# Pediatric Trauma Care — GCMD Library living collection

Updated: n/a · 25 episodes · 78 cited statements

## Episodes
### Injury Assessment & Clearance
- [Defining pediatric cervical spine clearance with computed tomography: A prospective observational study by the Western Pediatric Surgery Research Consortium and Western Trauma Association](https://library.globalcastmd.com/article/defining-pediatric-cervical-spine-clearance-with-computed-tomography-a-prospecti-16091) — article · [machine version](https://library.globalcastmd.com/article/defining-pediatric-cervical-spine-clearance-with-computed-tomography-a-prospecti-16091.md)
- [Update Course Rewind: Cervical Spine Clearance 2019](https://library.globalcastmd.com/watch/update-course-rewind-cervical-spine-clearance-2019-3990) — podcast · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-cervical-spine-clearance-2019-3990.md)
- [Cervical Spine Clearance - APSA Practice Gaps 2019](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306) — video · [machine version](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306.md)
- [Update Course Rewind: Updates in Screening for Blunt Cerebrovascular Injury 2023](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884) — video · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884.md)

### Organ-Specific Trauma
- [Update Course Rewind: Updates in Solid Organ Injury Management 2023](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098) — video · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098.md)
- [Admission for Isolated Low-Grade Solid Organ... : Journal of Trauma Nursing](https://library.globalcastmd.com/article/admission-for-isolated-low-grade-solid-organ-journal-of-trauma-nursing-16606) — article · [machine version](https://library.globalcastmd.com/article/admission-for-isolated-low-grade-solid-organ-journal-of-trauma-nursing-16606.md)
- [Variable management of pediatric blunt renal trauma: A multicenter retrospective cohort study.](https://library.globalcastmd.com/article/variable-management-of-pediatric-blunt-renal-trauma-a-multicenter-retrospective-16557) — article · [machine version](https://library.globalcastmd.com/article/variable-management-of-pediatric-blunt-renal-trauma-a-multicenter-retrospective-16557.md)
- [Percutaneous pigtail catheter versus chest tube for the treatment of pediatric traumatic hemothorax: An Eastern Association for the Surgery of Trauma multicenter study](https://library.globalcastmd.com/article/percutaneous-pigtail-catheter-versus-chest-tube-for-the-treatment-of-pediatric-t-16552) — article · [machine version](https://library.globalcastmd.com/article/percutaneous-pigtail-catheter-versus-chest-tube-for-the-treatment-of-pediatric-t-16552.md)
- [Percutaneous pigtail catheter versus chest tube for the treatment of pediatric traumatic hemothorax: An Eastern Association for the Surgery of Trauma multicenter study](https://library.globalcastmd.com/watch/percutaneous-pigtail-catheter-versus-chest-tube-for-the-treatment-of-pediatric-t-11303) — video · 0:59 · [machine version](https://library.globalcastmd.com/watch/percutaneous-pigtail-catheter-versus-chest-tube-for-the-treatment-of-pediatric-t-11303.md)
- [Percutaneous pigtail catheter versus chest tube for the treatment of pediatric traumatic hemothorax](https://library.globalcastmd.com/infographic/percutaneous-pigtail-catheter-versus-chest-tube-for-the-treatment-of-pediatric-t-11233) — article · [machine version](https://library.globalcastmd.com/infographic/percutaneous-pigtail-catheter-versus-chest-tube-for-the-treatment-of-pediatric-t-11233.md)
- [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](https://library.globalcastmd.com/article/crystalloid-volume-is-associated-with-short-term-morbidity-in-children-with-seve-16573) — article · [machine version](https://library.globalcastmd.com/article/crystalloid-volume-is-associated-with-short-term-morbidity-in-children-with-seve-16573.md)

### Resuscitation & Critical Care
- [Update Course Rewind: Massive Transfusion Protocol 2023](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117) — video · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117.md)
- [Early Enteral Nutrition and TPN Timing in Pediatric Trauma Patients](https://library.globalcastmd.com/watch/early-enteral-nutrition-and-tpn-timing-in-pediatric-trauma-patients-16612) — video · 1:30 · [machine version](https://library.globalcastmd.com/watch/early-enteral-nutrition-and-tpn-timing-in-pediatric-trauma-patients-16612.md)
- [Development and Validation of a Bayesian Network Predicting Intubation Following Hospital Arrival Among Injured Children](https://library.globalcastmd.com/article/development-and-validation-of-a-bayesian-network-predicting-intubation-following-16561) — article · [machine version](https://library.globalcastmd.com/article/development-and-validation-of-a-bayesian-network-predicting-intubation-following-16561.md)

