JPS Journal Club: July 2019 Part 3

The July issue of JPS had several trauma articles that we discussed already. Here's a highlight from part one. Interesting, so addressing school preparedness against teachers arming, and uh really reinforcing stop the bleed. Um Now, join us for the third and final part. So the last article we're going to be reviewing is another APs of position statement and it is child abuse and the pediatric surgeon. So we're going to start with their position statements. Number one is that child abuse equals traumatic disease. So it justifies the resource utilization of a trauma system. Got it. Number two. Number two is that they support admission to a surgical trauma service to ensure coordination of care. Got it. So these patients should go to the trauma service. Number three. Number three is that they support a multi-disciplinary team for screening, evaluation and management of these patients. Love it. Multi-disciplinary team for child abuse patients. Number four. Number four is the creation of a child abuse team as established by the recommendations with the American College of Surgeons and the children surgery verification program. Got it. So number three was that we should have multi-disciplinary team approach. Number four is saying, you actually should have a child abuse team. People to get called on on the child abuse cases each time. Correct. Number five. Number five is the systematic evaluation and this includes having checklists and institutional protocols that you follow every time. I love this. So this is again a standardization thing. Make it the same way each time so you're not reinventing the wheel, this will eliminate chance of errors. What's number six? Number six is that any reasonable suspicion of child abuse should be followed by a report. CPS mandates mandated by law and a transfer to another facility does not absolve you of this responsibility. Okay, this is the mandatory reporting thing. So if you suspect at all, even you don't have to think that maybe I'm right or wrong, it doesn't matter. If you suspect it, you have to have a system to report this every time. What's number seven? So number seven emphasizes universal screening. So whatever standardized screening tool you are using, you should apply it across the board regardless of socio economic status, race, ethnicity, or gender. Alex, out of all the ones you presented, this is the one that I liked the most because we have learned that actually we are terrible when we think we can predict when there was child abuse or not. Love that. Number seven, treat them all the same. I do have a question though. You know, um what hospitals should probably do is have it set up where if someone meets these criteria, it's not up to opinion. They meet these criteria. For example, a head injury in anyone who's under the age of six months, they automatically get moved into the child abuse workup. So that there's no emotion involved, there's no opinion involved, it's mandated. Does that exist? Yeah, it's part of the institutional protocols and recognizing the sentinel injuries and educating and training your providers at all levels to identify these risk factors. Awesome. Okay. I love it. Number eight. So number eight is about data collection. Use of a trauma registry and reporting to the national trauma databases for benchmarking and quality improvements. Okay, so I'm assuming most of these places have someone who is responsible for doing the data reporting and that exists at any uh trauma center that takes care of child abuse patients. And what's number nine? Number nine is that AP recognizes the existence of abusive head trauma. There's some skeptics out there, but it is a recognized of child physical abuse. It causes permanent and significant brain damage and neurodevelopmental issues and we no longer call it shaken baby syndrome. So thanks everyone for joining us. Uh, this was the July uh JPS issue review uh and we hope you all learned something special.