20 statements
· 1 topic
· summaries given as host listed separately
Featured statements
▶Ep 2 · 13:48
The 2012 PECARN prediction model using only history and physical exam was very sensitive for injuries requiring acute intervention but missed many clinically relevant solid organ injuries
A modified low-risk group (55% of patients) with fewer than all five variables positive has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention
epidemiological97% of pediatric blunt trauma patients presenting to trauma centers are hemodynamically stable↗
▶Ep 2 · 3:59
clinicalBowel injury is difficult to assess on CT scan even when solid organ injuries can be identified↗
▶Ep 2 · 3:59
quoteSo, a lot of surgeons may not see that very often, but it really means that there's a tremendous amount of force that's been generated against the patient uh and so you really need to be vigilant that that child does not have an underlying abdominal injury.↗
▶Ep 2 · 13:48
epidemiological90% of pediatric trauma patients present to non-pediatric centers where pan-CT is standard practice↗
▶Ep 2 · 13:48
epidemiologicalLess than 12% of pediatric patients scanned for blunt abdominal trauma have an intra-abdominal injury↗
▶Ep 2 · 13:48
epidemiologicalCT scan ordering rates for pediatric blunt abdominal trauma varied from 4% to 96% across 14 participating trauma centers↗
▶Ep 2 · 13:48
clinicalThe 2012 PECARN prediction model using only history and physical exam was very sensitive for injuries requiring acute intervention but missed many clinically relevant solid organ injuries↗
▶Ep 2 · 13:48
epidemiologicalFewer than 3% of pediatric blunt trauma patients with severe mechanisms have an injury requiring acute intervention↗
▶Ep 2 · 19:37
clinicalThe five-variable model identifies 34% of pediatric blunt trauma patients who can safely avoid abdominal CT↗
clinicalWhen all five prediction variables are negative, the risk of intra-abdominal injury is 0.6% and risk of injury requiring acute intervention is 0%↗
▶Ep 2 · 19:37
clinicalThe negative predictive value of the five-variable model was 100% for injury requiring intervention and 99.4% for all injuries↗
▶Ep 2 · 19:37
clinicalA modified low-risk group (55% of patients) with fewer than all five variables positive has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention↗
▶Ep 2 · 22:28
clinicalClinicians can wait up to one hour for laboratory results (AST, lipase) before deciding on abdominal CT in stable patients with reliable exams↗
▶Ep 2 · 24:20
clinicalModern multi-slice CT scanners typically show subtle findings (even without free air) that raise concern for hollow viscus injury↗
▶Ep 2 · 24:20
clinicalOral contrast does not add diagnostic value for identifying small bowel or colonic injuries in pediatric blunt trauma↗
▶Ep 2 · 26:31
clinicalLaparoscopy is extremely helpful in 2017 for patients with moderate free fluid and no hard signs of small bowel perforation↗
▶Ep 2 · 26:31
quoteI think uh this is a different era than you know, 20 years ago where patients went for DPL or immediately for a a big lapartomy. We're pretty good at laparoscopy now and it's very rare in my opinion that you would miss something doing a laparoscopic exploration.↗
▶Ep 2 · 27:37
clinicalEither amylase or lipase is acceptable for pancreatic injury screening; institutions vary in which enzyme they use↗
▶Ep 2 · 28:33
clinicalThe five-variable prediction model has been validated in the publicly available PECARN dataset with significant negative predictive value↗
Summaries Christian gave as host
· 2 summaries
Recaps of other experts' statements, not Christian's own clinical position.
Summaries Christian gave as host · Blunt Abdominal Trauma2 summaries
host summaryChristian Streck summarizing the discussion: Adult trauma literature suggests pan-CT is safer, has fewer missed injuries, and is more cost-effective↗
▶Ep 2 · 26:06
host summaryChristian Streck summarizing the discussion: An APSA study supports that missed bowel injury diagnosed within 24 hours does not increase morbidity↗
