# Cervical Spine Injury — GCMD Library living collection

Everything in the library about cervical spine injury — built automatically from dossiers that name it.

Updated: n/a · 4 episodes · 129 cited statements

## Episodes
### Diagnosis & Workup
- [Cervical Spine Injury: Update Course 2016](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861) — video · 21:01 · [machine version](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861.md)
- [#APSA50: Top Educational Content](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625) — podcast · 1:07:24 · [machine version](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625.md)

### Acute Management
- [Pediatric Trauma With Dr. Richard Falcone](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928) — podcast · 56:05 · [machine version](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928.md)
- [Trauma](https://qa.library.globalcastmd.com/watch/trauma-313) — podcast · 56:05 · [machine version](https://qa.library.globalcastmd.com/watch/trauma-313.md)

## Chapters
- [0:05](https://qa.library.globalcastmd.com/watch/trauma-313?t=5) Introduction and Center Overview (Ep 4)
- [4:06](https://qa.library.globalcastmd.com/watch/trauma-313?t=246) Cervical Spine Clearance in Cooperative Children (Ep 4)
- [15:10](https://qa.library.globalcastmd.com/watch/trauma-313?t=910) Cervical Spine Clearance in Obtunded and Young Children (Ep 4)
- [20:14](https://qa.library.globalcastmd.com/watch/trauma-313?t=1214) Pancreatic Trauma Management (Ep 4)
- [27:46](https://qa.library.globalcastmd.com/watch/trauma-313?t=1666) Non-Accidental Trauma Screening (Ep 4)
- [33:20](https://qa.library.globalcastmd.com/watch/trauma-313?t=2000) Blunt Abdominal Trauma Evaluation (Ep 4)
- [43:49](https://qa.library.globalcastmd.com/watch/trauma-313?t=2629) Solid Organ Injury Management (Ep 4)
- [48:28](https://qa.library.globalcastmd.com/watch/trauma-313?t=2908) Trauma Activation Criteria (Ep 4)
- [54:50](https://qa.library.globalcastmd.com/watch/trauma-313?t=3290) Closing and Conference Announcement (Ep 4)
- [0:00](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=0) 18-Month-Old Ejection Case: Initial Imaging Decision (Ep 1)
- [5:13](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=313) Radiation Exposure and Follow-up Strategies (Ep 1)
- [10:30](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=630) Clearance Algorithms and MRI Accuracy (Ep 1)
- [15:19](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=919) 10-Year-Old Skateboard Case and Age-Based Protocols (Ep 1)
- [19:20](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=1160) Neurologically Devastated Patients (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=0) Introduction and Center Overview (Ep 2)
- [2:54](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=174) Cervical Spine Clearance Protocols (Ep 2)
- [15:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=910) Cervical Spine Clearance in Infants (Ep 2)
- [20:48](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1248) Pancreatic Trauma Management (Ep 2)
- [27:46](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1666) Non-Accidental Trauma Screening (Ep 2)
- [33:09](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1989) Blunt Abdominal Trauma Evaluation (Ep 2)
- [39:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2350) Angioembolization in Pediatric Solid Organ Injury (Ep 2)
- [43:49](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2629) Solid Organ Injury Management Protocols (Ep 2)
- [48:28](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2908) Trauma Activation Criteria (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=0) Introduction and Cervical Spine Trauma Imaging Guidelines (Ep 3)
- [15:28](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=928) Q&A on Cervical Spine Imaging Protocols (Ep 3)
- [22:48](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1368) Antibiotic Stewardship in Pediatric Surgery (Ep 3)
- [27:06](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1626) Antibiotic Stewardship Implementation Discussion (Ep 3)
- [39:57](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2397) Sepsis as a Surgical Problem: The SAVE Algorithm (Ep 3)
- [54:44](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3284) Sepsis Management Details and TED Talk Methodology (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Cincinnati Children's Hospital is a Level 1 pediatric trauma center verified since 1993, seeing approximately 2000 trauma patients annually. — Rich Falcone (clinical) [Ep 4 · 3:08](https://qa.library.globalcastmd.com/watch/trauma-313?t=188)
- At Cincinnati Children's, the emergency department physician serves as team leader for all traumas, chosen because they are present when every patient arrives. — Rich Falcone (clinical) [Ep 4 · 3:32](https://qa.library.globalcastmd.com/watch/trauma-313?t=212)
- The ultimate risk of C-spine injury in pediatric trauma is actually pretty low. — Rich Falcone (epidemiological) [Ep 4 · 4:36](https://qa.library.globalcastmd.com/watch/trauma-313?t=276)
- At Cincinnati, 90% of children left in C-collars overnight can be clinically cleared the next morning when less distracted and not in the trauma bay. — Rich Falcone (clinical) [Ep 4 · 4:50](https://qa.library.globalcastmd.com/watch/trauma-313?t=290)
- Getting CT early in kids with normal neurologic exam and C-spine tenderness is not useful because clinicians won't feel comfortable removing the collar based on imaging alone without resolution of clinical tenderness. — Rich Falcone (clinical) [Ep 4 · 9:20](https://qa.library.globalcastmd.com/watch/trauma-313?t=560)
- There is enough evidence now that truly awake children without distracting injuries and no midline tenderness do not need X-rays for C-spine clearance. — Rich Falcone (clinical) [Ep 4 · 9:50](https://qa.library.globalcastmd.com/watch/trauma-313?t=590)
- For obtunded patients with severe TBI, Cincinnati's protocol is CT to rule out bony abnormalities followed by MRI if CT is clear, before removing the C-collar. — Rich Falcone (clinical) [Ep 4 · 13:17](https://qa.library.globalcastmd.com/watch/trauma-313?t=797)
- The primary challenge in pancreatic trauma is determining whether there is a pancreatic duct injury, which is the number one concern. — Rich Falcone (clinical) [Ep 4 · 21:35](https://qa.library.globalcastmd.com/watch/trauma-313?t=1295)
- CT scans can show significant pancreatic injuries with large cracks through the neck, but ERCP or MRCP may still show the duct is intact, and those children will heal without surgery. — Rich Falcone (clinical) [Ep 4 · 22:40](https://qa.library.globalcastmd.com/watch/trauma-313?t=1360)
- ERCP has the advantage of being potentially therapeutic with stent placement but the disadvantage of injecting dye that can cause pancreatic inflammation, a risk not present with MRCP. — Rich Falcone (clinical) [Ep 4 · 23:20](https://qa.library.globalcastmd.com/watch/trauma-313?t=1400)
- Centers that perform frequent pancreatic operations and are comfortable with laparoscopic distal pancreatectomy have better outcomes operating on pancreatic trauma; centers that rarely operate on the pancreas may put patients at more complication risk and should consider non-operative management. — Rich Falcone (opinion) [Ep 4 · 24:40](https://qa.library.globalcastmd.com/watch/trauma-313?t=1480)