### Injury Prevention & Screening
- [Update Course Rewind: Firearm Screening 2023](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992) — video · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992.md)
- [Preinjury and Event-Related Characteristics of Pediatric Firearm Injuries: The American College of Surgeons Firearm Study, United States, March 2021‒February 2022](https://library.globalcastmd.com/article/preinjury-and-event-related-characteristics-of-pediatric-firearm-injuries-the-am-16565) — article · [machine version](https://library.globalcastmd.com/article/preinjury-and-event-related-characteristics-of-pediatric-firearm-injuries-the-am-16565.md)
- [Pediatric Surgery Firearm Injury Collaborative Symposium.](https://library.globalcastmd.com/article/pediatric-surgery-firearm-injury-collaborative-symposium-16569) — article · [machine version](https://library.globalcastmd.com/article/pediatric-surgery-firearm-injury-collaborative-symposium-16569.md)
- [The COVID-19 pandemic and associated rise in pediatric firearm injuries: A multi-institutional study.](https://library.globalcastmd.com/article/the-covid-19-pandemic-and-associated-rise-in-pediatric-firearm-injuries-a-multi-16582) — article · [machine version](https://library.globalcastmd.com/article/the-covid-19-pandemic-and-associated-rise-in-pediatric-firearm-injuries-a-multi-16582.md)
- [Impact of "Stay-at-Home" orders on non-accidental trauma: A multi-institutional study](https://library.globalcastmd.com/article/impact-of-stay-at-home-orders-on-non-accidental-trauma-a-multi-institutional-stu-16583) — article · [machine version](https://library.globalcastmd.com/article/impact-of-stay-at-home-orders-on-non-accidental-trauma-a-multi-institutional-stu-16583.md)
- [Children at risk A prospective cohort study of acute stress development and patterns in pediatric trauma patients](https://library.globalcastmd.com/infographic/children-at-risk-a-prospective-cohort-study-of-acute-stress-development-and-patt-11399) — article · [machine version](https://library.globalcastmd.com/infographic/children-at-risk-a-prospective-cohort-study-of-acute-stress-development-and-patt-11399.md)
- [Children at risk: A prospective cohort study of acute stress development and patterns in pediatric trauma patients](https://library.globalcastmd.com/watch/children-at-risk-a-prospective-cohort-study-of-acute-stress-development-and-patt-12023) — video · 0:39 · [machine version](https://library.globalcastmd.com/watch/children-at-risk-a-prospective-cohort-study-of-acute-stress-development-and-patt-12023.md)

### Complications & Outcomes
- [Venous thromboembolic risk stratification in pediatric trauma: A Pediatric Trauma Society Research Committee multicenter analysis](https://library.globalcastmd.com/article/venous-thromboembolic-risk-stratification-in-pediatric-trauma-a-pediatric-trauma-16584) — article · [machine version](https://library.globalcastmd.com/article/venous-thromboembolic-risk-stratification-in-pediatric-trauma-a-pediatric-trauma-16584.md)
- [Impact of institutional prophylaxis guidelines on rates of pediatric venous thromboembolism following trauma-A multicenter study from the pediatric trauma society research committee.](https://library.globalcastmd.com/article/impact-of-institutional-prophylaxis-guidelines-on-rates-of-pediatric-venous-thro-16575) — article · [machine version](https://library.globalcastmd.com/article/impact-of-institutional-prophylaxis-guidelines-on-rates-of-pediatric-venous-thro-16575.md)

### Systems & Transfer
- [Pediatric Injury Transfer Patterns During the COVID-19 Pandemic: An Interrupted time Series Analysis.](https://library.globalcastmd.com/article/pediatric-injury-transfer-patterns-during-the-covid-19-pandemic-an-interrupted-t-16577) — article · [machine version](https://library.globalcastmd.com/article/pediatric-injury-transfer-patterns-during-the-covid-19-pandemic-an-interrupted-t-16577.md)
- [Making a move: Using simulation to identify... : Journal of Trauma and Acute Care Surgery](https://library.globalcastmd.com/article/making-a-move-using-simulation-to-identify-journal-of-trauma-and-acute-care-surg-16603) — article · [machine version](https://library.globalcastmd.com/article/making-a-move-using-simulation-to-identify-journal-of-trauma-and-acute-care-surg-16603.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=0) Case presentation: 2-year-old MVC patient with C-collar (Ep 3)
- [3:02](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=182) Clinical clearance approach and imaging considerations in young children (Ep 3)
