# Non-accidental Trauma — GCMD Library living collection Everything in the library about non-accidental trauma — built automatically from dossiers that name it. Updated: n/a · 4 episodes · 87 cited statements ## Episodes ### Diagnosis & Workup - [Escalation Injuries: Pediatric Trauma Series 2017](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377) — video · 25:14 · [machine version](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377.md) - [Pediatric Trauma Screening For Non-Accidental Trauma: Pediatric Trauma Series...](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378) — video · 1:04:09 · [machine version](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378.md) ### Evidence & Research - [Journal of Pediatric Surgery Article Review: June 2022, AAP Issue](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878) — video · 15:54 · [machine version](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878.md) - [Journal of Pediatric Surgery Article Review: June 2022, AAP Issue](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881) — podcast · 15:54 · [machine version](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881.md) ## Chapters - [0:00](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=0) Background and Rationale for NAT Screening Protocol Development (Ep 1) - [7:00](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=420) Screening Algorithm Components and Red Flags (Ep 1) - [12:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=750) Retrospective Study Findings: Pre-Implementation Baseline (Ep 1) - [17:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1050) Prospective Study Results: Post-Implementation Outcomes (Ep 1) - [21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) Pediatric Trauma Society Review: Evidence-Based Screening Recommendations (Ep 1) - [23:25](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1405) Discussion: Resource Challenges and Regional Trauma Center Role (Ep 1) - [0:00](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=0) Introduction and Series Context (Ep 2) - [1:23](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=83) Mary Bridge Hospital NAT Screening Protocol Development (Ep 2) - [25:06](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1506) Discussion: Regional Resources and Radiologist Access (Ep 2) - [27:23](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1643) Barriers to NAT Detection and Quality Improvement Approaches (Ep 2) - [51:47](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=3107) Panel Discussion: Implementation Strategies and Family Communication (Ep 2) - [0:06](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=6) Introduction and Episode Overview (Ep 3) - [1:56](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=116) Non-Accidental Trauma During COVID-19 Stay-at-Home Orders (Ep 3) - [6:22](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=382) Metastatic Hepatoblastoma Cell Line Development (Ep 3) - [9:18](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=558) Localization Techniques for Small Pulmonary Nodules (Ep 3) - [12:26](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=746) Puberty and Growth in Pediatric Intestinal Failure (Ep 3) - [15:08](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=908) Closing Remarks (Ep 3) - [0:06](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=6) Introduction and Episode Overview (Ep 4) - [1:56](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=116) Non-Accidental Trauma During COVID-19 Stay-at-Home Orders (Ep 4) - [6:22](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=382) Metastatic Hepatoblastoma Cell Line Development (Ep 4) - [9:18](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=558) Localization Techniques for Small Pulmonary Nodules (Ep 4) - [12:26](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=746) Puberty and Growth in Pediatric Intestinal Failure (Ep 4) - [15:08](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=908) Closing Remarks (Ep 4) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - NAT was higher after the lockdown, not during the lockdown — Todd Ponsky and Biran Modi (clinical) [Ep 3 · 4:07](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=247) - During times of public health crises, it's important to maintain systems of protection for children — Nicole Chandler (opinion) [Ep 3 · 5:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=337) - Management of metastatic hepatoblastoma continues to pose significant treatment challenges — Nicole Chandler (clinical) [Ep 3 · 7:13](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=433) - PSORC (Pediatric Surgical Oncology Research Collaborative) is a multi-institutional consortium of North American pediatric surgeons focused on advancing care of children with cancer — Marcus Malek (clinical) [Ep 3 · 9:46](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=586) - PSORC was founded because there was a need to amalgamate data from multiple institutions to better study surgical questions in pediatric cancer — Marcus Malek (clinical) [Ep 3 · 10:05](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=605) - Image-guided localization techniques varied significantly among institutions but all were wildly successful, showing that experience is probably more important than the actual technique itself — Nicole Chandler (opinion) [Ep 3 · 12:06](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=726) - Pediatric intestinal failure was defined as requirement of parenteral nutrition for 60 days or more at any time, with diagnosis before 8 years of age — Todd Ponsky and Biran Modi (clinical) [Ep 3 · 12:57](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=777) - The hypothesis was that chronic pediatric intestinal failure would delay puberty and potentially dull the sharp spike of puberty in terms of peak height velocity — Todd Ponsky and Biran Modi (clinical) [Ep 3 · 13:44](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=824) - There is a high incidence of short stature in chronic intestinal