- Cincinnati implemented standardized screening where all children under 2 admitted with head injuries from non-publicly-witnessed mechanisms receive skeletal surveys and social work evaluation, eliminating clinician bias in screening decisions. — Rich Falcone (clinical) [Ep 4 · 28:04](https://qa.library.globalcastmd.com/watch/trauma-313?t=1684)
- Before implementing standardized screening, Cincinnati was more likely to perform skeletal surveys on low SES or minority children with head injuries than on middle/upper class non-minority families with identical injuries. — Rich Falcone (clinical) [Ep 4 · 30:20](https://qa.library.globalcastmd.com/watch/trauma-313?t=1820)
- After implementing unbiased standardized screening criteria, Cincinnati's positive abuse rate remained at 50% despite evaluating more children, indicating they were finding abused children who would not have been screened under the previous biased system. — Rich Falcone (epidemiological) [Ep 4 · 31:00](https://qa.library.globalcastmd.com/watch/trauma-313?t=1860)
- A screening test with nearly 50% positive rate for abuse in admitted children under 2 with head injuries is more productive than most screening tests used for other conditions. — Rich Falcone (opinion) [Ep 4 · 31:40](https://qa.library.globalcastmd.com/watch/trauma-313?t=1900)
- Families find standardized screening more reassuring because clinicians can explain it is done for every family with this injury type without making judgments about truthfulness. — Rich Falcone (clinical) [Ep 4 · 33:09](https://qa.library.globalcastmd.com/watch/trauma-313?t=1989)
- Cincinnati does not routinely perform ophthalmologic exams for non-accidental trauma screening, only obtaining them if skeletal survey is positive or there are other concerning findings like bruising or abnormal head findings inconsistent with the given story. — Rich Falcone (clinical) [Ep 4 · 33:20](https://qa.library.globalcastmd.com/watch/trauma-313?t=2000)
- Cincinnati has gone away from getting LFTs, amylase, and lipase as routine in trauma patients, only obtaining them if there are other indications for CT scan such as abdominal bruising or tenderness. — Rich Falcone (clinical) [Ep 4 · 37:50](https://qa.library.globalcastmd.com/watch/trauma-313?t=2270)
- Cincinnati has not used angioembolization for solid organ injury in the last 4-5 years despite their high trauma volume. — Rich Falcone (clinical) [Ep 4 · 41:34](https://qa.library.globalcastmd.com/watch/trauma-313?t=2494)
- Cincinnati's current protocol for solid organ injuries: grade 1 gets one 12-hour lab check, grade 2 gets two checks, grade 3 may get two or three checks based on clinical exam. — Rich Falcone (clinical) [Ep 4 · 48:08](https://qa.library.globalcastmd.com/watch/trauma-313?t=2888)
- Pediatric surgeons self-admittedly over-image C-spines in trauma, as demonstrated by show of hands in a room of pediatric surgery experts. — Aaron Jensen (opinion) [Ep 3 · 0:59](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=59)
- Children with GCS 14-15 who are not intoxicated can be cleared clinically for C-spine injury unless they have a painful distracting injury, according to AANS/CNS evidence-based guidelines from 2013. — Aaron Jensen (guideline) [Ep 3 · 7:00](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=420)
- Children age 3 and under with high-risk mechanisms of injury, particularly child abuse, should be screened radiographically even if they appear totally fine, because C-spine injury rates are very high in child abuse. — Aaron Jensen (guideline) [Ep 3 · 7:30](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=450)
- In a Boston study of 300 children with no fractures on ED imaging, only 2% had ligamentous injury on MRI and none required surgery, demonstrating safety of sending patients home in collar with follow-up. — Aaron Jensen (clinical) [Ep 3 · 10:30](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=630)
- 84% of children sent home in a collar after normal initial imaging had their collar clinically cleared at first clinic visit 1-2 weeks later. — Aaron Jensen (clinical) [Ep 3 · 11:20](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=680)
- Pressure ulcers from cervical collars occur in 6-38% of patients, most commonly in ICU patients who receive fluid resuscitation and require ventilation, with ulcers occurring on clavicles, back of head, and base of neck. — Aaron Jensen (epidemiological) [Ep 3 · 13:00](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=780)
- Meta-analysis of 5 adult studies with 1000 patients showed that among those with completely normal CT scans, 9% had stable injuries on MRI requiring no treatment, and no patient required surgery. — Aaron Jensen (clinical) [Ep 3 · 13:40](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=820)
- The adult recommendation to remove collars based on normal CT scan may not apply to children, who have greater frequency of ligamentous injury and unstable ligamentous injury. — Aaron Jensen (opinion) [Ep 3 · 14:30](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=870)
- The ACS TQuip program offers a free downloadable resource with standardized evidence-based guidelines for imaging trauma patients, including pediatric-specific sections developed with input from five pediatric surgeons. — Aaron Jensen (guideline) [Ep 3 · 15:00](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=900)
- Clinical clearance of C-spine requires no neurologic deficits, no midline cervical tenderness, no painful distracting injury, no unexplained hypotension, and ability to move head in all directions without limitation. — Aaron Jensen (guideline) [Ep 3 · 8:00](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=480)
- For infants, clinical clearance requires certainty that the mechanism is not high-risk and that child abuse is not present, as clinical clearance has not been validated with high mechanism in young children. — Aaron Jensen (clinical) [Ep 3 · 17:30](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1050)
- 70,000 children are hospitalized with sepsis annually in the United States, with 7,000 deaths—three times more than pediatric cancers, approximately 20 deaths per day. — Samir Gattapoli (epidemiological) [Ep 3 · 39:57](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2397)
- Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, with no distinction of 'severe sepsis' anymore. — Samir Gattapoli (clinical) [Ep 3 · 41:20](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2480)
- Quick SOFA (sequential organ failure assessment) defines organ dysfunction using three criteria: mental status changes, elevated respiratory rate (22 in adults, age-appropriate in children), and low blood pressure (systolic <100 in adults, with heart rate being a better marker than blood pressure in children). — Samir Gattapoli (clinical) [Ep 3 · 41:50](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2510)
- Sepsis has a 10% mortality rate (1 in 10), while septic shock has a 40% mortality rate (more than 1 in 3). — Samir Gattapoli (epidemiological) [Ep 3 · 42:40](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2560)
- Three major trials (ProCESS, ProMISe, and ARISE) showed no difference with goal-directed or protocol-based resuscitation in sepsis. — Samir Gattapoli (clinical) [Ep 3 · 43:40](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2620)