- [6:02](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=362) Cervical spine imaging in suspected child abuse and institutional protocols (Ep 3)
- [9:36](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=576) Epidemiology and AAST cervical spine injury score (Ep 3)
- [14:32](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=872) Imaging modalities and Canadian consensus guidelines (Ep 3)
- [19:31](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=1171) Protocol development and resource sharing (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=0) Introduction to Update Course Series (Ep 4)
- [0:27](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=27) Case Presentation and Institutional Screening Approaches (Ep 4)
- [1:44](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=104) Epidemiology, Outcomes, and Screening Tool Comparison (Ep 4)
- [3:44](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=224) Summary and Closing (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=0) Introduction and Case Presentation (Ep 15)
- [1:16](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=76) Hospital-Based Prevention Programs and Resources (Ep 15)
- [2:59](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=179) Epidemiology and Data Challenges (Ep 15)
- [6:31](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=391) Regional Variation in Interventions (Ep 15)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=0) Introduction and Case Presentation (Ep 5)
- [0:53](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=53) Admission Decisions and APSA Guidelines (Ep 5)
- [3:44](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=224) Emergency Department Discharge for Low-Grade Injuries (Ep 5)
- [4:55](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=295) CT Scanning Rationale and Discharge Protocols (Ep 5)
- [7:17](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=437) Hemoglobin Monitoring and Contrast-Enhanced Ultrasound (Ep 5)
- [8:51](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=531) Summary and Closing (Ep 5)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=0) Case presentation and initial MTP activation decision (Ep 12)
- [1:17](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=77) MTP activation criteria and blood product sequencing (Ep 12)
- [3:50](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=230) Massive transfusion definition and balanced resuscitation evidence (Ep 12)
- [5:06](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=306) MTP team implementation and institutional protocols (Ep 12)
- [6:45](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=405) Pre-hospital care and adjunctive therapies (Ep 12)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- There is adult data to support starting with FFP in trauma resuscitation — Meera Kotagal (clinical) [Ep 12 · 1:17](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=77)
- The best definition for massive transfusion in kids is 40 ml/kg of any blood product over 24 hours — Meera Kotagal (guideline) [Ep 12 · 3:50](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=230)
- Activating MTP threshold is different than the definition of massive transfusion — Meera Kotagal (clinical) [Ep 12 · 3:50](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=230)
- There is great pediatric data on whole blood for trauma resuscitation — Meera Kotagal (clinical) [Ep 12 · 4:40](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=280)
- Kids bleed whole blood, making balanced resuscitation important — Meera Kotagal (clinical) [Ep 12 · 4:40](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=280)
- Blood can usually be returned to the blood bank unless you spike the bag — Meera Kotagal (clinical) [Ep 12 · 3:00](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=180)
- Most trauma coolers that come to the bay do not have platelets initially — Katie Russell (clinical) [Ep 12 · 3:28](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=208)
- After implementing an MTP team, balanced resuscitation rates improved from 25% to 85% — Katie Russell (epidemiological) [Ep 12 · 6:01](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=361)
- Pre-hospital transfusion could reduce mortality according to recent data (clinical) [Ep 12 · 6:23](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=383)
- There is evidence to support pre-hospital TXA use — Katie Russell (clinical) [Ep 12 · 7:32](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=452)
- Using TXA in MTP should be combined with rapid viscoelastic testing (ROTEM or TEG) to directly target resuscitation goals — Katie Russell (clinical) [Ep 12 · 7:32](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=452)