failure — Todd Ponsky and Biran Modi (clinical) [Ep 3 · 14:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=877) - The finding that short stature is not because kids are missing out on pubertal timing and peak height velocity suggests we need to do a better job at setting them up to go into puberty with working on their height and linear growth — Todd Ponsky and Biran Modi (opinion) [Ep 3 · 14:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=877) - NAT was higher after the lockdown, not during the lockdown — Todd Ponsky and Biran Modi (clinical) [Ep 4 · 4:07](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=247) - During times of public health crises, it's important to maintain systems of protection for children — Nicole Chandler (opinion) [Ep 4 · 5:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=337) - Management of metastatic hepatoblastoma continues to pose significant treatment challenges — Nicole Chandler (clinical) [Ep 4 · 7:13](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=433) - We never had a hepatoblastoma cell line mouse model before — Todd Ponsky and Biran Modi (clinical) [Ep 4 · 8:29](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=509) - PSORC (Pediatric Surgical Oncology Research Collaborative) is a multi-institutional consortium of North American pediatric surgeons focused on advancing care of children with cancer — Marcus Malek (clinical) [Ep 4 · 9:46](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=586) - There has not been consistency in localization techniques for small pulmonary nodules across North America, with surgeons doing their own thing — Marcus Malek (clinical) [Ep 4 · 10:19](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=619) - Time under anesthesia can be long and quite variable depending on whether institutions use hybrid ORs or have IR on different floors — Marcus Malek (clinical) [Ep 4 · 11:10](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=670) - ICG will become much more popular and more effective for nodule localization in 5 years — Todd Ponsky and Biran Modi (opinion) [Ep 4 · 11:54](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=714) - Image guided localization techniques varied significantly among institutions but all were wildly successful, showing that experience is probably more important than the actual technique itself — Nicole Chandler (opinion) [Ep 4 · 12:06](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=726) - The study focused on patients with pediatric intestinal failure, defined as requirement of parenteral nutrition for 60 days or more at any time, who had the diagnosis before age 8 and were older than 8 at time of study — Todd Ponsky and Biran Modi (clinical) [Ep 4 · 12:52](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=772) - Puberty is at least partially dependent on having good nutritional stores based on hormonal drivers of puberty — Todd Ponsky and Biran Modi (clinical) [Ep 4 · 13:38](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=818) - The hypothesis was that chronic pediatric intestinal failure would delay puberty and potentially dull the sharp spike of peak height velocity — Todd Ponsky and Biran Modi (clinical) [Ep 4 · 13:45](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=825) - Children with intestinal failure might be slightly short statured but are not severely undersized compared to the general population — Todd Ponsky and Biran Modi (clinical) [Ep 4 · 14:20](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=860) - There is a high incidence of short stature in chronic intestinal failure — Todd Ponsky and Biran Modi (clinical) [Ep 4 · 14:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=877) - The finding that kids with intestinal failure are not missing out on pubertal timing and peak height velocity suggests we need to do a better job at setting them up to go into puberty by working on their height and linear growth — Todd Ponsky and Biran Modi (opinion) [Ep 4 · 14:37](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=877) - In Mary Bridge's retrospective cohort, 89% of NAT cases had inconsistent or missing history, 79% had unwitnessed injuries, and almost 40% of patients had a prior ED visit — Tony Escobar (clinical) [Ep 2 · 11:20](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=680) - 60% of NAT patients with prior ED visits were less than a year of age — Tony Escobar (clinical) [Ep 2 · 11:50](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=710) - 41% to 73% of NAT patients were missing social history data in the chart — Tony Escobar (clinical) [Ep 2 · 12:10](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=730) - Perineal bruising or injury was found in a small number of patients, but the majority were less than 4 years of age and there was significantly increased risk of mortality and morbidity with this finding — Tony Escobar (clinical) [Ep 2 · 12:50](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=770) - 60% of NAT patients less than a year of age had fractures, with a fraction having undiagnosed healing fractures in other sites — Tony Escobar (clinical) [Ep 2 · 13:20](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=800) - A third of NAT patients had rib fractures, which were significantly associated with severe injury (ISS ≥16) and other undiagnosed healing fractures — Tony Escobar (clinical) [Ep 2 · 14:00](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=840) - In the retrospective cohort, 9 patients died, and 2/3 of those had a prior ED visit — Tony Escobar (clinical) [Ep 2 · 14:30](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=870) - After implementing standardized NAT screening at Mary Bridge, ED length of stay did not change — Tony Escobar (clinical) [Ep 2 · 19:40](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1180) - After implementing standardized screening, the number of admissions went down, possibly because more standardized screening in the ER led to safer disposition planning and fewer medical holds — Tony Escobar (clinical) [Ep 2 · 