthesia, NEC was induced in six newborn piglets by injection of bovine casein into terminal ileum. Six controls received an equal amount of saline. Four hours later, samples were taken from the macroscopically most affected part of the treated loop and from the macroscopically healthy untreated intestine. Monoclonal antibodies to porcine CD1, CD2, CD4, CD8, CD45 and IgM were used for immunohistochemical staining. Casein-treated bowel showed typical macro- and microscopic findings of NEC. No changes were found in the saline-treated bowel. In both groups the bowel outside the treatment sector was normal. In casein-treated animals, treated samples showed significant decrease in density of CD4+ cells when compared with saline-treated controls. Similar trend was found in CD2+ and CD8+ cells but without statistical significance. Macroscopically healthy proximal untreated samples showed significant decrease in densities of CD2+, CD4+ and CD8+ lymphocytes in casein-treated group when compared with control samples. In casein-treated animals the density of CD45+ cells in the non-injected bowel was also decreased, but this did not reach statistical significance. Densities of CD1+ and IgM+ cells did not differ between casein-treated and saline-treated groups. A significant T-cell decrease was found in the present NEC model. Surprisingly, this was most prominent in the macroscopically healthy bowel outside the casein injection segment. The reason for T-cell decrease remains unclear, but bovine casein is known to contain peptide fractions that can modulate immune function. These findings may have implications in the design of neonatal milk formulas.

Animals↗

PubMed2002

Intraluminal casein model of necrotizing enterocolitis for assessment of mucosal destruction, bacterial translocation, and the effects of allopurinol and N-acetylcysteine.

An intraluminal casein model (ICM) of necrotizing enterocolitis (NEC) is able to produce small-bowel changes reminiscent of human NEC in neonatal animals. We studied bacterial translocation (BT) in NEC induced by using the ICM in neonatal piglets. We also studied whether allopurinol (AL) and N-acetylcysteine (NAC) have an effect on BT and mucosal changes in the ICM of NEC. Twenty-eight neonatal piglets were randomized into four groups. NEC was induced in 21 by injecting casein-d-gluconate into a loop of terminal ileum: group Cas (n = 7) had no premedication, in group Cas/AL (n = 7) intravenous (i.v.) Al (100 mg/kg), and in group Cas/NAC (n = 7) i.v. NAC (200 mg/kg) was given. Group Sham (n = 7) had the ileum injected with 0.9% saline with no premedication. Immediately after the injection a mesenteric lymph node (MLN) adjacent to the loop was harvested for quantitative aerobic bacterial culture; 4 h after the injection another MLN and samples of spleen, liver, kidney, and lung were harvested and cultured. Comparison of the incidence of samples with positive bacterial cultures and the number of colony-forming units (CFU) in samples was made between groups. The severity of NEC in the ileum was graded from 0 to 3 according to macroscopic and histologic findings. NEC changes in the bowel were most severe in Cas piglets, less severe in Cas/NAC piglets ( P < 0.5), and sham piglets had the least severe changes ( P < 0.05). piglets with NEC changes in the ileum had a higher incidence of BT into the MLN than piglets without NEC changes ( P < 0.05), but the difference in CFU was not significant ( P > 0.05). In Cas and Cas/NAC piglets a high incidence of BT into the MLN was noted as early at -5 min after casein injection. The incidence of BT into the MLN was significantly higher in Cas and Cas/NAC piglets than in Sham piglets ( P < 0.05), the difference in CFU being not significant ( P > 0.05). BT in Cas/Al piglets was not significantly different from that of Cas piglets ( P > 0.05), but less than in Cas/NAC piglets ( P < 0.05). Four hours after casein injection into the ileum there was significant BT into the MLN. Premedication with NAC was associated with less severe NEC changes, but neither NAC nor AL significantly affected BT.

Acetylcysteine↗

PubMed2001

Loss-of-function mutations in SIP1 Smad interacting protein 1 result in a syndromic Hirschsprung disease.

Hirschsprung disease (HD) has been described in association with microcephaly, mental retardation and characteristic facial features, delineating a syndrome possibly caused by mutations localized at chromosome 2q22--q23. We have analyzed a de novo translocation breakpoint at 2q22 in one patient presenting with this syndrome, and identified a gene, SIP1, which is disrupted by this chromosomal rearrangement. SIP1 encodes Smad interacting protein 1, a new member of the delta EF1/Zfh-1 family of two-handed zinc finger/homeodomain transcription factors. We determined the genomic structure and expression of the human SIP1 gene. Further analysis of four independent patients showed that SIP1 is altered by heterozygous frameshift mutations causing early truncation of the protein. SIP1, among other functions, seems to play crucial roles in normal embryonic development of neural structures and neural crest. Its deficiency, in altering function of the TGF beta/BMP/Smad-mediated signalling cascade, is consistent with some of the dysmorphic features observed in this syndrome, in particular the enteric nervous system defect that underlies HD.