- For each hour delay in antibiotic administration after sepsis diagnosis, mortality increases (Kumaral, Critical Care Medicine, 2006). — Samir Gattapoli (clinical) [Ep 3 · 45:20](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2720)
- Procalcitonin is a biomarker specific for bacterial infections, with trending more important than absolute values; when it reaches normal levels, antibiotics can be stopped. — Samir Gattapoli (clinical) [Ep 3 · 45:50](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2750)
- The STOP-IT trial showed that for abdominal sepsis, antibiotics can be stopped at 4 days once adequate source control is achieved. — Samir Gattapoli (clinical) [Ep 3 · 46:30](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2790)
- The sepsis clock starts from the time blood pressure is checked and found low to when antibiotics are actually hung, sometimes requiring IV placement within the first hour. — Samir Gattapoli (guideline) [Ep 3 · 47:00](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2820)
- The Andromeda shock study (2019, Hernandez et al., JAMA) found capillary refill was as good as or better than lactate levels for resuscitation endpoints, with 35% mortality in the cap refill group versus 43% in the lactate group (p=0.06). — Samir Gattapoli (clinical) [Ep 3 · 48:40](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2920)
- The lactate group in the Andromeda study received significantly more fluid, and over-resuscitation is associated with worse outcomes. — Samir Gattapoli (clinical) [Ep 3 · 49:30](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2970)
- 30 mL/kg of isotonic fluid is a good initial volume for sepsis resuscitation. — Samir Gattapoli (guideline) [Ep 3 · 50:00](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3000)
- The FEAST trial showed that fluid boluses in African children with severe infections increased mortality, demonstrating that over-resuscitation increases mortality in pediatric sepsis. — Samir Gattapoli (clinical) [Ep 3 · 50:20](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3020)
- The ALBIOS trial showed that albumin use in sepsis decreases the amount of fluid needed to achieve resuscitation goals. — Samir Gattapoli (clinical) [Ep 3 · 51:00](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3060)
- The TRISS trial identified that a hemoglobin of 7 is an adequate transfusion threshold in septic shock. — Samir Gattapoli (clinical) [Ep 3 · 51:30](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3090)
- For pressor selection, dopamine is used in babies and norepinephrine in older children, with most pediatric sepsis patients having good heart function. — Samir Gattapoli (clinical) [Ep 3 · 52:10](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3130)
- The VANISH trial showed vasopressin is a good adjunct to use in septic shock with renal failure. — Samir Gattapoli (clinical) [Ep 3 · 52:40](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3160)
- Milrinone is recommended for warm shock (adequate blood pressure but inadequate perfusion) as it provides good inotropic support. — Samir Gattapoli (clinical) [Ep 3 · 53:00](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3180)
- Steroids should be started when initiating a second pressor, with no data supporting routine STIM testing; hydrocortisone 1.5-2 mg/kg every 6 hours is the typical dose. — Samir Gattapoli (guideline) [Ep 3 · 53:30](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3210)
- ECMO should be considered when patients are on two pressors with hydrocortisone, but ECMO helps with oxygenation and cardiac output while having difficulty with SVR, so pressors may still be needed on VA ECMO. — Samir Gattapoli (clinical) [Ep 3 · 54:10](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3250)
- On ECMO, if SVO2 is 70%, there is adequate flow; at that point, reassess source control, antibiotics, and monitoring rather than increasing ECMO flow (McLaren et al., Australia). — Samir Gattapoli (clinical) [Ep 3 · 54:50](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3290)
- CVP is trended intermittently rather than continuously in pediatric patients because limited central line lumens are often occupied by sedation drips and antibiotics. — Samir Gattapoli (clinical) [Ep 3 · 57:30](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3450)
- Bedside ultrasound for sepsis management includes checking IVC for respiratory variation and collapse, right atrium for dilation and pulmonary hypertension, and heart function for dynamic contractility. — Samir Gattapoli (clinical) [Ep 3 · 58:10](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3490)
- In sepsis, diastolic blood pressure typically drops significantly (e.g., 70/30 or 80/20) due to loss of systemic vascular resistance. — Samir Gattapoli (clinical) [Ep 3 · 59:00](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3540)
- Fluid overload is associated with acute kidney injury, and most children do not need 10 liters of resuscitation fluid despite older teaching. — Samir Gattapoli (clinical) [Ep 3 · 59:30](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3570)
- Each resuscitation intervention should be followed by reassessment after approximately 20 minutes to determine if the intervention made a difference. — Samir Gattapoli (clinical) [Ep 3 · 60:00](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3600)
- A mildly elevated lactate (e.g., 2.5) that plateaus should not be aggressively chased to normal if the patient has good blood pressure, urine output, improving kidney function, and normal mental status. — Samir Gattapoli (opinion) [Ep 3 · 60:50](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3650)
- Procalcitonin serves as a second-line test to support stopping antibiotics when the patient is clinically improving, preventing the common practice of extending antibiotics 'just a couple more days.' — Samir Gattapoli (clinical) [Ep 3 · 62:10](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=3730)
- One neck CT delivers radiation equivalent to approximately 600 plain films. — Todd Ponsky (clinical) [Ep 1 · 4:05](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=245)
- C-spine injuries in children under 2 years typically require significant force and present with either death or paralysis, rarely with normal neurologic examination. — Dan (clinical) [Ep 1 · 5:24](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=324)
- NEXUS trial criteria do not cover pediatric patients. — Dan (guideline) [Ep 1 · 2:22](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=142)
- In children under 2 years, CT imaging does not add diagnostic value above adequate plain radiographs for C-spine evaluation. — Dan (clinical) [Ep 1 · 4:50](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=290)
- MRI is the gold standard for evaluating ligamentous injury and SCIWORA (spinal cord injury without radiographic abnormality). — Sean (clinical) [Ep 1 · 15:19](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=919)
- Institutional protocols typically drive imaging decisions in level 2 trauma patients, with automatic CT scanning common in many centers. — Todd Ponsky (clinical) [Ep 1 · 5:13](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=313)
