Rich Falcone

157 statements · 5 topics · summaries given as host listed separately

Featured statements

▶ Ep 10 · 8:54
The old ATLS was you give 20 per kilo, you see how they respond, then you give another 20 per kilo and see how they respond, and then you can just, you know, and only after that can you use blood. The the teaching, even in ATLS, ATLS is a little soft on saying go straight to blood, although I think that's the right thing in a situation like this if you have blood available, but they're very clear on now saying it's one, and if you get either transient or no response, you can go right to blood as the next, the next step.
quote · Trauma
▶ Ep 10 · 12:42
I mean, I'm most scared when you have a kid this age that's not crying, right? I mean a kid that doesn't respond to their IV stick or their IO or a kid that's crying a lot and then suddenly stops crying, that's who I'm most worried about in the trauma bay from a neurostatus.
quote · Trauma
▶ Ep 3 · 38:50
FAST is great if you have a hypotensive patient. Um, that you're really looking for the, the, as I'd say, the classic reason that FAS was developed, the hypotensive patient you're trying to prove, do they have a bunch of blood in their, in their abdomen or not.
quote · Cervical Spine Injury
▶ Ep 3 · 24:00
There's data that's a conservative management can work even if there is a duct disruption. They may get a pseudocyst, but those are manageable and drainable. But there's also data that says that takes longer, more TPN time, more hospital length of stay.
quote · Cervical Spine Injury
▶ Ep 9 · 10:15
A 12 kg kid's entire blood volume is gonna be about a liter.
quote · Early Assessment and Management of Trauma
▶ Ep 4 · 24:40
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.
opinion · Cervical Spine Injury

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Rich's statements about Blunt Abdominal Trauma 6 statements

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Abdominal Evaluation: Pediatric Trauma Series 2017

▶ Ep 1 · 1:00:51
epidemiological In a study comparing adolescent trauma care at adult versus pediatric centers, outcomes were equivalent or slightly better at pediatric centers with less imaging, shorter length of stay, and lower implied costs. ↗
▶ Ep 1 · 1:05:00
opinion Chest CT rarely changes management in pediatric trauma patients with normal chest X-ray or minor pulmonary contusions on plain film. ↗
▶ Ep 1 · 1:11:21
opinion For a 12-year-old with bilateral iliac crest tenderness but benign abdominal exam after MVC, observation with chest X-ray, screening labs, PO challenge for 1-2 hours, then discharge home if reliable family is appropriate—CT not required. ↗
▶ Ep 1 · 1:11:52
opinion Most pediatric trauma is cared for at adult trauma centers, not pediatric centers, so convincing adult surgeons of selective imaging protocols is essential to reducing unnecessary CT use. ↗
▶ Ep 1 · 1:14:00
opinion One or two episodes of emesis at the scene increases concern but may not mandate CT if subsequent exam remains benign; could admit for serial exams rather than scan. ↗
▶ Ep 1 · 1:16:29
clinical Delaying next abdominal exam for 6-8 hours in an admitted patient is not harmful for detecting delayed small bowel injury, which is well-tolerated in pediatric literature. ↗
Rich's statements about Cervical Spine Injury 30 statements