Abnormalities, Multiple↗

PubMed2001

Hirschsprung disease associated with severe cartilage-hair hypoplasia.

Cartilage-hair hypoplasia is a chondrodysplasia with a high incidence of Hirschsprung disease. This study suggests that Hirschsprung disease is associated especially with severe cartilage-hair hypoplasia: the patients with Hirschsprung disease had severe growth failure and a higher incidence of alopecia, infections, malignancies, and childhood anemia than the patients with cartilage-hair hypoplasia who did not have Hirschsprung disease.

Exostoses, Multiple Hereditary↗

PubMed2001

T cells of the colonic mucosa in patients with infantile colitis.

BACKGROUND: Infantile colitis is a heterogeneous group of disorders, including enterocolitis complicating Hirschsprung disease, allergic colitis, inflammatory bowel disease, and Behçet syndrome. There are limited data concerning the immune responses induced by the inflammation of the intestine in young infants. METHODS: Twenty-four colonic biopsy specimens from 12 infantile colitis patients and 12 age-matched control patients were studied by immunohistologic methods. The authors compared the T cells, their subsets expressing the surface antigens CD8 and CD4, and T-cell receptors alphabeta and deltagamma, and densities of mononuclear and epithelial cells expressing human leukocyte antigen class II antigens. RESULTS: The density of CD3+ intraepithelial lymphocytes (IELs) in the large intestinal specimens was significantly higher (P = 0.036) in colitis patients than in the control group. The majority of the CD3+ IELs were CD8+-expressing cells, and only a minority were CD4+ cells in both groups. T-cell receptors alphabeta+ (P = 0.023) and deltagamma+ (P = 0.027) IELs were observed significantly more frequently in colitis patients than in the control group. In surface epithelium, delta non-disulphide-linked type T-cell receptor (deltaTCS1) IELs were found strikingly more frequently (P = 0.001) in the specimens taken from the colitis patients. Also, the density of the deltaTCS1+ cells in crypts of the large intestine was significantly higher in colitis patients than in the control patients (P = 0.047). CONCLUSIONS: A significant increase of CD3+ lymphocytes in the colonic epithelium of the patients with infantile colitis was noted. This increase involved both T-cell receptor alphabeta-positive and deltagamma-positive IELs. The finding of this study supports the proposal that intraluminal antigens, either microbial or food derived, are important in the pathogenesis of colitis in young infants.

Antibodies, Monoclonal↗

PubMed2001

Hirschsprung disease, mental retardation and dysmorphic facial features in five unrelated children.

We report five patients with Hirschsprung disease, severe mental retardation and dysmorphic facial features including hypertelorism, prominent forehead and dysmorphic ears. All four boys had hypospadias. All had postnatally retarded growth. One of them had a de novo apparently balanced translocation 46,XY,t(2;11)(q22.2;q21). There are several reports on patients with Hirschsprung disease, mental retardation and various dysmorphic features. Some of them, especially those reported by Tanaka et al. [(1993) Pediatr Neurol 9:479-481], Lurie et al. [(1994) Genet Couns 5:11-14] and Mowat et al. [(1998) J Med Genet 35:617-623] closely resemble our patients suggesting that they have the same malformation syndrome.

Child↗

PubMed2000

The effects of intravenous epidermal growth factor on bacterial translocation and central venous catheter infection in the rat total parenteral nutrition model.

