Update Course Rewind: Updates in Screening for Blunt Cerebrovascular Injury 2023

Global Cast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. Hello pediatric surgery family. I'm M. Godi, a research fellow from Cincinnati Children's Hospital Medical Center. 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 review updates in screening for blunt cerebrovascular injury or BCVI with doctors Katie Russell and Mira Kotagal. We've got an 11-year-old female who got hit by a truck when she was crossing the street. She's GCS of three and she's got obvious chest trauma. What criteria do you guys use to figure out if she needs screening for a BCVI or blunt cerebrovascular injury. The people who are the biggest advocates for us in our system about BCVI screening were our neurologists. And we had a couple of patients, one with a delayed diagnosis stroke from a BCVI that was missed. That really prompted us last year to make a routine protocol for BCVI and to determine all of these patients should get CTA head and neck because of concern. We use Utah score and I hope nobody says they use that because it's the worst score out there and we need a switch. This has been a hot topic in adult trauma for several years now, and I think we're behind the ball. According to Dr. Russell, this is one of those times where pediatric surgeons can follow the adult trauma surgeons to not miss kids with these injuries. And they need to figure out what they're going to do as a community to screen them. We implemented our screening about a year ago now and what we have found is that we haven't had an increase in incidence, but we have not had any delayed diagnosis. So we had prior to that at least two children in the previous year who had strokes, which then led to identification of their BCVI. And now they're catching kids upfront and intervening early, which made a difference, at least in the very small series that Dr. Kotagal has. We'll know more as we gather more data. So lots of variation in what people are doing. So there is a PTS guideline hopefully coming out at PTS this November. So we will report back. 1.3% of the trauma patients will have BCVI. It's the same number of kids that have cervical spine injuries. Pediatric surgeons are screening nearly everyone for cervical spine injuries, but they're not screening kids for BCVIs. And about a third of them will have a stroke. And then if you have a stroke, your mortality can be as high as 20%. The Atomic group just did a study and basically said exactly what we said in this poll, that screening is all over the place. More info to come, but I think it's important that we all think about it. In this Atomic paper, the Memphis score is what they use and it is the most sensitive score. If Dr. Russell was going to make a recommendation based on everything they know, she would tell everyone to use the Memphis score. Those are all the options for screening protocols. When you have this many different tools, it means we don't know what to do, right? So there are so many different tools that different people are using and certainly an opportunity for improvement. In conclusion, BCVI screening is essential in pediatric trauma care. Previous misdiagnosis resulted in strokes, emphasizing the need for routine protocols. While practices vary, the Memphis score is recommended as the most sensitive tool for BCVI screening. More than 1% of the trauma patients have BCVI, and a third might suffer a stroke with a potential mortality rate of 20%. The numerous tools available indicate a pressing need for standardized guidelines. Thank you for watching this video. Don't forget to subscribe to the StayCurrentMD YouTube channel. Follow our social media channels and download the StayCurrentMD app for tons of content in pediatric surgery. Global Cast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.