- Whole blood for pediatric trauma needs to be irradiated, which creates blood bank implementation challenges — Meera Kotagal (clinical) [Ep 12 · 3:00](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=180)
- The MTP team consists of a trauma APP running the team and an ER nurse who knows how to run the Belmont rapid infuser — Katie Russell (clinical) [Ep 12 · 5:35](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=335)
- 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. (guideline) [Ep 5 · 1:45](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=105)
- In kids, the data doesn't support the need for angioembolization, even if you see active arterial extravasation on CT. (clinical) [Ep 5 · 2:10](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=130)
- APSA guidelines indicate discharge when patients are clinically doing well, with no indication for repeat imaging after discharge. (guideline) [Ep 5 · 2:25](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=145)
- Activity restrictions have moved towards shorter duration; previously grade 4 spleen lacerations required 12 weeks or longer out of activity. (guideline) [Ep 5 · 2:45](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=165)
- Cincinnati Children's Hospital guideline states only hemodynamically abnormal patients go to the ICU. (guideline) [Ep 5 · 3:44](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=224)
- Cincinnati has started discharging isolated grade 1 or 2 splenic injuries from the emergency department. (clinical) [Ep 5 · 3:44](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=224)
- 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. (epidemiological) [Ep 5 · 4:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=240)
- Grade 1-2 injuries are discharged from ED if patients are watched for 4 hours and able to tolerate a PO challenge. (clinical) [Ep 5 · 4:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=240)
- CT scanning serves two purposes: making a diagnosis overall and determining appropriate discharge activity restrictions, which differ between splenic laceration and small bowel contusion. (clinical) [Ep 5 · 4:55](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=295)
- In the blunt abdominal trauma guideline at Cincinnati, not all patients are scanned; AST and lipase are used to decide who needs a scan. (clinical) [Ep 5 · 5:37](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=337)
- Standardized discharge instructions are created and given to all patients in collaboration with the emergency department. (clinical) [Ep 5 · 6:42](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=402)
- 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. (clinical) [Ep 5 · 6:42](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=402)
- At the Utah practice, 80% of pediatric trauma patients are transfers and most have already had a CBC at the referring hospital. (epidemiological) [Ep 5 · 7:17](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=437)
- For hemodynamically normal children with solid organ injury going to the floor, CBC is not repeated. (clinical) [Ep 5 · 7:39](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=459)
- Data suggests that patients more likely to fail non-operative management have an initial hemoglobin less than 9.25. (epidemiological) [Ep 5 · 8:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=480)
- Cincinnati protocol: if initial hemoglobin is less than 9.25, patient gets one repeat hemoglobin; if greater than 9.25, no repeats unless clinically indicated. (clinical) [Ep 5 · 8:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=480)
- Contrast-enhanced ultrasound for grading solid organ injuries is not done routinely because radiologists and ultrasonographers comfortable with the technique are not available at 2:00 in the morning. (clinical) [Ep 5 · 8:24](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=504)
- Contrast-enhanced ultrasound has not been found to be very reliable yet as an alternative to CT for solid organ injury grading. (opinion) [Ep 5 · 8:24](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=504)
- In resource-constrained settings like Uganda, grade 4 splenic laceration patients would be placed in ICU due to limited monitoring capacity on the floor, where there may not be monitors and minimal staff. (clinical) [Ep 5 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=53)
- Management of splenic lacerations is a reflection of available resources; ICU admission decisions differ between resource-constrained and well-resourced settings. (opinion) [Ep 5 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-solid-organ-injury-management-2023-8098?t=53)