Sepsis is a major complication of total parenteral nutrition (TPN) in children. Gut mucosal atrophy (GMA) and bacterial translocation (BT) occur in patients receiving TPN, and the translocated enteric organisms may cause central venous catheter (CVC) infection. Epidermal growth factor (EGF) has a trophic effect on the gut mucosa and may reduce BT, thereby reducing catheter infection. Using a rat TPN model, the relationship between GMA, BT, and catheter sepsis was examined and the effect on these of intravenous EGF was studied. There were four experimental groups. Group 1 had no CVC, Groups 2, 3, and 4 had a continuous central venous infusion as follows: group 2, saline; group 3, TPN; group 4, TPN with EGF. Groups 1 and 2 had free access to chow, groups 3 and 4 had no enteral feeds. After killing at 1 week, blood, tissue, and catheter specimens were cultured and mucosal morphology analysed. BT was defined as the presence of the same organism in cultures from the gut lumen and mesenteric lymph nodes (MLN). TPN only (group 3) resulted in GMA and BT, and 5 of 12 animals with BT had the same gut bacteria in blood and/or catheter cultures. The addition of EGF to the TPN significantly reduced GMA, BT to the MLN, and blood and/or catheter infections (P = <0.05). In animals carrying enterococci, there was a significant reduction in translocation of enterococci (group 3: 8/14; group 4: 0/11; P<0.05) and catheter infection by enterococci was prevented (group 3: 3/14; group 4: 0/11). EGF thus reduced GMA, BT, and blood and/or catheter infection when given IV to rats receiving TPN. Enterococcal translocation and subsequent blood and/or catheter infection was completely prevented, suggesting a selective effect of EGF.

Animals↗

PubMed2000

A longitudinal study of electrogastrography in normal neonates.

BACKGROUND/PURPOSE: Gastric motility is partly regulated by an inherent electric control activity (ECA). Electrogastrography (EGG) measures gastric ECA through cutaneous electrodes. Little is known about EGG in neonates. A slow wave frequency of 3 cycles per minute (cpm) accounts for 85% to 100% of gastric ECA in normal adults and children. However, the authors have shown previously a lower percentage of 3 cpm activity in neonates. Abnormal EGG patterns (tachygastria and bradygastria) have been described in adults and children with gastric motility disorders. In neonates, especially premature infants, disorders of gastrointestinal motility are common, especially after gastrointestinal operations. It is necessary to characterise normal ECA before the pathophysiology of these disorders can be studied. The aim of this study was to investigate the pattern of ECA in the developing neonate. METHODS: Nine healthy neonates born at 34 weeks' gestation were studied using Synectics EGG sampling at 4 Hz. Each subject underwent 4 hourly EGG recordings at fortnightly intervals from birth until age 8 weeks, and then every 2 months until age 2 years. The paired sample t test (95% Confidence Interval [CI]) was used to compare recordings. RESULTS: Between birth and age 2 years, 3 cpm activity increased from 38% to 57% of recorded time. The mean percentage recorded time of tachygastria decreased from 47% to 35%, and bradygastria decreased from 15% to 8%. Statistically significant differences were seen between birth, 6 months, and 2 years of age. CONCLUSIONS: The pattern of ECA in the normal neonatal stomach differs from that seen in adult studies. Tachygastria and bradygastria are seen more frequently, with fewer periods of 3 cpm. There is an increase in the percentage of 3 cpm activity over time, with statistically significant differences from the ECA pattern at birth first seen at the age of 6 months. The authors suggest that neonatal ECA undergoes a maturation process and that larger longitudinal and normal range studies are required to investigate this phenomenon.

Child, Preschool↗

PubMed2000

Rectosigmoid pHi monitoring during experimental necrotizing enterocolitis.

BACKGROUND/PURPOSE: Gastric or rectosigmoid intramural pH (pHi) is considered a reliable indicator of splanchnic perfusion. The aim of this study was to evaluate whether rectosigmoid pHi reflects the severity of bowel damage in experimental necrotizing enterocolitis (NEC). METHODS: A total of 36 neonatal piglets, (median age, 3; range, 1 to 11 days; median weight, 2.5; range, 1.2 to 3.8 kg), were anesthetized, ventilated mechanically, and had invasive monitoring of hemodynamics. A sigmoid tonometer was inserted into the rectosigmoid colon. Enterocolitis was induced in 27 piglets by intraluminal injection of casein-d-gluconate (16.0 mL/kg) into terminal 100 cm of the ileum. Nine control piglets received an equal amount of intraluminal saline. NEC was graded macroscopically as follows: 0, no changes; 1, mild; 2, moderate; and 3, severe. Histology was evaluated according to Chiu scale from 0 to 5. RESULTS: The macroscopical bowel injury in caseine-injected piglets was as follows: grade 3 (n = 6), grade 2 (n = 9), grade 1 (n = 12). All control piglets showed macroscopically normal bowel (grade 0). All affected bowels showed histologic changes (Chiu's scale 2 to 4). All study animals had an initial drop of pHi after injection of casein or saline. In control piglets and those with mild NEC (grade 1) pHi tended to return to preinjection level. In animals with moderate or severe NEC (grade 2 to 3) the initial drop was deeper and the pHi continued to decrease significantly throughout the experiment (P < .05). In the arterial pH and mean blood pressure there were no statistically significant differences between piglets with no NEC and mild NEC, and these with moderate or severe NEC. CONCLUSION: Drop in rectosigmoid pHi was the most sensitive and earliest sign of severe mucosal necrosis of ileum in this experimental NEC model.

