Traumatic Brain Injury
Everything in the library about traumatic brain injury — built automatically from the recorded discussions that name it
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
Acute Management
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Traumatic Brain Injury
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Dr. Pramod Puligandla, Traumatic Pediatric Surgeon and Intensivist at Montreal Children’s Hospital, joins the Stay Current Team to review the Cliff Notes on traumatic brain injury (TBI).Dr. Pramod Puligandla, Traumatic Pediatric Surgeon and
podcast14:04 · Dec 2020
Case-Based Learning
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Solid Organ Injury Management: Update Course 2017
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At the 5th Annual Stay Current Pediatric Surgery Update Course in 2017, Dr. David Notricadiscusses solid organ injury management in the pediatric patient. He focuses on evaluation and management of the patient, including shock index-pediatr
video32:57 · Sep 2018
In-Depth Reviews
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Pediatric Trauma With Dr. Richard Falcone
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Discussion with Dr. Richard Falcone that touches on multiple topics in pediatric trauma.
podcast56:05 · Jan 2019
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Solid Organ Injury Management: Update Course 2017
A normal shock index is less than 1 or less than 0.9, with adjustments now available for pediatric patients
clinicalDavid7:00 ↗
The shock index allows clinicians not regularly seeing pediatric patients to assess for shock without knowing normalized blood pressure values for children
clinicalDavid7:30 ↗
Massive transfusion protocol must be activated as soon as massive bleeding is recognized, not after reaching a specific threshold, to make a difference in outcome
clinicalDavid9:00 ↗
FAST (Focused Assessment with Sonography for Trauma) examines four specific areas: three in the abdomen and one in the pericardial sac, looking only for hemoperitoneum or pericardial effusion, not organ injury
clinicalDavid13:00 ↗
FAST has lost appeal in stable pediatric trauma patients because it misses too many injuries, as shown by the PECARN Group study
host_summaryDavid14:00 ↗
FAST remains useful in unstable patients as a replacement for diagnostic peritoneal lavage (DPL)
opinionDavid14:30 ↗
The ATOMAC guideline divides patients into stable and unstable categories: stable patients can be transfused to hemoglobin >7 and discharged when bleeding stops; unstable patients who don't respond to packed cells and fluids need operative intervention
guidelineDavid20:00 ↗
Young children with head injury are often hypotensive even without active bleeding, while some bleeding children are not hypotensive, making it difficult to define 'stable' vs. 'unstable'
clinicalDavid21:00 ↗
Hypotension due to solid organ injury is ominous, with significant risk of death and failure of non-operative management
clinicalDavid22:00 ↗
In younger children (not teenagers), blood pressure less than 50 mmHg is a really ominous sign with high risk of poor outcome
clinicalDavid22:30 ↗
Teenagers and adults can become hypotensive, respond to blood transfusion, and often be managed non-operatively, unlike younger children
clinicalDavid23:00 ↗
Adult studies show that ideal blood pressure after head injury is much higher than previously thought, with blood pressure of 150-160 mmHg associated with better outcomes than 90-120 mmHg, suggesting Cushing's reflex may be protective
host_summaryDavid24:00 ↗
In patients with traumatic brain injury and shock, resuscitation should be managed based on cerebral perfusion pressure rather than absolute blood pressure when intracranial monitoring is in place
clinicalDavid25:00 ↗
The ATOMAC guideline was modified 8 months into the prospective study to specify that recurrent hypotension or lack of sustained response to packed cells constitutes failure of non-operative management, after a patient with multiple injuries died following recurrent hypotension in the PICU
guidelineDavid27:00 ↗
The ATOMAC guideline effectively guided care for 1,007 pediatric trauma patients in the prospective validation study
epidemiologicalDavid28:00 ↗
Only about half of children in shock are hypotensive, meaning shock does not necessarily equal low blood pressure in pediatric patients
clinicalDavid28:30 ↗
40 mL/kg (or 4 units of packed cells) remains a validated threshold for failure of non-operative management, supported by both expert opinion and military experience data
guidelineDavid32:00 ↗
Blood evacuated from the chest via chest tube may originate from abdominal bleeding through a ruptured diaphragm, making it difficult to determine whether chest tube output should count toward the 40 mL/kg solid organ injury transfusion threshold
clinicalDavid32:30 ↗
Pediatric Trauma With Dr. Richard Falcone
Cincinnati Children's Hospital is a Level 1 pediatric trauma center verified since 1993, seeing approximately 2000 patients per year.
clinicalRichard Falcone3:08 ↗
At Cincinnati Children's, the ED physician serves as team leader for all traumas, chosen because they are present when the patient arrives.
clinicalRichard Falcone3:32 ↗
The ultimate risk of C-spine injury in pediatric trauma is actually pretty low.
epidemiologicalRichard Falcone4:32 ↗
Approximately 90% of children admitted in C-collars can be clinically cleared the next morning when they are less distracted and not in the trauma bay.
clinicalRichard Falcone4:50 ↗
The Trauma Association of Canada Pediatric Subcommittee published evidence-based C-spine clearance recommendations in the Journal of Trauma 2-3 years ago, emphasizing clinical exam as the first test.
host_summaryRichard Falcone6:04 ↗
For children greater than 8 years with normal X-rays and normal neurologic exam, re-examination is recommended; if the repeat exam is normal, the C-spine can be cleared without further imaging.
host_summaryRichard Falcone7:00 ↗
CT or MRI of the C-spine should only be considered for patients with abnormal neurologic exam findings.
host_summaryRichard Falcone7:30 ↗
Getting CT early in kids with normal neurologic exam and persistent tenderness is not useful because you won't feel comfortable removing the collar based on imaging alone without clinical improvement.
clinicalRichard Falcone8:27 ↗
There is enough evidence now that you don't need to get an X-ray on every awake child without distracting injuries and no midline tenderness.
clinicalRichard Falcone9:50 ↗
A multi-site study published in Journal of Trauma around 2009 developed a point system for C-spine injury risk in children under 3: 3 points for GCS <14, 2 points for GCSI score of 1, 2 points for motor vehicle collision, 1 point for age 2-3 years.
host_summaryRichard Falcone16:07 ↗
Children under 3 with a C-spine risk score of 0 or 1 had a 0.0% chance of C-spine injury and don't need imaging.
host_summaryRichard Falcone17:30 ↗
Children under 3 with a C-spine risk score of 7 or 8 had about a 21% chance of having a C-spine injury and need imaging.
host_summaryRichard Falcone18:00 ↗
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