Chris Streck

17 statements · 1 topic · summaries given as host listed separately

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▶ Ep 1 · 28:30
The five variables with greatest predictive value for intraabdominal injury were AST >200, abnormal abdominal physical examination, abnormal chest X-ray, complaint of abdominal pain, and abnormal pancreatic enzymes.
clinical · Blunt Abdominal Trauma
▶ Ep 1 · 33:10
Abnormal physical examination (seatbelt sign) had the highest odds ratio for injury requiring intervention; elevated AST >200 had highest odds ratio for injury not requiring intervention.
clinical · Blunt Abdominal Trauma

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Chris's statements about Blunt Abdominal Trauma 17 statements

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Abdominal Evaluation: Pediatric Trauma Series 2017

▶ Ep 1 · 26:30
epidemiological Overall 12% of the study population had an intraabdominal injury and 3% had an injury requiring acute intervention (surgery, transfusion, or angiography). ↗
▶ Ep 1 · 27:06
epidemiological In the 14-center prospective study, 45% of blunt trauma patients underwent abdominal CT, with range across centers of 4% to 96% in similarly injured populations. ↗
▶ Ep 1 · 28:30
clinical The five variables with greatest predictive value for intraabdominal injury were AST >200, abnormal abdominal physical examination, abnormal chest X-ray, complaint of abdominal pain, and abnormal pancreatic enzymes. ↗
▶ Ep 1 · 29:20
clinical In 34% of patients (very low-risk population with all five variables negative), there was 0.6% risk of intraabdominal injury and 0% risk of injury requiring intervention. ↗
▶ Ep 1 · 30:00
clinical The prediction rule had negative predictive value of 99.4% for any intraabdominal injury and 100% for injury requiring acute intervention. ↗
▶ Ep 1 · 32:00
clinical With just one positive variable, risk of injury was 4.5% and risk of injury requiring intervention was low; risk increased significantly with multiple positive variables. ↗
▶ Ep 1 · 33:10
clinical Abnormal physical examination (seatbelt sign) had the highest odds ratio for injury requiring intervention; elevated AST >200 had highest odds ratio for injury not requiring intervention. ↗
▶ Ep 1 · 39:25
clinical Pelvic plain film did not add predictive value to the model on multivariate analysis and was not included in the final algorithm. ↗
▶ Ep 1 · 39:25
quote I think one of the challenges is that we didn't order a pelvis plain film on, on all of the patients, but in the end, I don't think it would have added anything to the model. ↗
▶ Ep 1 · 41:28
opinion A single complaint of abdominal pain alone, without other positive variables, should not mandate CT—the patient can be re-examined after observation. ↗
▶ Ep 1 · 43:42
quote If you really dig down in the manuscript, we kind of list what is an abdominal, uh, an abnormal abdominal examination, and when we say, uh, bruising, we're really talking about like handlebar contusions from a bicycle or an abdominal seatbelt contusion. ↗
▶ Ep 1 · 43:42
opinion Seatbelt sign definition matters: handlebar contusion or true abdominal lap-belt contusion warrants CT, but small abrasions over iliac crest or costal margin do not mandate imaging. ↗
▶ Ep 1 · 44:10
epidemiological 97% of patients in the study had normal blood pressure for age on arrival, indicating most children with significant mechanism do not require acute intervention. ↗
▶ Ep 1 · 44:40
clinical 75% of blunt trauma patients are admitted for other injuries (orthopedic, head), providing opportunity for serial abdominal exams without immediate CT. ↗
▶ Ep 1 · 45:10
opinion Patients with one positive variable and reliable family living nearby could potentially be discharged home with return precautions rather than admitted or scanned. ↗
▶ Ep 1 · 1:23:09
clinical In the very low-risk population, you would need to scan 250 patients to find one intraabdominal injury. ↗
▶ Ep 1 · 1:23:50
clinical Mechanism of injury (rollover, prolonged extrication) was not predictive of intraabdominal injury in multivariate analysis in both PECARN and the 14-center study. ↗

Summaries Chris gave as host · 1 summary

Recaps of other experts' statements, not Chris's own clinical position.

Summaries Chris gave as host · Blunt Abdominal Trauma 1 summary

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Abdominal Evaluation: Pediatric Trauma Series 2017

▶ Ep 1 · 24:00
host summary Chris Streck summarizing the discussion: PECARN rule (history and physical only) has excellent negative predictive value for injury requiring urgent intervention (surgery, angio, transfusion) but misses many clinically relevant solid organ injuries that warrant admission or activity restriction. ↗