- Two-view C-spine films (not three-view with odontoid) are the standard initial imaging in pediatric patients at some institutions. — Sean (clinical) [Ep 1 · 10:30](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=630)
- Flexion-extension films can be performed two ways: voluntary patient movement in cooperative older children, or assisted movement under fluoroscopy with a physician present. — Todd Ponsky (clinical) [Ep 1 · 12:08](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=728)
- Patients with normal plain films and normal MRI but persistent midline tenderness are typically discharged home in a soft collar for comfort. — Dan (clinical) [Ep 1 · 13:28](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=808)
- Children without distracting injuries, without neurologic symptoms, and with minimal or no tenderness are likely over-imaged for C-spine injury. — Steve Stilianos (opinion) [Ep 1 · 16:31](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=991)
- For children 8 years and older, high-risk features warrant skipping plain films and proceeding directly to CT, especially when head CT is already indicated. — Sean (clinical) [Ep 1 · 18:21](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=1101)
- In neurologically devastated patients requiring emergency surgery, the neck should remain immobilized in a collar regardless of imaging findings until definitive clearance can be obtained electively. — Dan (clinical) [Ep 1 · 19:36](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=1176)
- If an initial lateral C-spine film is inadequate, proceeding to CT results in radiation exposure from both modalities. — Todd Ponsky (clinical) [Ep 1 · 4:41](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=281)
- Physical examination reliability for C-spine clearance is limited in 18-month-old children who cannot verbally report tenderness and may be distressed from the trauma evaluation itself. — Dan (clinical) [Ep 1 · 2:22](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=142)
- Tincture of time—observing a child overnight in a collar and re-examining when calm—is a valid alternative to immediate advanced imaging in some cases. — Todd Ponsky (clinical) [Ep 1 · 2:00](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=120)
- MRI requires sedation or anesthesia in young children, which is a significant barrier to obtaining the study emergently. — Dan (clinical) [Ep 1 · 3:50](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=230)
- The degree of midline tenderness, believability of patient report, and presence of paraspinal muscle spasm guide the astute clinician in deciding whether to pursue MRI. — Steve Stilianos (clinical) [Ep 1 · 16:04](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=964)
- Patients sometimes remain in cervical collars for 6 weeks due to clinic follow-up patterns rather than clinical indication. — Dan (clinical) [Ep 1 · 9:12](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=552)
- Cincinnati Children's Hospital is a Level 1 pediatric trauma center verified since 1993, seeing approximately 2000 trauma patients per year. — Richard Falcone (clinical) [Ep 2 · 3:08](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=188)
- At Cincinnati Children's Hospital, the ED physician serves as team leader for all trauma activations because they are present when the patient arrives. — Richard Falcone (clinical) [Ep 2 · 3:32](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=212)
- The ultimate risk of C-spine injury in pediatric trauma is actually pretty low. — Richard Falcone (epidemiological) [Ep 2 · 4:32](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=272)
- Approximately 90% of children admitted in C-collars can be clinically cleared the next morning when they are less distracted and not in the trauma bay. — Richard Falcone (clinical) [Ep 2 · 4:50](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=290)
- Some children are sent home in C-collars with follow-up in trauma clinic in one week where nurse practitioners clear them clinically. — Richard Falcone (clinical) [Ep 2 · 5:20](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=320)
- Flexion-extension films obtained early when a child is still tender and scared often yield inadequate images. — Richard Falcone (clinical) [Ep 2 · 8:27](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=507)
- Getting CT early in children with normal neurologic exam is not useful because clinicians will not feel comfortable removing the collar based on imaging alone if the child still has tenderness. — Richard Falcone (clinical) [Ep 2 · 9:00](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=540)
- There is sufficient evidence that awake children without distracting injuries and no midline tenderness do not require X-rays for C-spine clearance. — Richard Falcone (clinical) [Ep 2 · 9:50](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=590)
- For severe TBI patients, MRI is obtained before C-spine clearance because a normal exam for clinical clearance will not be available within days or even a week. — Richard Falcone (clinical) [Ep 2 · 13:17](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=797)
- Most pediatric centers obtain both CT (for bony abnormalities) and MRI (for soft tissue and ligaments) before clearing the C-spine in obtunded patients, though adult literature suggests CT alone may be sufficient. — Richard Falcone (clinical) [Ep 2 · 13:50](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=830)
- For severe TBI patients, C-spine CT is not obtained during initial resuscitation but is deferred until the follow-up head CT in the next 24 hours when the patient is more stable. — Richard Falcone (clinical) [Ep 2 · 15:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=910)
- The challenge in pancreatic trauma is determining whether there is a pancreatic duct injury. — Todd Ponsky (clinical) [Ep 2 · 21:35](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1295)
- There is increasing evidence that true pancreatic duct disruption is better treated with early distal pancreatectomy, ideally spleen-preserving. — Todd Ponsky (clinical) [Ep 2 · 21:50](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1310)
- Some children can have significant-appearing pancreatic injuries on CT, but ERCP or MRCP shows the duct is intact, and these children will heal without surgery. — Todd Ponsky (clinical) [Ep 2 · 22:30](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1350)
- ERCP has the advantage of being potentially therapeutic (stent placement) but the disadvantage of injecting dye that can cause pancreatic inflammation. — Todd Ponsky (clinical) [Ep 2 · 23:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1390)
- MRCP does not carry the risk of causing pancreatic inflammation that ERCP does. — Todd Ponsky (clinical) [Ep 2 · 23:40](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1420)
- Conservative management of pancreatic duct disruption can work and pseudocysts are manageable and drainable, but this approach results in longer TPN time and longer hospital length of stay compared to early pancreatectomy. — Todd Ponsky (clinical) [Ep 2 · 24:00](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1440)
