Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Children where you're concerned about child abuse need a skeletal survey as part of their evaluation, and as part of that skeletal survey, you need at least a single view of the cervical spine — Meera Kotagal, Cervical Spine Clearance - APSA Practice Gaps 2019 · 7:34
Cervical Spine3 items
Defining pediatric cervical spine clearance with computed tomography: A prospective observational study by the Western Pediatric Surgery Research Consortium and Western Trauma Association
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Introduction: The optimal imaging strategy for pediatric cervical spine clearance remains controversial. The primary objective of this study was to determine the sensitivity of computed tomography (CT) in detecting clinically significant ce
article · Oct 2026
Update Course Rewind: Cervical Spine Clearance 2019
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Cervical spine clearance in the pediatric trauma patient can be difficult - especially in those patients less than 3 years old. That's why Dr. Meera Kotagal reviewed the C-spine literature and recommendations during our 2019 Pediatric Surge
podcast · May 2021
Cervical Spine Clearance - APSA Practice Gaps 2019
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At the 7th Annual Pediatric Surgery Update Course, Dr. Meera Kotagal discusses cervical spine clearance, one of the 2019 practice gaps identified by the American Pediatric Surgical Association’s Professional Development Committee.
video · Mar 2020
Blunt Cerebrovascular Injury1 item
Update Course Rewind: Updates in Screening for Blunt Cerebrovascular Injury 2023
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Our 11th Annual Update Course in Pediatric Surgery was held past August. In this video series, we'll recap the sessions and share the main highlights with you. Today, we'll talk about "Updates in Screening for Blunt Cerebrovascular Injury"
video · Jan 2024
Activity restrictions have moved towards shorter duration; previously grade 4 spleen lacerations required 12 weeks or longer out of activity. Update Course Rewind: Updates in Solid Organ Injury Management 2023 · 2:45
Solid Organ Injury2 items
Update Course Rewind: Updates in Solid Organ Injury Management 2023
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Our 11th Annual Update Course in Pediatric Surgery was held past August. In this video series, we'll recap the sessions and share the main highlights with you. Today, we'll talk about "Updates in Solid Organ Injury Management". Joining the
video · Mar 2024
Admission for Isolated Low-Grade Solid Organ... : Journal of Trauma Nursing
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Background:Recent publications indicate that blunt solid organ injuries can be safely managed with reduced length of stay using pathways focused on...
article · Nov 2026
Renal Trauma1 item
Variable management of pediatric blunt renal trauma: A multicenter retrospective cohort study.
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There are no comprehensive management guidelines for pediatric blunt renal injury; therefore, we hypothesized that wide variation in care exists. We sought to describe contemporary management of pediatric blunt renal trauma and explore asso
article · Nov 2026
Thoracic Trauma3 items
Percutaneous pigtail catheter versus chest tube for the treatment of pediatric traumatic hemothorax: An Eastern Association for the Surgery of Trauma multicenter study
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Background: Small percutaneously placed pigtail catheters (PCs) for traumatic hemothorax (HTX) are safe and effective in adults but have not been evaluated in children. We hypothesized that PC would have similar efficacy and complication ra
article · Nov 2026
Percutaneous pigtail catheter versus chest tube for the treatment of pediatric traumatic hemothorax: An Eastern Association for the Surgery of Trauma multicenter study
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Laura F Goodman 1, Alice M Martino, John Schomberg, Jason D Sciarretta, Mari Freedberg, Adora Santos, Sharven Taghavi, Martin Tafazoli, David V Shatz, Kathleen E Doyle, Samantha M Koenig, Robert T Russel, V Christian Sanderfer, Samuel W Ros
video0:59 · Dec 2025
Percutaneous pigtail catheter versus chest tube for the treatment of pediatric traumatic hemothorax
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Laura F Goodman, Alice M Martino, John Schomberg, Jason D Sciarretta, Mari Freedberg, Adora Santos, Sharven Taghavi, Martin Tafazoli, David V Shatz, Kathleen E Doyle, Samantha M Koenig, Robert T Russel, V Christian Sanderfer, Samuel W Ross,
article · Nov 2025
Traumatic Brain Injury1 item
Crystalloid volume is associated with short-term morbidity in children with severe traumatic brain injury: An Eastern Association for the Surgery of Trauma multicenter trial post hoc analysis
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Objective: This study examined differences in clinical and resuscitation characteristics between injured children with and without severe traumatic brain injury (sTBI) and aimed to identify resuscitation characteristics associated with impr
article · Nov 2026
The best definition for massive transfusion in kids is 40 ml/kg of any blood product over 24 hours — Meera Kotagal, Update Course Rewind: Massive Transfusion Protocol 2023 · 3:50