19:55](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1195) - The use of head CT did not change after implementing the NAT screening protocol — Tony Escobar (clinical) [Ep 2 · 19:10](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1150) - In Ohio's TRAIN collaborative baseline data, around 40% of kids less than 6 months with a bruise were getting skeletal surveys — Kristen Crichton (epidemiological) [Ep 2 · 40:20](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=2420) - In a TRAIN collaborative study of 367 infants <6 months with bruising, significantly more infants with public insurance had skeletal surveys than those with private insurance, with no racial difference seen — Kristen Crichton (epidemiological) [Ep 2 · 41:20](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=2480) - Posterior rib fractures, classic metaphyseal fractures, and pattern bruises will all get better without medical intervention, but identifying them provides information to protect children — Kristen Crichton (clinical) [Ep 2 · 43:00](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=2580) - Child abuse is more common than every bleeding disorder — Kristen Crichton (epidemiological) [Ep 2 · 45:50](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=2750) - A skeletal survey following American College of Radiologists and AAP guidelines requires about 24 separate X-rays, not a single babygram — Kristen Crichton (guideline) [Ep 2 · 49:10](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=2950) - At Nationwide Children's, an automatic consult to the child abuse team is triggered for any child under age 5 admitted to the hospital, which has increased team visibility and access without increasing length of stay or imaging studies — Kristen Crichton (clinical) [Ep 2 · 56:20](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=3380) - The risk of dying from repeated abuse is far higher than the risk of brain cancer from a head CT — Kristen Crichton (opinion) [Ep 2 · 61:15](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=3675) - 48% of child fatalities each year are a result of physical abuse. (epidemiological) [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=0) - Approximately 12% of child fatalities from abuse involve families that had some sort of CPS intervention in the last 5 years prior to the fatality. (epidemiological) [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=0) - The majority of child fatalities from abuse were less than 4 years of age. (epidemiological) [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=0) - At one level 1 trauma center, only about a little over half of the kids being evaluated for NAT were seen by a pediatric surgeon. (clinical) [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=0) - Approximately 30% of children with abusive head trauma had NAT not originally considered or recognized (from Carol Jenny's study). (epidemiological) [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=0) - Patients with recurrent NAT had a significantly higher mortality than during their first presentation (from Kate Dean's group in Columbus). (epidemiological) [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=0) - In the retrospective cohort, 89% of NAT cases had inconsistent or missing history. (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=750) - 79% of NAT cases in the retrospective cohort had unwitnessed injuries. (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=750) - Almost 40% of NAT patients had a prior ED visit, and 60% of those were less than a year of age. (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=750) - 41% to 73% of NAT patients were missing social history data in the retrospective review. (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=750) - Bruising was found in almost 2/3 of NAT patients in the retrospective cohort. (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=750) - Perineal bruising or injury was found in a small number of patients, with the majority less than 4 years of age, and was associated with significantly increased risk of mortality and increased morbidity. (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=750) - 60% of NAT patients less than a year of age had fractures, with a fraction having undiagnosed healing fractures in other sites. (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=750) - Of patients with subdural or subarachnoid hemorrhages, the vast majority were less than a year of age. (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=750) - A third of NAT patients had rib fractures, which were significantly associated with other undiagnosed healing fractures, and half had an injury severity score ≥16. (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=750) - 9 patients died in the retrospective cohort, with 2/3 having had a prior ED visit. (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=750) - 5 of the 9 patients who died had prior contact with CPS. (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=750) - Although 3 patients who died had a history of domestic violence recorded, the majority did not have data at all on domestic violence. (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=750) - There is a significantly increased number of severely injured patients when they come in with NAT as a mechanism compared to overall accidental trauma patients. (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=750) - After implementation of the standardized screening tool on January 1, 2014, there was no significant increase in the number of NATs diagnosed. (clinical) [Ep 1 · 17:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1050) - There was an increase in referral to pediatric surgeons after implementation of the screening tool. (clinical) [Ep 1 · 17:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1050) - The use of head CT did not change after implementation of the screening tool. (clinical) [Ep 1 · 17:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1050) - ED length of stay did not change after implementation of the screening