- Centers that report good outcomes with distal pancreatectomy for pancreatic trauma are those with surgeons who are very comfortable operating on the pancreas and do it frequently. — Todd Ponsky (opinion) [Ep 2 · 24:40](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1480)
- Surgeons who rarely operate on the pancreas may put patients at more complication risk by attempting distal pancreatectomy, and non-operative management may be in the patient's best interest at such centers. — Todd Ponsky (opinion) [Ep 2 · 25:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1510)
- Being indecisive about pancreatic trauma management and operating around day 3 leads to worse outcomes than either early surgery or committed non-operative management. — Richard Falcone (opinion) [Ep 2 · 25:33](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1533)
- More literature is trending toward operating on pancreatic duct injuries more frequently, and if surgery is chosen, it should be done within the first 24 hours. — Todd Ponsky (clinical) [Ep 2 · 26:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1570)
- The decision to operate on pancreatic trauma should be made within the 24-hour window after obtaining ERCP or MRCP to confirm duct disruption. — Todd Ponsky (clinical) [Ep 2 · 26:50](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1610)
- If intraoperative findings show parenchymal pancreatic injury without ductal disruption, the appropriate management is drainage rather than distal pancreatectomy. — Todd Ponsky (clinical) [Ep 2 · 27:28](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1648)
- Cincinnati Children's Hospital data showed that before implementing standardized screening, low socioeconomic status and minority children with head injuries were much more likely to receive skeletal surveys and social services evaluation than middle/upper class non-minority families. — Todd Ponsky (epidemiological) [Ep 2 · 28:04](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1684)
- Abuse occurs in all races and all socioeconomic groups, though economic stress may add some risk. — Todd Ponsky (epidemiological) [Ep 2 · 29:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1750)
- Cincinnati Children's Hospital implemented a protocol where all children under 2 admitted with head injuries from mechanisms not witnessed publicly receive skeletal survey and social work evaluation. — Todd Ponsky (clinical) [Ep 2 · 29:40](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1780)
- Publicly witnessed mechanisms are defined as events seen by unrelated parties (e.g., fall from grocery cart at supermarket, motor vehicle collision), not events witnessed only by family members or caregivers. — Todd Ponsky (clinical) [Ep 2 · 30:30](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1830)
- After implementing standardized screening criteria, the percentage of positive abuse cases remained at 50% despite evaluating more children, indicating previously undetected abuse was being identified. — Todd Ponsky (epidemiological) [Ep 2 · 31:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1870)
- The 50% positive abuse rate in screened children represents a biased population because they had injuries severe enough to require hospital admission. — Todd Ponsky (epidemiological) [Ep 2 · 31:40](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1900)
- A screening test with nearly 50% positive rate is more productive than most screening tests used for other conditions. — Todd Ponsky (opinion) [Ep 2 · 32:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1930)
- Families find standardized non-accidental trauma screening more reassuring because it can be explained as standard protocol for all families with this injury type, not a judgment about the specific family. — Todd Ponsky (clinical) [Ep 2 · 32:40](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1960)
- Ophthalmologic examination is not part of routine non-accidental trauma screening at Cincinnati Children's Hospital but is obtained if skeletal survey is positive or there are other concerning findings. — Richard Falcone (clinical) [Ep 2 · 33:23](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2003)
- Abnormal liver function tests greater than 150-200 indicate good chance of some abdominal injury, but normal LFTs provide very little evidence of safety. — Todd Ponsky (clinical) [Ep 2 · 37:00](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2220)
- Cincinnati Children's Hospital has moved away from routine LFTs, amylase, and lipase in trauma patients, obtaining them only when other indications for CT scan already exist. — Todd Ponsky (clinical) [Ep 2 · 37:40](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2260)
- FAST examination has low sensitivity and is very user-dependent, providing false sense of security in stable patients. — Todd Ponsky (clinical) [Ep 2 · 38:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2290)
- FAST remains useful for hypotensive patients to rapidly determine if there is blood in the abdomen, which was the original indication for its development. — Todd Ponsky (clinical) [Ep 2 · 38:40](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2320)
- Laboratory tests may be useful as one additional screening test for children with vague symptoms and mechanisms who are being considered for discharge, with positive labs prompting CT and negative labs supporting discharge. — Richard Falcone (opinion) [Ep 2 · 41:26](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2486)
- Cincinnati Children's Hospital has not used angioembolization for solid organ injury in approximately 4-5 years despite high trauma volume. — Richard Falcone (clinical) [Ep 2 · 41:50](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2510)
- Angioembolization is used more frequently at adult trauma centers that routinely perform the procedure for adult patients. — Richard Falcone (clinical) [Ep 2 · 42:20](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2540)
- CT blush on imaging puts patients at higher risk for needing intervention or transfusion but does not mandate intervention. — Richard Falcone (clinical) [Ep 2 · 42:50](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2570)
- In small children, angioembolization may put them at more risk of injury and may eliminate most of the spleen anyway, losing the benefit of splenic preservation. — Richard Falcone (clinical) [Ep 2 · 43:20](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2600)
- Pediatric surgeons' approach to solid organ injury management was subsequently adopted by adult trauma surgeons. — Richard Falcone (clinical) [Ep 2 · 44:40](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2680)
- Children with solid organ injuries can be mobilized much more quickly than originally recommended, without the slow progression from bed to bathroom to ambulation. — Richard Falcone (clinical) [Ep 2 · 46:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2770)
- Very few grade 1 solid organ injuries require transfusion, so routine serial lab draws as outlined in original Stylianos protocol are probably unnecessary. — Richard Falcone (clinical) [Ep 2 · 46:38](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2798)
- There is growing support for less frequent lab draws and shorter length of stay for pediatric solid organ injuries. — Richard Falcone (clinical) [Ep 2 · 47:50](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2870)