Massive Transfusion1 item
Update Course Rewind: Massive Transfusion Protocol 2023
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Our 11th Annual Update Course in Pediatric Surgery was held past August. In this video series, we'll recap the sessions and share the main highlights with you. Today, we'll talk about "Massive Transfusion Protocol". Joining the discussion a
video · Mar 2024
Nutrition Support1 item
Early Enteral Nutrition and TPN Timing in Pediatric Trauma Patients
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In this episode, Dr. Deidre Wyrick (Trauma Medical Director at Arkansas Children’s Hospital) and Dr. Meera Kotagal (Trauma Medical Director at Cincinnati Children’s Hospital) take a deep dive into nutrition and TPN for pediatric trauma pati
video1:30 · Nov 2026
Intubation Prediction1 item
Development and Validation of a Bayesian Network Predicting Intubation Following Hospital Arrival Among Injured Children
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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 ti
article · Nov 2026
According to the American College of Surgeons non-fatal firearm study, 50-60% of pediatric firearm injuries are assault related, with many being bystander injuries. — Meera Kotagal, Update Course Rewind: Firearm Screening 2023 · 2:59
Firearm Injury4 items
Update Course Rewind: Firearm Screening 2023
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Our 11th Annual Update Course in Pediatric Surgery was held past August. In this video series, we'll recap the sessions and share the main highlights with you. Today, we'll talk about "Firearm Screening". Joining the discussion are Drs. Mee
video · Feb 2024
Preinjury and Event-Related Characteristics of Pediatric Firearm Injuries: The American College of Surgeons Firearm Study, United States, March 2021‒February 2022
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Objectives. To assess differences in contextual factors by intent among pediatric firearm injury patients and determine factors associated with data missingness. Methods. We retrospectively queried the American College of Surgeons Firearm S
article · Nov 2026
Pediatric Surgery Firearm Injury Collaborative Symposium.
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Injury from a firearm is now the leading cause of death of children and youth under age 19 in the United States (U.S.) [1] and the incidence of these deaths continues to increase each year [2]. For every death from firearm violence, there a
article · Nov 2026
The COVID-19 pandemic and associated rise in pediatric firearm injuries: A multi-institutional study.
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Firearm sales in the United States (U.S.) markedly increased during the COVID-19 pandemic. Our objective was to determine if firearm injuries in children were associated with stay-at-home orders (SHO) during the COVID-19 pandemic. We hypoth
article · Nov 2026
Non-Accidental Trauma1 item
Impact of "Stay-at-Home" orders on non-accidental trauma: A multi-institutional study
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Background: It is unclear how Stay-at-Home Orders (SHO) of the COVID-19 pandemic impacted the welfare of children and rates of non-accidental trauma (NAT). We hypothesized that NAT would initially decrease during the SHO as children did not
article · Nov 2026
Acute Stress & Mental Health2 items
Children at risk A prospective cohort study of acute stress development and patterns in pediatric trauma patients
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Marissa Ray, Allison Bailey, Elizabeth Lendrum, Emily Vore, Susan Beiting, Megan Reichert, Suzanne Moody, Emily Rheaume, Richard A Falcone, Meera Kotagal Background: Children are at significant risk for acute stress after injury which can i
article · Jan 2026
Children at risk: A prospective cohort study of acute stress development and patterns in pediatric trauma patients
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Marissa Ray, Allison Bailey, Elizabeth Lendrum, Emily Vore, Susan Beiting, Megan Reichert, Suzanne Moody, Emily Rheaume, Richard A Falcone, Meera KotagalBackground: Children are at significant risk for acute stress after injury which can im
video0:39 · May 2026
Venous Thromboembolism2 items
Venous thromboembolic risk stratification in pediatric trauma: A Pediatric Trauma Society Research Committee multicenter analysis
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Background: Venous thromboembolism (VTE) in injured children is rare, but its consequences are significant. Several risk stratification algorithms for VTE in pediatric trauma exist with little consensus, and all are hindered in development
article · Nov 2026
Impact of institutional prophylaxis guidelines on rates of pediatric venous thromboembolism following trauma-A multicenter study from the pediatric trauma society research committee.
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A paucity of data exists with regard to the incidence, management, and outcomes of venous thromboembolism (VTE) in injured children. We sought to determine the impact of institutional chemoprophylaxis guidelines on VTE rates in a pediatric
article · Nov 2026
Pediatric Injury Transfer Patterns During the COVID-19 Pandemic: An Interrupted time Series Analysis.
