Update Course 2023 - Rapid Updates in Pediatric Trauma

Cincinnati Children's is now discharging isolated grade 1 and 2 solid organ injuries from the emergency department after 4 hours of observation if patients can tolerate oral intake.

Cincinnati Children's protocol eliminates repeat hemoglobin checks in solid organ injury patients with initial hemoglobin greater than 9.25 g/dL unless there is clinical concern.

Bed rest is only used for ICU-level patients who are hemodynamically abnormal, at least overnight until hemodynamics stabilize; all other solid organ injury patients do not require bed rest.

After implementing an MTP team at Primary Children's Hospital, balanced resuscitation compliance improved from 25% to 85% in approximately 50 patients.

Cincinnati Children's implemented routine BCVI screening approximately one year ago and has not had any delayed diagnoses since, after having at least 2 children with strokes from missed BCVI in the previous year.

Blunt cerebrovascular injury occurs in approximately 1.3% of pediatric trauma patients, similar to the rate of cervical spine injuries.

About one-third of pediatric patients with BCVI will have a stroke, and mortality can be as high as 20% if stroke occurs.

Firearm-related injury is now the leading cause of death for children in the United States.

School shootings represent a tiny percentage of pediatric firearm deaths.

In the American College of Surgeons non-fatal firearm study data, approximately 50-60% of pediatric firearm injuries are assault-related, about 30% are unintentional, and the remainder are self-inflicted.

In rural populations, self-inflicted firearm injuries are much more common, while in urban populations, assaults remain the predominant source of pediatric firearm injury.