- Isolated grade 1 splenic injuries may not require hospital admission because they never require transfusion and never have problems. — Richard Falcone (clinical) [Ep 2 · 48:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2890)
- Cincinnati Children's Hospital protocol for grade 1 solid organ injuries includes one 12-hour lab check only. — Richard Falcone (clinical) [Ep 2 · 48:28](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2908)
- Grade 2 solid organ injuries receive two lab checks, and grade 3 injuries may receive two or three checks based on clinical exam. — Richard Falcone (clinical) [Ep 2 · 48:50](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2930)
- There is evidence supporting tiered trauma activation systems with different levels of team response. — Richard Falcone (clinical) [Ep 2 · 49:20](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2960)
- Cincinnati Children's Hospital uses a 3-level activation system: lowest level is ED only with surgery called if needed, mid-level includes ED and surgery resident, highest level includes attending surgeon, OR staff, anesthesia, and ICU. — Richard Falcone (clinical) [Ep 2 · 49:50](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2990)
- Centers often add multiple additional activation criteria based on individual cases, resulting in 10-20 criteria that cause confusion. — Richard Falcone (clinical) [Ep 2 · 51:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=3070)
- The optimal number of activation criteria is around 8-9, as more criteria lower under-triage but significantly increase over-triage. — Richard Falcone (clinical) [Ep 2 · 54:00](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=3240)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The Trauma Association of Canada Pediatric Subcommittee published evidence-based C-spine clearance recommendations emphasizing clinical examination as the first test, with imaging only if clinical clearance is not possible. — Rich Falcone summarizing a resource [Ep 4 · 6:04](https://qa.library.globalcastmd.com/watch/trauma-313?t=364)
- For children over 8 with normal X-rays and normal neurologic exam, the Canadian guidelines recommend re-examination rather than immediate CT, with CT or MRI reserved only for those with abnormal neurologic exams. — Rich Falcone summarizing a resource [Ep 4 · 7:20](https://qa.library.globalcastmd.com/watch/trauma-313?t=440)
- A multi-site study published in Journal of Trauma 2009 developed a scoring system for children under 3: 3 points for GCS <14, 2 points for GCS injury score of 1, 2 points for motor vehicle collision, 1 point for age 2-3. Scores of 0-1 had 0.0% chance of C-spine injury; scores of 7-8 had 21% chance. — Rich Falcone summarizing a resource [Ep 4 · 16:07](https://qa.library.globalcastmd.com/watch/trauma-313?t=967)
- In the multi-site study of children under 3, pediatric Level 1 centers obtained C-spine CTs only 17% of the time compared to adult centers which obtained them 24-45% of the time, indicating pediatric centers do too many CTs overall. — Rich Falcone summarizing a resource [Ep 4 · 18:48](https://qa.library.globalcastmd.com/watch/trauma-313?t=1128)
- There is increasing evidence that true pancreatic duct disruption is better treated with early distal pancreatectomy, ideally splenic-preserving, for grade 3 injuries. — Rich Falcone summarizing a resource [Ep 4 · 22:00](https://qa.library.globalcastmd.com/watch/trauma-313?t=1320)
- Conservative management of pancreatic duct disruption can work and pseudocysts are manageable and drainable, but this approach takes longer with more TPN time and longer hospital length of stay compared to early pancreatectomy. — Rich Falcone summarizing a resource [Ep 4 · 24:00](https://qa.library.globalcastmd.com/watch/trauma-313?t=1440)
- The literature increasingly agrees that if operating for pancreatic duct disruption, it should be done within the first 24 hours, not as an immediate surgical emergency but within that window. — Rich Falcone summarizing a resource [Ep 4 · 26:45](https://qa.library.globalcastmd.com/watch/trauma-313?t=1605)
- Literature shows clinicians are less likely to suspect abuse in families who look like them, are from the same neighborhood, and are from higher socioeconomic groups, even with identical injury patterns, compared to lower SES or minority families. — Rich Falcone summarizing a resource [Ep 4 · 29:20](https://qa.library.globalcastmd.com/watch/trauma-313?t=1760)
- The PECARN study published in Annals of Emergency Medicine 2013 identified children at very low risk (0.1%) of clinically important blunt abdominal injuries: no abdominal wall trauma, GCS 14-15, no abdominal tenderness, no thoracic wall trauma, no abdominal pain, normal breath sounds, and no vomiting. — Rich Falcone summarizing a resource [Ep 4 · 34:48](https://qa.library.globalcastmd.com/watch/trauma-313?t=2088)
- The PECARN study found that if their very low-risk criteria were followed and everyone else was scanned, it would actually recommend more CTs than pediatric trauma centers currently perform. — Rich Falcone summarizing a resource [Ep 4 · 36:24](https://qa.library.globalcastmd.com/watch/trauma-313?t=2184)
- Abnormal liver function tests greater than 150-200 indicate a good chance of some abdominal injury, but normal LFTs provide very little evidence of safety and may create false security. — Rich Falcone summarizing a resource [Ep 4 · 37:00](https://qa.library.globalcastmd.com/watch/trauma-313?t=2220)
- FAST ultrasound is very user-dependent and has low sensitivity. Normal FAST in stable healthy children may miss injuries if trusted too much. FAST remains useful for hypotensive patients to identify intra-abdominal blood. — Rich Falcone summarizing a resource [Ep 4 · 38:30](https://qa.library.globalcastmd.com/watch/trauma-313?t=2310)
- Eric Scaife from Utah published that using FAST to screen low-risk children was giving false security due to the test's low sensitivity. — Rich Falcone summarizing a resource [Ep 4 · 38:30](https://qa.library.globalcastmd.com/watch/trauma-313?t=2310)
- In the PECARN data, children with abdominal wall trauma (seatbelt sign, handlebar sign) or GCS <14 had about 5% chance of abdominal injury; those with only abdominal tenderness had 1.4% risk; those with only thoracic wall trauma, vague abdominal pain, or vomiting had 0.7% risk. — Rich Falcone summarizing a resource [Ep 4 · 39:39](https://qa.library.globalcastmd.com/watch/trauma-313?t=2379)
- Adult trauma centers use angiography for solid organ injuries more frequently than pediatric centers, and there has been a trend of embolizing based on seeing a blush or bad injury rather than waiting to see how the patient does. — Rich Falcone summarizing a resource [Ep 4 · 42:10](https://qa.library.globalcastmd.com/watch/trauma-313?t=2530)
- A blush on imaging puts children at higher risk for needing intervention or transfusion but does not mandate intervention. Literature supports that many children with blush do not require intervention. — Rich Falcone summarizing a resource [Ep 4 · 43:00](https://qa.library.globalcastmd.com/watch/trauma-313?t=2580)
