Hematuria after Trauma…Urine Trouble?
Spoon Feed
In a cohort of children with blunt trauma, the presence of hematuria does not predict clinically important intraabdominal injury.
Source
Presence of Microscopic Hematuria Does Not Predict Clinically Important Intra-Abdominal Injury in Children. Pediatr Emerg Care. 2024 Jun 7. doi: 10.1097/PEC.0000000000003210. Epub ahead of print. PMID: 38849150.
POCUS for Pediatric Chest Tube – Is Fifth ICS Too Low?
Spoon Feed
Reliance on landmark guidance for chest tube placement may pose significant safety issues in pediatric patients.
Source
Ultrasound Investigation of the Fifth Intercostal Space Landmark for Chest Tube Thoracostomy Site Selection in Pediatric Patients. Pediatr Emerg Care. 2024 Apr 23. doi: 10.1097/PEC.0000000000003207. Epub ahead of print. PMID: 38713844.
Living More Days with TXA?
Spoon Feed
This bias-adjusted meta-analysis of randomized controlled trials (RCT) finds a one-month mortality benefit in trauma patients receiving tranexamic acid (TXA) during initial emergency management.
Source
Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials. Ann Emerg Med. 2024 May;83(5):435-445. doi: 10.1016/j.annemergmed.2023.10.004. Epub 2023 Nov 22. PMID: 37999653.
What You Need to Know About Pediatric Concussion
Spoon Feed
This new review summarizes the current evidence regarding diagnosis and management of mild TBI in children.
Source
Contemporary diagnosis and management of mild TBI (concussions): What you need to know. J Trauma Acute Care Surg. 2024 Jun 1;96(6):865-869. doi: 10.1097/TA.0000000000004297. Epub 2024 May 2. PMID: 38696496.
Being Safe with SDH – The SafeSDH Tool
Spoon Feed
The SafeSDH prediction tool can help to identify patients with subdural hematoma (SDH) who may not necessitate a higher level of care (either ICU stay or interfacility transfer) and can safely be monitored in the community or lower acuity setting.
Source
External Validation of a Tool to Identify Low-Risk Patients With Isolated Subdural Hematoma and Preserved Consciousness. Ann Emerg Med. 2024 May;83(5):421-431. doi: 10.1016/j.annemergmed.2023.08.481. Epub 2023 Sep 19. PMID: 37725019.
Does Seatbelt Sign Need Neck CTA to Rule Out BCVI in Children?
Spoon Feed
In the setting of pediatric trauma, patients with a seatbelt sign are at greater risk of blunt cardiovascular injury if they have an injury severity score greater than 15, c-spine fracture, basilar skull fracture, or "other motorized" (i.e. ATV but not MVC) mechanism of injury.
Source
Risk Factors for Blunt Cerebrovascular Injury in a Cohort of Pediatric Patients With Cervical Seat Belt Sign. Pediatr Emerg Care. 2024;40(5):359-363.
What AST/ALT Threshold Warrants CT in Suspected Child Abuse?
Spoon Feed
Current American Academy of Pediatrics (AAP) guidelines recommend a lower LFT threshold to obtain CT imaging for abdominal injury in children under 60 months old being evaluated for physical abuse than is recommended by general trauma guidelines - AST or ALT >80 IU/L vs AST>200 or ALT>125. This study suggests that, in the absence of signs and symptoms of abdominal injury, the higher LFT threshold may sufficient…but let’s pump the brakes.
Source
AST and ALT Elevation in Suspected Physical Abuse: Can the Threshold to Obtain an Abdominal CT be Raised? J Trauma Acute Care Surg. 2024 Apr 11. doi: 10.1097/TA.0000000000004329. Epub ahead of print. PMID: 38527969
PECARN Head and Abdomen Rules…Validated!
Spoon Feed
This multicenter prospective validation study of the PECARN prediction rules for CT imaging of children with blunt abdominal or minor head trauma performed extremely well (all three having NPVs of 100%).
Source
PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study. Lancet Child Adolesc Health. 2024 May;8(5):339-347. doi: 10.1016/S2352-4642(24)00029-4. PMID: 38609287.
Rapid MRI for Pediatric C-spine Injury
Spoon Feed
Limited sequence MRI is adequate to identify clinically-significant unstable cervical spine injuries in pediatric blunt trauma patients.
Source
The Sensitivity of Limited-Sequence MRI in Identifying Pediatric Cervical Spine Injury: A Western Pediatric Surgery Research Consortium Multicenter Retrospective Cohort Study. J Trauma Acute Care Surg. Published online March 25, 2024.
Think Outside the Zone – How to Manage Penetrating Neck Injuries
Spoon Feed
This review article illustrates the evidence-based “no-zone” approach in managing penetrating neck injuries, with a reliance on clinical symptoms as well as multidetector computed tomographic angiography (MDCTA) to mitigate unnecessary invasive tests and negative explorations.
Source
Diagnostic Approach to Penetrating Neck Trauma: What You Need to Know. J Trauma Acute Care Surg. 2024 Mar 25. doi: 10.1097/TA.0000000000004292. Epub ahead of print. PMID: 38523116