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Trauma

▶ Ep 3 · 3:08
clinical Cincinnati Children's Hospital is a Level 1 pediatric trauma center verified since 1993, seeing approximately 2000 trauma patients annually. ↗
▶ Ep 3 · 3:32
clinical At Cincinnati Children's, the emergency department physician serves as team leader for all traumas, chosen because they are present when every patient arrives. ↗
▶ Ep 3 · 4:36
quote I think there's a couple things that that we've learned. One is the, the ultimate risk of injury is actually pretty low, um, and C-spine, a C collar is often a useful adjunct, um, uh, that gives you time. ↗
▶ Ep 3 · 4:36
epidemiological The ultimate risk of C-spine injury in pediatric trauma is actually pretty low. ↗
▶ Ep 3 · 4:50
clinical 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. ↗
▶ Ep 3 · 9:20
clinical 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. ↗
▶ Ep 3 · 9:50
clinical 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. ↗
▶ Ep 3 · 11:40
quote I think the bottom line is trust your clinical exam, and I think we've, you know, across all pediatric surgery, probably in all adult surgery, have gone away from trusting your clinical exam and falling to imaging. ↗
▶ Ep 3 · 13:17
clinical 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. ↗
▶ Ep 3 · 21:35
quote I think the challenge in pancreas trauma is really trying to figure out is there a duct, a duct injury or not. I think that's, that's your number one, your number one question and your number one concern. ↗
▶ Ep 3 · 21:35
clinical The primary challenge in pancreatic trauma is determining whether there is a pancreatic duct injury, which is the number one concern. ↗
▶ Ep 3 · 22:40
clinical 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. ↗
▶ Ep 3 · 23:20
clinical 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. ↗
▶ Ep 3 · 24:00
quote There's data that's a conservative management can work even if there is a duct disruption. They may get a pseudocyst, but those are manageable and drainable. But there's also data that says that takes longer, more TPN time, more hospital length of stay. ↗
▶ Ep 3 · 24:40
opinion 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. ↗
▶ Ep 3 · 28:04
quote One of the things that that we struggled with is who's making that decision to that which kid needs to be screened and it and how much bias, how much bias there exists around that decision. ↗
▶ Ep 3 · 28:04
clinical 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. ↗
▶ Ep 3 · 30:20
clinical 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. ↗
▶ Ep 3 · 31:00
epidemiological 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. ↗
▶ Ep 3 · 31:00
quote Despite evaluating more kids, we would, you would have expected if you increased your denominator, um, you know, your percent positives, you know, positive abuse rates are going to drop. We actually didn't see that. We saw it stayed exactly the same. ↗
▶ Ep 3 · 31:40
opinion 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. ↗
▶ Ep 3 · 33:09
quote Families find it. More reassuring now with our new system, and it's easier, quite honestly, for us to be able to say we do this for every family with this type of injury. We're not making any judgment about you. We're not making any judgment about whether you're telling us the truth or not. ↗
▶ Ep 3 · 33:09
clinical 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. ↗
▶ Ep 3 · 33:20
clinical 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. ↗
▶ Ep 3 · 37:50
clinical 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. ↗
▶ Ep 3 · 38:30
quote Normal labs don't prove that you don't have an. Injury, they just make us feel better. ↗
▶ Ep 3 · 38:50
quote FAST is great if you have a hypotensive patient. Um, that you're really looking for the, the, as I'd say, the classic reason that FAS was developed, the hypotensive patient you're trying to prove, do they have a bunch of blood in their, in their abdomen or not. ↗
▶ Ep 3 · 41:34
clinical Cincinnati has not used angioembolization for solid organ injury in the last 4-5 years despite their high trauma volume. ↗
▶ Ep 3 · 48:08
clinical 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. ↗
▶ Ep 3 · 52:30
quote We found that doing this we would have had a under over triage rate of 39% and an under triage of of only 10 10%. ↗
Rich's statements about Cervical Spine Injury 30 statements

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Trauma

▶ Ep 4 · 3:08
clinical Cincinnati Children's Hospital is a Level 1 pediatric trauma center verified since 1993, seeing approximately 2000 trauma patients annually. ↗
▶ Ep 4 · 3:32
clinical At Cincinnati Children's, the emergency department physician serves as team leader for all traumas, chosen because they are present when every patient arrives. ↗
▶ Ep 4 · 4:36
quote I think there's a couple things that that we've learned. One is the, the ultimate risk of injury is actually pretty low, um, and C-spine, a C collar is often a useful adjunct, um, uh, that gives you time. ↗
▶ Ep 4 · 4:36
epidemiological The ultimate risk of C-spine injury in pediatric trauma is actually pretty low. ↗
▶ Ep 4 · 4:50
clinical 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. ↗
▶ Ep 4 · 9:20
clinical 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. ↗
▶ Ep 4 · 9:50
clinical 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. ↗
▶ Ep 4 · 11:40
quote I think the bottom line is trust your clinical exam, and I think we've, you know, across all pediatric surgery, probably in all adult surgery, have gone away from trusting your clinical exam and falling to imaging. ↗
▶ Ep 4 · 13:17
clinical 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. ↗
▶ Ep 4 · 21:35
quote I think the challenge in pancreas trauma is really trying to figure out is there a duct, a duct injury or not. I think that's, that's your number one, your number one question and your number one concern. ↗
▶ Ep 4 · 21:35
clinical The primary challenge in pancreatic trauma is determining whether there is a pancreatic duct injury, which is the number one concern. ↗
▶ Ep 4 · 22:40
clinical 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. ↗
▶ Ep 4 · 23:20
clinical 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. ↗
▶ Ep 4 · 24:00
quote There's data that's a conservative management can work even if there is a duct disruption. They may get a pseudocyst, but those are manageable and drainable. But there's also data that says that takes longer, more TPN time, more hospital length of stay. ↗
▶ Ep 4 · 24:40
opinion 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. ↗
▶ Ep 4 · 28:04
quote One of the things that that we struggled with is who's making that decision to that which kid needs to be screened and it and how much bias, how much bias there exists around that decision. ↗
▶ Ep 4 · 28:04
clinical 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. ↗
▶ Ep 4 · 30:20
clinical 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. ↗
▶ Ep 4 · 31:00
epidemiological 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. ↗
▶ Ep 4 · 31:00
quote Despite evaluating more kids, we would, you would have expected if you increased your denominator, um, you know, your percent positives, you know, positive abuse rates are going to drop. We actually didn't see that. We saw it stayed exactly the same. ↗
▶ Ep 4 · 31:40
opinion 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. ↗
▶ Ep 4 · 33:09
clinical 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. ↗
▶ Ep 4 · 33:09
quote Families find it. More reassuring now with our new system, and it's easier, quite honestly, for us to be able to say we do this for every family with this type of injury. We're not making any judgment about you. We're not making any judgment about whether you're telling us the truth or not. ↗
▶ Ep 4 · 33:20
clinical 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. ↗
▶ Ep 4 · 37:50
clinical 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. ↗
▶ Ep 4 · 38:30
quote Normal labs don't prove that you don't have an. Injury, they just make us feel better. ↗
▶ Ep 4 · 38:50
quote FAST is great if you have a hypotensive patient. Um, that you're really looking for the, the, as I'd say, the classic reason that FAS was developed, the hypotensive patient you're trying to prove, do they have a bunch of blood in their, in their abdomen or not. ↗
▶ Ep 4 · 41:34
clinical Cincinnati has not used angioembolization for solid organ injury in the last 4-5 years despite their high trauma volume. ↗
▶ Ep 4 · 48:08
clinical 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. ↗
▶ Ep 4 · 52:30
quote We found that doing this we would have had a under over triage rate of 39% and an under triage of of only 10 10%. ↗
Rich's statements about Early Assessment and Management of Trauma 19 statements