Animals↗

PubMed1999

Intrapulmonary ectopic liver.

A case of intrapulmonary ectopic liver in a patient who had undergone right-sided diaphragmatic hernia is described. The intrapulmonary ectopic liver was found incidentally in chest x-ray at the age of 6 years. The final diagnosis was established at thoracotomy. Fewer than 10 cases of intrathoracic ectopic liver have been reported previously, but an intrapulmonary ectopic liver like the present case has not been described previously.

Choristoma↗

PubMed1999

Intravenous glutamine or short-chain fatty acids reduce central venous catheter infection in a model of total parenteral nutrition.

BACKGROUND/PURPOSE: In children receiving total parenteral nutrition (TPN) translocated enteric organisms are a possible cause of central venous catheter infection. The aim of this study was to determine the relationship between gut mucosal atrophy, bacterial translocation, and catheter sepsis in rats receiving TPN alone or supplemented with intravenous short chain fatty acids (SCFA) or glutamine. METHODS: Mature Wistar rats were studied. Groups 2 to 5 had a central venous catheter inserted. Group 1 (n = 12) had enteral feeds only, group 2 (n = 14) had enteral feeds and intravenous saline, group 3 (n = 15) had TPN only, group 4 (n = 13) had TPN with SCFA, and group 5 (n = 15) had TPN with glutamine. At 1 week, blood, tissue, and catheter specimens were obtained for culture and mucosal morphometry. RESULTS: Villus height and crypt depth were reduced significantly in group 3 compared with group 1 (P < .05). Glutamine and SCFA significantly ameliorated the mucosal atrophy. Significant bacterial translocation and catheter infection occurred in group 3. Reduced translocation with SCFA was not significant, but catheter infection was (P < .05). Glutamine significantly reduced translocation and catheter infection. CONCLUSIONS: There is an association between bacterial translocation and central venous catheter infection. The risk of catheter infection is reduced by supplementing TPN with SCFA or glutamine.

Animals↗

PubMed1999

Gastroesophageal reflux in children with a congenital abdominal wall defect.

BACKGROUND/PURPOSE: Gastroesophageal reflux (GER) is considered common in patients with congenital abdominal wall defects (CAWD). The aim of this study was to find out the frequency of GER in children with CAWD and, in particular, whether there is difference between patients with omphalocele and gastroschisis. METHODS: Forty-two children, 19 with gastroschisis and 23 with omphalocele were examined for GER at the median age of 12.0 months (range, 1 to 132). Esophagoduodenoscopy with biopsies was performed on all patients. Eighteen patients underwent 18-hour esophageal pH-monitoring. RESULTS: GER was detected in 13 patients. All but one patient of the 13 had either macroscopic or microscopic esophagitis. One patient had pathological pH monitoring only. In children with omphalocele, the incidence of GER was 43% (10 of 23), whereas in gastroschisis patients the incidence was 16% (3 of 19), (P value, not significant). The median age of omphalocele patients with GER was significantly lower (7 months) than the median age of those without GER (72 months; P = .01). In patients with gastroschisis age made no difference. Six of 32 patients (19%) with primary fascial closure (small defects) had GER, whereas 7 of 10 patients (70%) in which primary fascial closure was impossible (large defects) had GER (P < .01). CONCLUSION: CAWD patients, especially those with omphalocele and a large defect have a high incidence of GER complicated by esophagitis during the first few years of life.

Abdominal Muscles↗

PubMed1999

Microbiological and chemical identification of antimicrobial drugs in kidney and muscle samples of bovine cattle and pigs.

Microbiological and chemical identification of antimicrobial drug residues was attempted in 95 kidney and 76 muscle samples from 58 cattle, 36 pigs and one horse which had revealed kidneys positive to an inhibitor test. Information on pre-slaughter medication with one antimicrobial drug was available for 63% of the carcasses. Microbiological identification was performed by agar diffusion using 17 or 18 combinations of eight test bacteria, varying medium pH and three substances blocking the action of certain antimicrobials. Sample activity patterns compiled from inhibition zone diameters on test plates were compared with those obtained with standard antimicrobial solutions both visually and by locating the minimal sum of absolute pairwise differences over the tests. Chemical identification of residues was based on liquid chromatography. In kidney samples containing one microbiologically-identified antimicrobial the two methods gave fully consistent results with tetracyclines (15/15) and fluoroquinolenes (8/8). Preparation and storage of the kidney samples before chemical analyses appeared to influence the chemical identification of penicillin G. The results were consistent in 37 of the 41 samples stored without homogenization at -70 degrees C. The residue was identified by chemical means only in six and neither microbiologically nor chemically in four kidney samples with information on pre-slaughter medication. The same residue as in the kidney samples was identifiable microbiologically in 41% of the muscle samples of the same carcasses. The results show that the microbiological method is well suited for identification of antibiotic residues. They indicate further that an enhanced resolution with a reduced combination of plates is attainable.