- Firearm injuries are the leading cause of death for kids in the United States, though not necessarily the same around the world. — Meera Kotagal (epidemiological) [Ep 15 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=53)
- The Bullet Points project is a great source of information in Ohio for firearm counseling. — Katie Russell (clinical) [Ep 15 · 1:16](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=76)
- The AAP chapter in Ohio has a program called Store It Safe with materials that can be transferred into other institutions. — Katie Russell (clinical) [Ep 15 · 1:16](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=76)
- Cincinnati Children's Hospital started a firearm related injury task force to address the problem in community, focusing on both safety and education, suicide prevention, and community level violence prevention. — Katie Russell (clinical) [Ep 15 · 1:16](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=76)
- School shootings are a tiny percentage of pediatric firearm injuries. — Meera Kotagal (epidemiological) [Ep 15 · 2:59](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=179)
- 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 (epidemiological) [Ep 15 · 2:59](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=179)
- About 30% of pediatric firearm injuries are unintentional, involving kids playing with firearms or engaging with them at home because they're not safely stored. — Katie Russell (epidemiological) [Ep 15 · 3:26](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=206)
- The remaining pediatric firearm injuries after assault and unintentional are self-inflicted. — Katie Russell (epidemiological) [Ep 15 · 3:26](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=206)
- The rural-urban divide in pediatric firearm injuries is very different: rural populations are much more likely to see self-inflicted injuries in both adults and kids, while urban populations see assaults as the predominant source. — Katie Russell (epidemiological) [Ep 15 · 3:26](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=206)
- One size doesn't fit all for all communities in terms of reducing firearm injury; interventions must address both safety and community violence drivers like poverty and economic opportunity. — Katie Russell (opinion) [Ep 15 · 3:26](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=206)
- The biggest driver of community level violence is poverty and economic opportunity. — Katie Russell (epidemiological) [Ep 15 · 3:26](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=206)
- Pediatric colleagues in Cincinnati, Matt Zaf and Joe Real, are doing virtual reality counseling and screening for firearm safety. — Katie Russell (clinical) [Ep 15 · 3:26](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=206)
- VR counseling is a strategy to help people become comfortable with firearm safety conversations in a virtual reality way, and this work will continue to develop and grow. — Katie Russell (opinion) [Ep 15 · 3:26](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=206)
- The data on pediatric firearm injuries is poor, with huge amounts of missingness in terms of location, weapon type, and relationship to shooter. — Katie Russell (epidemiological) [Ep 15 · 5:41](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=341)
- Papers from the ACS firearm study will show that we don't collect data very well on pediatric firearm injuries, including whether incidents happened at school, proximity to home, weapon type, and relationship to the shooter. — Katie Russell (epidemiological) [Ep 15 · 5:41](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=341)
- Firearm injury prevention can't be done effectively on a national basis alone; local environments differ significantly and require tailored interventions. (opinion) [Ep 15 · 6:31](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=391)
- The institution implemented BCVI screening about a year ago and has not had any delayed diagnosis since, whereas they had at least two children in the previous year who had strokes which then led to identification of their BCVI. (clinical) [Ep 4 · 1:44](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=104)
- The institution has not had an increase in BCVI incidence after implementing screening, but has not had any delayed diagnosis. (clinical) [Ep 4 · 1:44](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=104)
- Neurologists were the biggest advocates for BCVI screening in the institution's system. (clinical) [Ep 4 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=53)
- The institution had a couple of patients, one with a delayed diagnosis stroke from a BCVI that was missed, which prompted them to make a routine protocol for BCVI. (clinical) [Ep 4 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=53)