tool. (clinical) [Ep 1 · 17:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1050) - The number of admissions went down after implementation, posited to be due to more standardized screening in the ER and safer disposition planning from the start, resulting in fewer medical holds. (clinical) [Ep 1 · 17:30](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1050) - The 10-4 clinical prediction rule (torso, ears, and neck bruising in children <4 years, or any bruising in infants <4 months) is highly suspicious for NAT, developed by Mary Clyde Pierce. (guideline) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - Characteristic patterns of bruising such as whip marks or cigarette burns warrant a child abuse workup. (guideline) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - Up to 25% of children admitted to a burn center had been abused (from the most recent Parkland systematic review). (epidemiological) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - Greater than 95% of patients presenting with intentional burns were aged less than 5 years. (epidemiological) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - For intracerebral injury or abusive head trauma, the PD Burn clinical prediction rule and the PREDAHT clinical prediction rule have the largest amount of evidence. (guideline) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - If there is a traumatic brain injury associated with additional features from the PD Burn or PREDAHT rules, a NAT workup is recommended. (guideline) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - Hollow viscous injuries, specifically duodenal injuries in children less than 4 years, are highly suggestive of abuse. (clinical) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - If there is an associated hollow viscous injury and solid organ injury in children less than 4 years, a non-accidental trauma workup is recommended. (guideline) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - Abusive abdominal injury can occur without external signs such as bruising. (clinical) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - Screening for elevated liver function tests is recommended, and if elevated, further axial imaging is recommended to evaluate for intraabdominal injury. (guideline) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - High-risk long bone injuries include proximal and mid humeral fractures, femur fractures, and especially rib fractures in infants without a preceding history of major trauma. (clinical) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - If skeletal injury patterns are inconsistent with the degree of mobility, a child abuse workup is recommended. (guideline) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - The American Academy of Pediatrics recommends a skeletal survey to screen for occult fractures in any child less than 2 years with suspected non-accidental trauma, read by a pediatric radiologist. (guideline) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - Bucket handle fractures are classically associated with NAT in smaller children due to the twisting motion. (clinical) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - Posterior rib fractures result from a squeezing type of mechanism in infants. (clinical) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - In mobile children, the incidence of lip injuries, oral injuries, and frenulum injuries are equivalent between accidental trauma and non-accidental trauma mechanisms. (clinical) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - Frenulum tears in and of themselves do not have sufficient evidence to recommend a child abuse workup, but in an infant with an oral injury it should raise a red flag, and if there is another finding, a workup is recommended. (guideline) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - Historical factors are the least well studied of all the NAT screening categories. (opinion) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - Historical factors in conjunction with a finding suspicious for non-accidental trauma typically prompt the child abuse workup. (clinical) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - Anecdotally, there was more comfort discussing NAT workup with parents from both physicians and staff once the language was standardized. (opinion) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) - Implementation of the NAT screening guideline did not lead to increased utilization of resources and resources were felt to be better utilized. (clinical) [Ep 1 · 21:20](https://origin-library.globalcastmd.com/watch/escalation-injuries-pediatric-trauma-series-2017-377?t=1280) ## Host summaries Recaps by a host of what the experts said — not the host's own clinical position. - The Midwest Pediatric Surgery Research Consortium (MWPSC) was established by departments of Pediatric Surgery from 11 children's hospitals — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 3 · 2:15](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=135) - The NAT study used historical patterns captured by trauma registries to predict what the volume should have been during the initial COVID time period and compared that to observed rates — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 3 · 3:42](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=222) - Initially non-accidental trauma rates dropped a little bit, but after that the rate increased above what they had expected during the stay at home orders — Nicole Chandler summarizing the discussion [Ep 3 · 4:16](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=256) - Patients disproportionately affected were older kids who were older than 5 years who would most commonly be in school, minority children, and lower socioeconomic groups as determined by the social vulnerability index — Nicole Chandler summarizing the discussion [Ep 3 · 4:31](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=271) - CDC Social Vulnerability Index was uniquely created to see neighborhood's vulnerability during times of crises — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 3 · 5:12](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=312) - One has to be careful not to make too strong of conclusions based on any data when it's related to simply ICD 10 codes, regardless of how many institutions and how long the evaluation period was — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 3 · 6:07](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=367) - There are very few cell lines available to study hepatoblastoma, and a number of cell lines touted to be hepatoblastoma are actually hepatocellular carcinoma — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 3 · 6:47](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=407) - The new hepatoblastoma cell line was created by injecting labeled cells into mouse tail vein, harvesting lung metastases, culturing surviving cells, and repeating the process until establishing a reliably metastatic cell line — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 3 · 7:24](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=444) - Compared to the original human cell line, the new cell line exhibited increased tumorigenicity, invasiveness, and increased resistance to chemotherapy — Nicole Chandler summarizing the discussion [Ep 3 · 8:14](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=494) - The most common localization techniques for small pulmonary nodules were wire and methylene blue dye, followed by methylene blue dye only — Nicole Chandler summarizing the discussion [Ep 3 · 10:49](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=649) - There was no difference in successful IR localization or successful resection of pulmonary nodules when comparing different localization techniques — Nicole Chandler summarizing the discussion [Ep 3 · 10:56](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=656) - Peak height velocity occurred at significantly younger ages for both males and females with intestinal failure — Nicole Chandler summarizing the discussion [Ep 3 · 14:00](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=840) - Puberty onset occurred significantly earlier compared to established norms for males, meaning they reached pubertal onset earlier than the CDC 50th percentile — Nicole Chandler summarizing the discussion [Ep 3 · 14:00](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5878?t=840) - The Midwest Pediatric Surgery Research Consortium (MWPSC) was established by departments of Pediatric Surgery from 11 children's hospitals — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 4 · 2:15](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=135) - The NAT study used historical patterns captured by trauma registries to predict what the volume should have been during the initial COVID time period and compared that to observed rates — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 4 · 3:42](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=222) - Initially non-accidental trauma rates dropped a little bit, but after that the rate increased above what they had expected during the stay at home orders — Nicole Chandler summarizing the discussion [Ep 4 · 4:16](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=256) - Patients disproportionately affected were older kids who were older than 5 years who would most commonly be in school, minority children, and lower socioeconomic groups as determined by the social vulnerability index — Nicole Chandler summarizing the discussion [Ep 4 · 4:31](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=271) - CDC's Social Vulnerability Index was uniquely created to see neighborhood's vulnerability during times of crises — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 4 · 5:12](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=312) - One has to be careful not to make too strong of conclusions based on ICD 10 codes, no matter how many institutions and how long the evaluation period was — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 4 · 6:07](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=367) - There are very few cell lines available to study hepatoblastoma, and a number of cell lines touted to be hepatoblastoma are actually hepatocellular carcinoma — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 4 · 6:47](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=407) - The researchers labeled hepatoblastoma cells with luciferase, injected them into mouse tail veins where they preferentially went to lungs, harvested and cultured surviving cells, and repeated this process until establishing a reliable metastatic cell line — Ellen Incisco and M. Tom Bash summarizing the discussion [Ep 4 · 7:24](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=444) - The new metastatic hepatoblastoma cell line exhibited increased tumorigenicity, invasiveness, and increased resistance to chemotherapy compared to the original human cell line — Nicole Chandler summarizing the discussion [Ep 4 · 8:14](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=494) - The most common localization techniques were wire and methylene blue dye, followed by methylene blue dye only — Nicole Chandler summarizing the discussion [Ep 4 · 10:49](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=649) - There was no difference in successful IR localization or successful resection of pulmonary nodules among the different localization techniques — Nicole Chandler summarizing the discussion [Ep 4 · 10:56](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=656) - Peak height velocity occurred at significantly younger ages for both males and females with intestinal failure — Nicole Chandler summarizing the discussion [Ep 4 · 14:00](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=840) - Puberty onset occurred significantly earlier compared to established norms for males, meaning they reached pubertal onset earlier than the CDC 50th percentile — Nicole Chandler summarizing the discussion [Ep 4 · 14:00](https://origin-library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-june-2022-aap-issue-5881?t=840) - 