Animals↗

PubMed1999

B-cell development in lamina propria of the large intestine: influence of age and t-cell densities.

The development of B-cells and immunoglobulin-isotype and IgA subclass-positive cells in the lamina propria of the large intestine during infancy was investigated. Biopsy specimens from 36 infants, taken for diagnostic purposes, were available. All samples showed normal morphology. Monoclonal antibodies to CD22, IgA, IgA1, IgA2, IgM and IgG and a peroxidase method were used to demonstrate positive cells in the cryostat sections. Cell densities were counted from a known area. T-cells had been measured in a previous study using the same specimens. The density of CD22+ cells was already high in infants below the age of 1 month and increased little with age. Four specimens from infants below the age of 40 days lacked IgA-, IgA1- and IgA2-positive cells. The densities of these cells increased with age; the correlation coefficient between the age and the density of the cells was for IgA: R=0.47, p=0.04; for IgA1: R=0.57, p=0.001, and for IgA2: R=0.34, p=0.04. The densities of IgG- and IgM-positive cells remained unchanged with age. The negative correlation between density of IgG+cells and CD8+ cells in the lamina propria (R= -0.43, p=0.01) was significant. Strong local stimulation results in early accumulation of CD22+, IgM+ and IgG+ cells in the large intestine, but little change takes place after the first few days of life. The terminal differentiation to IgA-positive cells is slowest, and this population showed significant developmental change.

Age Factors↗

PubMed1998

Severe and fatal childhood trauma.

We wanted to study epidemiology and the outcome of severe childhood trauma. A retrospective study was carried out of 347 severely injured children under 16 years of age, who required intensive care or died during a 10-year period in southern Finland. Of the severely injured children, 65.4 per cent were male. Blunt injuries were the most common (83.0 per cent) followed by penetrating injuries (4.9 per cent), burns (4.6 per cent) and others (7.5 per cent). Of the patients with blunt or penetrating trauma, 85.6 per cent had head injury alone, or combined with other injuries. The majority of all injuries (58.2 per cent) and deaths (59.3 per cent) in children were caused by road traffic accidents. Of this patient population, 64 died at the scene, 54 died in hospital and 229 survived. Most of the deceased trauma patients (77.1 per cent) died within the first 6 h following the incident and all the deaths occurred within 9 days. The annual incidence of severe trauma was 14.1 per 100,000 children, and the annual mortality was 4.8 per 100,000. All the trauma deaths occurred immediately or within a few days of the accident. Late trauma deaths due to sepsis or multiple organ failure were not seen in children.

Accidents, Home↗

PubMed1998

Prehospital care and survival of pediatric patients with blunt trauma.

BACKGROUND: The aim of this study was to compare the outcome of severe blunt trauma in children receiving prehospital care from either physician-staffed advanced life support (ALS) units, or from basic life support (BLS) units staffed by emergency medical technicians. METHODS: The records of 288 children with severe blunt trauma who required intensive care in the regional level 1 trauma center or who died from their injuries were analyzed retrospectively. Patients were excluded if resuscitation at the scene was not attempted, if the level of prehospital care was unspecified, or if arrival at the level 1 trauma center was delayed beyond 150 minutes. Seventy-two patients met the inclusion criteria of BLS-, and 49 the criteria of ALS-prehospital care. RESULTS: A reduced mortality rate (22.4% v 31.9%) was seen in the ALS group, which was more apparent in a "salvageable but high-risk" subgroup, characterized by Glasgow Coma of Scale 4 through 8, Pediatric Trauma Score of 0 through 5, and Injury Severity Score (ISS) of 25 through 49. However, a statistically significant difference was only seen when trauma severity was evaluated by the ISS. CONCLUSION: An improved outcome in children with severe blunt trauma has been demonstrated when prehospital care is provided by physician-staffed ALS units compared with BLS units.

Adolescent↗