- The institution determined all patients with concern should get CTA head and neck for BCVI screening. (clinical) [Ep 4 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=53)
- Cervical spine injury occurs in 1 to 2% of all pediatric traumas — Meera Kotagal (epidemiological) [Ep 3 · 10:18](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=618)
- In older children, 70 to 80% of cervical spine injuries are bony injuries — Meera Kotagal (epidemiological) [Ep 3 · 10:38](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=638)
- In children less than or equal to eight years old, about 50% will have isolated fractures and 50% will have ligamentous injury, dislocations or spinal cord injury without radiologic abnormality — Meera Kotagal (epidemiological) [Ep 3 · 10:58](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=658)
- 60 to 80% of vertebral injuries in kids will be in their cervical spine compared to 34 to 40% of vertebral injuries in adults — Meera Kotagal (epidemiological) [Ep 3 · 11:28](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=688)
- In a 2-year-old, their most likely injury is going to be ligamentous (clinical) [Ep 3 · 4:23](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=263)
- About 50% of injuries in children under eight are bony and about 50% are ligamentous or spinal cord injury without radiological abnormality — Meera Kotagal (epidemiological) [Ep 3 · 4:51](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=291)
- If you can clinically clear the patient, that would be the best way to do it (guideline) [Ep 3 · 5:16](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=316)
- In older children, mechanism of injury should not play a role in cervical spine clearance decisions (guideline) [Ep 3 · 5:16](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=316)
- In younger patients, particularly those with suspected non-intentional trauma (child abuse), there is a higher risk of cervical injury (clinical) [Ep 3 · 5:16](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=316)
- 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 (guideline) [Ep 3 · 7:34](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=454)
- For skeletal survey in suspected child abuse, a lateral view is used as the single cervical spine view — Meera Kotagal (guideline) [Ep 3 · 14:32](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=872)
- If using imaging to clear cervical spine (not just for skeletal survey), you need two views at least: an AP and lateral — Meera Kotagal (guideline) [Ep 3 · 14:32](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=872)
- 46% of institutions don't have a protocol for cervical spine clearance in children — Meera Kotagal (epidemiological) [Ep 3 · 9:36](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=576)
- The AAST study looked at over 12,000 kids who'd undergone blunt trauma and found 87 cervical spine injuries (0.6%) — Meera Kotagal (epidemiological) [Ep 3 · 11:48](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=708)
- Four independent predictors of cervical spine injury in children under three were identified: GCS less than 14, GCS eye of one, involvement in motor vehicle crash, and age greater than or equal to two years — Meera Kotagal (clinical) [Ep 3 · 12:32](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=752)
- Patients with cervical spine injury score of zero to one points had a negative predictive value for cervical spine injury of over 99% and did not need imaging — Meera Kotagal (clinical) [Ep 3 · 13:12](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=792)
- Five patients in the AAST study had a cervical spine injury score less than two but actually had injury; these patients had concurrent significant traumatic injuries including facial fracture, skull fracture, long bone fractures, loss of consciousness, and neck pain or splinting — Meera Kotagal (clinical) [Ep 3 · 13:42](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=822)
- Patients with neck pain and splinting need imaging and would automatically fall out of the no imaging category — Meera Kotagal (guideline) [Ep 3 · 13:42](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=822)
- CT is not commonly done in kids for cervical spine injury because most injuries are not bony but ligamentous, so MRI is preferred if cross-sectional imaging is needed — Meera Kotagal (guideline) [Ep 3 · 17:02](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=1022)
- In unreliable patients, you can leave them in a collar, wait till they calm down or pain is under control, then reexamine and may be able to clinically clear them at that point — Meera Kotagal (clinical) [Ep 3 · 17:02](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=1022)
