New PECARN C-Spine Rule
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A new PECARN clinical decision rule for cervical spine imaging in children after blunt trauma identifies children at low risk for C-spine injury utilizing nine risk factors.
Source
PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. Lancet Child Adolesc Health. 2024 Jul;8(7):482-490. doi: 10.1016/S2352-4642(24)00104-4. Epub 2024 Jun 4. PMID: 38843852; PMCID: PMC11261431.
When to Pan-Scan vs. Selectively CT Elderly Patients
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Based on key history and physical examination findings, the Eastern Association for the Surgery of Trauma (EAST) developed an algorithm for the evaluation of blunt trauma patients ≥65 years.
Source
Scanning the aged to minimize missed injury: An EAST multicenter study. J Trauma Acute Care Surg. 2024 May 27. doi: 10.1097/TA.0000000000004390. Online ahead of print. PMID: 38797882
Does Liberal Transfusion Benefit Patients with TBI?
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In ICU patients with traumatic brain injury (TBI) and anemia, transfusing blood to a liberal hemoglobin threshold (10 g/dL) compared to a restrictive threshold (7 g/dL) did not lead to better neurological outcomes at 6 months.
Source
Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury. N Engl J Med. 2024 Jun 13. doi: 10.1056/NEJMoa2404360. Epub ahead of print. PMID 38869931.
Hematuria after Trauma…Urine Trouble?
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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?
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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?
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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
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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
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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?
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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?
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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