Pediatric Trauma (Bellman, 12/8/2021)

 A big thanks to Dr. Lilly Bellman of CPMC Pediatric Emergency Medicine for her presentation on Pediatric Trauma this week.

A recording of her presentation is available HERE

We learned that trauma in children is different: remember KIDS ARE SQUISHY

    *many have internal injuries without much sign on the outside

    *children have bigger heads proportionally

    *their bodies are more flexible and their bones are less calcified

    *their abdominal organs are less protected and relatively larger, thus more susceptible to trauma

Clinical decision tools can help us determine risk and evaluation. They help us identify children that are at lower risk and in whom we can avoid imaging.

• Head CT has 1:6,000 lifetime risk of fatal cancer
• Abdominal CT has 1:1,000 lifetime risk of fatal cancer

The mechanism matters, for example in an MVA, how fast? restrained? rollover? need for extrication? Or a fall - from what height? onto what surface?

What is your clinical evaluation - are they acting normally? ambulatory? LOC? witnesses? Intoxicated? and of course - last Td? (if they are 10+ may not be protected)

Decision Tools: 

Nexus Criteria for neck injuries

In addition to Nexus, get a Neck CT if trauma + torticollis. Get Neck CT or XR if midline tenderness. Get MRI if abnormal neuro findings

Blunt abdominal trauma algorithm: 

and there are several other useful decision tools...

When to get imaging in children with head trauma 

• PECARN and Choosing Wisely https://californiaacep.org/page/PECARN
• Australian and New Zealand's algorithm for moderate to severe head trauma https://www.predict.org.au/head-injury-guideline/
• And several cases to practice and test your newfound knowledge Predicting paediatric traumatic brain injuries - Don't Forget the Bubbles

Predicting paediatric traumatic brain injuries - Don't Forget the Bubbles A bump to the head or something more serious? The new PREDICT guidelines have been released.

Finally, don't forget about NAT (non-accidental trauma) any time there's a history and/or mechanism inconsistent with injuries or the child's development.

If they can't cruise, they can't bruise....

• Sentinel injuries include: bruises (trunk, ears, neck) <4 yo, oral injuries in infants, or patterned bruises or burns
• Evaluation: skeletal survey (<2 yo), screening labs for occult abdominal trauma (LFTs, lipase), have a low threshold for head CT, and consult CPS. 
• Protocolized systems for NAT screening are helpful to reduce bias - remember to check your biases along with your suspicions!