- Patients with abnormal neurologic exam cannot be clinically cleared and need an MRI — Meera Kotagal (guideline) [Ep 3 · 17:02](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=1022)
- The CDC has transitioned to calling non-accidental trauma 'child abuse' in the past year (guideline) [Ep 3 · 6:31](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=391)
- The APSA position statement on child abuse was released last month in the Journal of Pediatric Surgery (guideline) [Ep 3 · 6:31](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=391)
- At one institution, neurosurgeons have a protocol where any child three and under gets cleared by the neurosurgeons (clinical) [Ep 3 · 9:15](https://library.globalcastmd.com/watch/cervical-spine-clearance-apsa-practice-gaps-2019-2306?t=555)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- After 20 ml/kg of blood within an hour, you should activate the MTP according to the MATIC trial investigators — Katie Russell summarizing the discussion [Ep 12 · 2:34](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=154)
- The more fresh frozen plasma (FFP) you give, the lower your mortality is in balanced resuscitation — Meera Kotagal summarizing the discussion [Ep 12 · 4:40](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=280)
- The closer you are to 1:1:1 ratio is better and this has been shown in kids, not just adult data — Meera Kotagal summarizing the discussion [Ep 12 · 4:40](https://library.globalcastmd.com/watch/update-course-rewind-massive-transfusion-protocol-2023-8117?t=280)
- Firearms are now the leading cause of death in all children and adolescents in the US, overtaking motor vehicle crashes in 2019. — Em Gootee summarizing the discussion [Ep 15 · 0:00](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=0)
- Mike Nash published a study in JAMA showing that the majority of pediatric firearm injuries are self-inflicted coming out of rural communities. — Katie Russell summarizes what Dr. Mira Koral said [Ep 15 · 3:26](https://library.globalcastmd.com/watch/update-course-rewind-firearm-screening-2023-7992?t=206)
- 1.3% of trauma patients will have BCVI, the same number of kids that have cervical spine injuries. — The host summarizing the discussion [Ep 4 · 2:11](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=131)
- About a third of BCVI patients will have a stroke. — The host summarizing the discussion [Ep 4 · 2:11](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=131)
- If you have a stroke from BCVI, your mortality can be as high as 20%. — The host summarizing the discussion [Ep 4 · 2:11](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=131)
- Pediatric surgeons are screening nearly everyone for cervical spine injuries, but they're not screening kids for BCVIs. — The host summarizing the discussion [Ep 4 · 2:11](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=131)
- The Memphis score is the most sensitive score for BCVI screening. — The host summarizing the discussion [Ep 4 · 2:11](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=131)
- Dr. Russell would tell everyone to use the Memphis score based on everything they know. — The host summarizing the discussion [Ep 4 · 2:11](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=131)
- A PTS guideline for BCVI screening is hopefully coming out at PTS in November. — The host summarizing the discussion [Ep 4 · 2:11](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=131)
- The Utah score is the worst score out there for BCVI screening and needs a switch. — The host summarizing the discussion [Ep 4 · 1:18](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=78)
- BCVI screening has been a hot topic in adult trauma for several years, and pediatric trauma is behind the ball. — The host summarizing the discussion [Ep 4 · 1:18](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=78)
- According to Dr. Russell, this is one of those times where pediatric surgeons can follow the adult trauma surgeons to not miss kids with BCVI injuries. — The host summarizing the discussion [Ep 4 · 1:18](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=78)
- The Atomic group study showed that BCVI screening is all over the place with lots of variation. — The host summarizing the discussion [Ep 4 · 2:11](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=131)
- When you have many different screening tools, it means we don't know what to do. — The host summarizing the discussion [Ep 4 · 2:11](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-screening-for-blunt-cerebrovascular-injury-2023-7884?t=131)

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