- Stylianos' 1999 paper with the American Pediatric Surgical Association Trauma Committee was a landmark that changed solid organ trauma management, with adult trauma surgeons following pediatric surgeons' lead rather than the reverse. — Rich Falcone summarizing a resource [Ep 4 · 44:00](https://qa.library.globalcastmd.com/watch/trauma-313?t=2640)
- Sean St. Peter's group in Kansas City published papers showing grade 1 and 2 solid organ injuries need at most overnight observation (12 hours) and grade 3 or 4 injuries need maybe two nights, significantly shortening length of stay without readmissions or complications. — Rich Falcone summarizing a resource [Ep 4 · 44:50](https://qa.library.globalcastmd.com/watch/trauma-313?t=2690)
- The original Stylianos guidelines recommended slow progression from bed rest to bathroom to ambulation, but current evidence supports mobilizing children much more quickly from solid organ injuries. — Rich Falcone summarizing a resource [Ep 4 · 45:50](https://qa.library.globalcastmd.com/watch/trauma-313?t=2750)
- Very few grade 1 solid organ injuries require transfusion, so the lab draws initially outlined in Stylianos' paper are probably unnecessary. — Rich Falcone summarizing a resource [Ep 4 · 46:30](https://qa.library.globalcastmd.com/watch/trauma-313?t=2790)
- Dennis Bensard's group in Colorado presented at Western Trauma Association proposing no lab draws for solid organ injuries if children are clinically stable without tachycardia, pain, or vital sign changes, using labs only as directed by physical findings. — Rich Falcone summarizing a resource [Ep 4 · 47:00](https://qa.library.globalcastmd.com/watch/trauma-313?t=2820)
- Isolated grade 1 spleen injuries potentially do not need hospital admission because they never require transfusion and never have problems based on Cincinnati and Kansas City data. — Rich Falcone summarizing a resource [Ep 4 · 47:50](https://qa.library.globalcastmd.com/watch/trauma-313?t=2870)
- A multi-center prospective analysis published in 2012 examined pediatric trauma activation criteria, finding that matching criteria to resources used (rather than injury severity scores) provides better over-triage and under-triage rates. — Rich Falcone summarizing a resource [Ep 4 · 48:32](https://qa.library.globalcastmd.com/watch/trauma-313?t=2912)
- The American College of Surgeons requires 6 trauma activation criteria but they are generic, adult-based, and lack strong evidence. Centers often add 10-20 additional criteria based on individual cases, creating confusion. — Rich Falcone summarizing a resource [Ep 4 · 49:40](https://qa.library.globalcastmd.com/watch/trauma-313?t=2980)
- The multi-center study defined appropriate high-level trauma activation as needing intubation, blood transfusion within 30 minutes, chest tube within 30 minutes, CPR within 30 minutes, or OR within 60 minutes of arrival. — Rich Falcone summarizing a resource [Ep 4 · 50:30](https://qa.library.globalcastmd.com/watch/trauma-313?t=3030)
- Evidence-based trauma activation criteria identified by the multi-center study: penetrating wound to head/neck/torso, age-appropriate tachycardia or poor perfusion, receiving blood prior to arrival, systolic BP <90 or age-appropriate hypotension, 40ml/kg fluid prior to arrival, respiratory distress or failure, and GCS ≤8. — Rich Falcone summarizing a resource [Ep 4 · 51:20](https://qa.library.globalcastmd.com/watch/trauma-313?t=3080)
- Using the evidence-based 8-9 criteria resulted in 39% over-triage rate and 10% under-triage rate. The break point where adding more criteria stops improving under-triage but increases over-triage is around 8 or 9 criteria. — Rich Falcone summarizing a resource [Ep 4 · 52:30](https://qa.library.globalcastmd.com/watch/trauma-313?t=3150)
- A recent Journal of Trauma paper led by Brooke Lerner used the Delphi method to formally define high resources justifying trauma activation, including ICU stay greater than 48 hours among other criteria. — Rich Falcone summarizing a resource [Ep 4 · 53:20](https://qa.library.globalcastmd.com/watch/trauma-313?t=3200)
- Over 40% of all patients undergoing clean surgical procedures without foreign body implantation at freestanding children's hospitals receive unindicated antibiotic prophylaxis. — The host summarizing the discussion [Ep 3 · 22:48](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1368)
- Over 50% of patients who appropriately receive antibiotic prophylaxis have it extended well past incision closure, with colorectal procedures averaging 2.5 days of prophylaxis. — The host summarizing the discussion [Ep 3 · 23:20](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1400)
- Almost 30% of patients receive antibiotic agents broader than recommended guidelines, with double coverage (Flagyl and Zosyn) being common. — The host summarizing the discussion [Ep 3 · 23:50](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1430)
- The three major areas of inappropriate antibiotic use in pediatric surgery account for 85% of inappropriate utilization: prophylaxis for clean cases without foreign bodies (50%), prophylaxis after incision closure (30%), and anaerobic coverage for proximal GI procedures (remaining portion). — The host summarizing the discussion [Ep 3 · 25:40](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1540)
- Cochrane reviews show no strong conclusion on antibiotic prophylaxis for central line placement, but there is a trend toward reduced infection rates in the oncology population. — The host summarizing the discussion [Ep 3 · 28:20](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1700)
- Adult literature shows that for colorectal procedures, giving antibiotics past incision closure provides no benefit. — The host summarizing the discussion [Ep 3 · 30:00](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1800)
- NSQIP data shows surgical site infection rates in children are much lower than adults when adjusting for procedure type and RVUs, because children lack risk factors like morbid obesity, diabetes, and tobacco use. — The host summarizing the discussion [Ep 3 · 30:30](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1830)
- Bratzler consensus guidelines from the Infectious Disease Society of America, Surgical Infection Society, and American Society of Hospital Pharmacists agree that routine fungal coverage is not necessary because SSI data does not show fungal infections. — The host summarizing the discussion [Ep 3 · 31:40](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=1900)
- The NSQIP collaborative of 84 hospitals will collect data on 85,000 children over one year, providing the first rigorous data relating prophylaxis to surgical site infections in pediatric surgery. — The host summarizing the discussion [Ep 3 · 36:40](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2200)
- In a collaborative to reduce CT utilization for appendicitis, CT rates decreased from 25% to 15% within NSQIP hospitals, but 50% of transferred patients had already received CTs at outside hospitals, highlighting the need for community outreach. — The host summarizing the discussion [Ep 3 · 37:30](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2250)