48% of child fatalities each year are a result of physical abuse — Tony Escobar summarizes what Dr. Kristen Crichton said [Ep 2 · 3:06](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=186) - Approximately 12% of child abuse fatalities involve families that had CPS intervention in the last 5 years prior to the fatality, with the majority of these children less than 4 years of age — Tony Escobar summarizes what Dr. Kristen Crichton said [Ep 2 · 3:15](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=195) - In Carol Jenny's study, approximately 30% of children with abusive head trauma had NAT not originally considered or recognized by physicians — Tony Escobar summarizes what Dr. Kristen Crichton said [Ep 2 · 5:30](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=330) - Kate Dean's group demonstrated that patients with recurrent NAT had significantly higher mortality than during their first presentation — Tony Escobar summarizes what Dr. Kristen Crichton said [Ep 2 · 5:50](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=350) - The 10-4 clinical prediction rule (torso, ears, neck bruising in children <4 years, or any bruising in infants <4 months) is highly suspicious for NAT — Tony Escobar summarizes what Dr. Kristen Crichton said [Ep 2 · 22:30](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1350) - In the most recent systematic review of burns, up to 25% of children admitted to burn centers had been abused — Tony Escobar summarizes what Dr. Kristen Crichton said [Ep 2 · 23:40](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1420) - Greater than 95% of patients with intentional burns were aged less than 5 years — Tony Escobar summarizes what Dr. Kristen Crichton said [Ep 2 · 24:05](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1445) - Hollow viscous injuries, specifically duodenal injuries in children less than 4 years old, are highly suggestive of abuse — Tony Escobar summarizes what Dr. Kristen Crichton said [Ep 2 · 25:40](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1540) - Abusive abdominal injury can occur without external signs such as bruising — Tony Escobar summarizes what Dr. Kristen Crichton said [Ep 2 · 26:15](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1575) - Screening for elevated liver function tests is recommended, and if elevated, further axial imaging is recommended to evaluate for intraabdominal injury — Tony Escobar summarizes what Dr. Kristen Crichton said [Ep 2 · 26:25](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1585) - Frenulum tears in mobile children have equivalent incidence between accidental and non-accidental trauma, so in and of themselves there is not sufficient evidence to recommend a child abuse workup — Tony Escobar summarizes what Dr. Kristen Crichton said [Ep 2 · 27:10](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1630) - In a national study of primary care providers, PCPs often fail to report injuries concerning for child abuse to CPS due to familiarity with the family, perceived lack of value from CPS involvement, or use of their own alternative management plan — Kristen Crichton summarizes what Dr. Tony Escobar said [Ep 2 · 29:10](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1750) - In a study of pediatric nurses, barriers to reporting included difficulty with cases that aren't clear cut, especially in small infants where injuries can be non-severe or non-specific — Kristen Crichton summarizes what Dr. Tony Escobar said [Ep 2 · 30:10](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1810) - In a Dutch study of ED physicians, barriers included lack of time, fear of inaccurate suspicion, insufficient communication skill, and turnover of ED staff — Kristen Crichton summarizes what Dr. Tony Escobar said [Ep 2 · 30:40](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=1840) - In Carol Jenny's 1999 study of missed abusive head trauma, children where abuse was missed were significantly more likely to be white and in dual parent homes — Kristen Crichton summarizes what Dr. Tony Escobar said [Ep 2 · 34:40](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=2080) - Wendy Lane and colleagues found minority children had higher rates of evaluation for abuse and higher reports of suspected abuse, separate from any racial disparity in actual abuse — Kristen Crichton summarizes what Dr. Tony Escobar said [Ep 2 · 35:00](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=2100) - Physical abuse is considered more often in children with low socioeconomic status — Kristen Crichton summarizes what Dr. Tony Escobar said [Ep 2 · 35:30](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=2130) - In a 2018 study of 746 child abuse pediatrician consult notes, CAP perception of a child's socioeconomic status was strongly linked to perception of risk, even when other social cues were accounted for — Kristen Crichton summarizes what Dr. Tony Escobar said [Ep 2 · 36:40](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=2200) - In a 2015 study by Dan Lindberg, only 20% of infants under 6 months old who had a bruise had a skeletal survey done, though by AAP guidelines most should have — Kristen Crichton summarizes what Dr. Tony Escobar said [Ep 2 · 38:00](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=2280) - Joanne Wood found that 68% of children less than a year old with traumatic brain injury had a skeletal survey done — Kristen Crichton summarizes what Dr. Tony Escobar said [Ep 2 · 38:30](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=2310) - At Mary Bridge, standardized NAT screening eliminated racial and socioeconomic disparities in screening — Rich summarizing the discussion [Ep 2 · 62:30](https://origin-library.globalcastmd.com/watch/pediatric-trauma-screening-for-non-accidental-trauma-pediatric-trauma-series-378?t=3750) ## Changelog - Sep 25: 1 item added automatically - Sep 15: 3 items added automatically --- Educational content from recorded physician discussions — not medical advice. 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