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With the expected surge of adult patients with COVID-19, the Children's Hospital Association recommended a tiered approach to divert children to pediatric centers. Our objective was understanding changes in interfacility transfer to Pediatr
article · Nov 2026
Making a move: Using simulation to identify... : Journal of Trauma and Acute Care Surgery
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BACKGROUNDIn today's rapidly changing health care environment, hospitals are expanding into newly built spaces. Preserving patient safety by...
article · Nov 2026
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Update Course Rewind: Massive Transfusion Protocol 2023
After 20 ml/kg of blood within an hour, you should activate the MTP according to the MATIC trial investigators
Host summaryKatie Russell summarizing the discussion — not the host's own clinical position2:34 ↗
There is adult data to support starting with FFP in trauma resuscitation
clinicalMeera Kotagal1:17 ↗
The best definition for massive transfusion in kids is 40 ml/kg of any blood product over 24 hours
guidelineMeera Kotagal3:50 ↗
Activating MTP threshold is different than the definition of massive transfusion
clinicalMeera Kotagal3:50 ↗
The more fresh frozen plasma (FFP) you give, the lower your mortality is in balanced resuscitation
Host summaryMeera Kotagal summarizing the discussion — not the host's own clinical position4:40 ↗
The closer you are to 1:1:1 ratio is better and this has been shown in kids, not just adult data
Host summaryMeera Kotagal summarizing the discussion — not the host's own clinical position4:40 ↗
There is great pediatric data on whole blood for trauma resuscitation
clinicalMeera Kotagal4:40 ↗
Kids bleed whole blood, making balanced resuscitation important
clinicalMeera Kotagal4:40 ↗
Blood can usually be returned to the blood bank unless you spike the bag
clinicalMeera Kotagal3:00 ↗
Most trauma coolers that come to the bay do not have platelets initially
clinicalKatie Russell3:28 ↗
After implementing an MTP team, balanced resuscitation rates improved from 25% to 85%
epidemiologicalKatie Russell6:01 ↗
Pre-hospital transfusion could reduce mortality according to recent data
clinical6:23 ↗
There is evidence to support pre-hospital TXA use
clinicalKatie Russell7:32 ↗
Using TXA in MTP should be combined with rapid viscoelastic testing (ROTEM or TEG) to directly target resuscitation goals
clinicalKatie Russell7:32 ↗
Whole blood for pediatric trauma needs to be irradiated, which creates blood bank implementation challenges
clinicalMeera Kotagal3:00 ↗
The MTP team consists of a trauma APP running the team and an ER nurse who knows how to run the Belmont rapid infuser
clinicalKatie Russell5:35 ↗
Update Course Rewind: Updates in Solid Organ Injury Management 2023
APSA guidelines include four basic categories for solid organ injury management: where patients should be admitted, procedures, when to discharge them, and what to do after discharge.
guideline1:45 ↗
In kids, the data doesn't support the need for angioembolization, even if you see active arterial extravasation on CT.
clinical2:10 ↗
APSA guidelines indicate discharge when patients are clinically doing well, with no indication for repeat imaging after discharge.
guideline2:25 ↗
Activity restrictions have moved towards shorter duration; previously grade 4 spleen lacerations required 12 weeks or longer out of activity.
guideline2:45 ↗
Cincinnati Children's Hospital guideline states only hemodynamically abnormal patients go to the ICU.
guideline3:44 ↗
Cincinnati has started discharging isolated grade 1 or 2 splenic injuries from the emergency department.
clinical3:44 ↗
In a study of grade 1 and 2 injuries with no other major organ injured, not a single patient got an intervention during hospitalization, including transfusion.
epidemiological4:00 ↗
Grade 1-2 injuries are discharged from ED if patients are watched for 4 hours and able to tolerate a PO challenge.
clinical4:00 ↗
CT scanning serves two purposes: making a diagnosis overall and determining appropriate discharge activity restrictions, which differ between splenic laceration and small bowel contusion.
clinical4:55 ↗
In the blunt abdominal trauma guideline at Cincinnati, not all patients are scanned; AST and lipase are used to decide who needs a scan.
clinical5:37 ↗
Standardized discharge instructions are created and given to all patients in collaboration with the emergency department.
clinical6:42 ↗
Every patient discharged with solid organ injury is seen in trauma clinic within the week to ensure the child is doing well and to provide continued counseling about activity restrictions.
clinical6:42 ↗
At the Utah practice, 80% of pediatric trauma patients are transfers and most have already had a CBC at the referring hospital.
epidemiological7:17 ↗
For hemodynamically normal children with solid organ injury going to the floor, CBC is not repeated.
clinical7:39 ↗
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