- For pediatric patients with suspected appendicitis who are not thought to have perforation, starting with cefoxitin or ceftriaxone and Flagyl rather than anti-pseudomonal agents is the most important stewardship intervention in pediatric surgery. — The host summarizing the discussion [Ep 3 · 39:00](https://qa.library.globalcastmd.com/watch/apsa50-top-educational-content-1625?t=2340)
- Some radiologists argue that the radiation from a neck CT is trivial and comparable to radiation exposure from a transcontinental flight. — Dan summarizing the discussion [Ep 1 · 20:39](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=1239)
- Work from PECARN (Pediatric Emergency Care Applied Research Network) is helping identify which pediatric patients do not need any C-spine imaging. — Steve Stilianos summarizing the discussion [Ep 1 · 14:30](https://qa.library.globalcastmd.com/watch/cervical-spine-injury-update-course-2016-861?t=870)
- The Trauma Association of Canada Pediatric Subcommittee published evidence-based C-spine clearance recommendations in the Journal of Trauma 2-3 years ago emphasizing clinical examination as the first test. — Richard Falcone summarizing a resource [Ep 2 · 6:04](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=364)
- For children greater than 8 years old with normal X-rays and normal neurologic exam, re-examination allows clinical clearance without CT if the repeat exam is normal. — Richard Falcone summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=420)
- CT or MRI of the C-spine should be considered only when there is an abnormal neurologic exam, requiring involvement of spine surgeons. — Richard Falcone summarizing a resource [Ep 2 · 7:30](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=450)
- A multi-site study published in Journal of Trauma around 2009 developed a scoring system for C-spine injury risk in children under 3: 3 points for GCS <14, 2 points for GCS injury score of 1, 2 points for motor vehicle collision, 1 point for age 2-3 years. — Richard Falcone summarizing a resource [Ep 2 · 16:07](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=967)
- Children under 3 with a C-spine risk score of 0 or 1 have 0.0% chance of C-spine injury and do not need imaging. — Richard Falcone summarizing a resource [Ep 2 · 17:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1030)
- Children under 3 with a C-spine risk score of 7 or 8 have approximately 21% chance of C-spine injury and clearly need imaging. — Richard Falcone summarizing a resource [Ep 2 · 17:40](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1060)
- In the multi-site study, pediatric Level 1 centers obtained C-spine CTs only 17% of the time compared to adult centers which obtained them 24-45% of the time. — Richard Falcone summarizing a resource [Ep 2 · 18:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=1090)
- The Pediatric Emergency Care Research Network published criteria in Annals of Emergency Medicine in 2013 for identifying children at very low risk of clinically important blunt abdominal injuries. — Todd Ponsky summarizes what Dr. Richard Falcone said [Ep 2 · 34:29](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2069)
- Children with no abdominal wall trauma, no seatbelt sign, GCS 14-15, no abdominal tenderness, no thoracic wall trauma, no abdominal pain, no altered breath sounds, and no vomiting have 0.1% chance of clinically important intraabdominal injury and do not need CT scanning. — Todd Ponsky summarizes what Dr. Richard Falcone said [Ep 2 · 35:20](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2120)
- If the PECARN criteria were strictly followed to scan everyone not in the very low risk group, more CTs would be recommended than pediatric trauma centers currently perform. — Todd Ponsky summarizes what Dr. Richard Falcone said [Ep 2 · 36:24](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2184)
- Children with abdominal wall trauma (seatbelt sign, handlebar sign) or GCS less than 14 have approximately 5% chance of abdominal injury requiring intervention. — Richard Falcone summarizing a resource [Ep 2 · 39:39](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2379)
- Children with only abdominal tenderness (without wall trauma or altered GCS) have approximately 1.4% risk of intraabdominal injury needing intervention. — Richard Falcone summarizing a resource [Ep 2 · 40:20](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2420)
- Children with only thoracic wall trauma, vague abdominal pain, or vomiting have only 0.7% risk of intraabdominal injury. — Richard Falcone summarizing a resource [Ep 2 · 40:50](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2450)
- Dr. Stylianos published landmark paper in 1999 with the American Pediatric Surgical Association Trauma Committee that changed management of splenic and liver trauma in children. — Richard Falcone summarizing a resource [Ep 2 · 44:00](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2640)
- Sean St. Peter and the Kansas City group published papers showing that bed rest windows for solid organ injuries can be shortened: grade 1-2 injuries need at most overnight (12 hours), grade 3-4 injuries need about two nights. — Richard Falcone summarizing a resource [Ep 2 · 45:00](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2700)
- Shortened bed rest protocols significantly reduce length of stay without causing readmissions or complications. — Richard Falcone summarizing a resource [Ep 2 · 45:50](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2750)
- Dennis Bensard's group from Colorado presented at Western Trauma Association proposing no lab draws at all for solid organ injuries if patients are clinically stable (not tachycardic, no pain, no vital sign changes). — Richard Falcone summarizing a resource [Ep 2 · 47:10](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=2830)
- The American College of Surgeons specifies 6 required trauma activation criteria but these are generic, adult-based, and lack strong evidence. — Richard Falcone summarizing a resource [Ep 2 · 50:40](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=3040)
- A multi-center prospective study published in 2012 matched activation criteria to resources used (intubation, blood transfusion within 30 minutes, chest tube within 30 minutes, CPR within 30 minutes, OR within 60 minutes). — Richard Falcone summarizing a resource [Ep 2 · 51:40](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=3100)
- The resource-based study identified optimal activation criteria as: penetrating wound to head/neck/torso, age-appropriate tachycardia or poor perfusion, receiving blood prior to arrival, systolic BP <90 or age-appropriate hypotension, 40+ mL/kg fluid prior to arrival, respiratory distress/failure, or GCS ≤8. — Richard Falcone summarizing a resource [Ep 2 · 52:30](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=3150)
- Using the resource-based criteria resulted in 39% over-triage rate and only 10% under-triage rate. — Richard Falcone summarizing a resource [Ep 2 · 53:30](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=3210)
- Brooke Lerner led a recent Journal of Trauma paper using Delphi method to formally define high-resource utilization justifying highest-level activation, including ICU stay >48 hours. — Richard Falcone summarizing a resource [Ep 2 · 54:30](https://qa.library.globalcastmd.com/watch/pediatric-trauma-with-dr-richard-falcone-928?t=3270)

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