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ATLS 2021 Pediatric Surgery Update

▶ Ep 9 · 2:44
clinical The priorities when evaluating a small child with multi-system trauma are the same as for an adult patient: airway, breathing, circulation ↗
▶ Ep 9 · 2:44
quote The answer is actually a lot more simple than you think. Just go back to your ABC's. The key message though is it's the same. It's the same as you would do for an adult patient. ↗
▶ Ep 9 · 3:58
clinical Pediatric patients have more pliable chests so the ribs don't necessarily break, but they can have a lot of pulmonary contusions and other injuries ↗
▶ Ep 9 · 4:20
clinical Pediatric patients are more susceptible to tension pneumothorax because their mediastinum is more mobile and will shift more easily in response to that tension ↗
▶ Ep 9 · 5:06
clinical When children are laid on a backboard, their large occiput causes head flexion which can obstruct the airway; pediatric backboards have a cutout for the head or a bump to keep the torso higher and maintain ear in line with shoulder ↗
▶ Ep 9 · 5:06
clinical For pediatric airway management, start with simple maneuvers like a jaw thrust because children have big tongues and big heads ↗
▶ Ep 9 · 5:06
quote I love that rule, ear in line with the shoulder because little kids like this, they just got big heads. ↗
▶ Ep 9 · 6:13
quote You save the kid's life, but you give them a little, you know, tracheal ring damage and Subglottic stenosis, well, that's a lot better choice than being dead because you didn't do something. ↗
▶ Ep 9 · 6:13
guideline Needle cricothyroidotomy is recommended for children under 10 years old, while surgical cricothyroidotomy is for children over 10, according to ATLS guidelines ↗
▶ Ep 9 · 10:15
clinical Pediatric blood volume is calculated as weight in kilos times 80 mLs ↗
▶ Ep 9 · 10:15
clinical A 12 kg child's entire blood volume is about a liter, and a 25 kg child has about 2 liters ↗
▶ Ep 9 · 10:15
quote A 12 kg kid's entire blood volume is gonna be about a liter. ↗
▶ Ep 9 · 12:09
opinion A child who does not respond to IV stick or IO placement, or a child who is crying a lot and then suddenly stops crying, is most concerning from a neurostatus perspective in the trauma bay ↗
▶ Ep 9 · 12:09
quote I mean, I'm most scared when you have a kid this age that's not crying, right? I mean, a kid that doesn't respond to their IV stick or their IO is, or a kid that's crying a lot and then suddenly stops crying, that's who I'm most worried about in the trauma bay from a neurostatus. ↗
▶ Ep 9 · 12:09
clinical Glasgow Coma Scale can be performed in a nonverbal child; if they cannot talk normally, they do not lose points for the verbal component ↗
▶ Ep 9 · 12:09
clinical For verbal GCS scoring in nonverbal children: if they babble and say nonsense normally, they get full score; if irritable and crying, they get a 4; if just moaning, a 2; if doing nothing, that is most concerning ↗
▶ Ep 9 · 12:57
clinical Kids are more at risk for head injury because of big heads, soft skulls, and they often fall on their head ↗
▶ Ep 9 · 12:57
clinical Kids have more diffuse brain injuries in general than the adult population ↗
▶ Ep 9 · 12:57
epidemiological Child abuse is the most common cause of severe head injury in kids less than 2 years old ↗
Rich's statements about Trauma 72 statements

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Differences Between Pediatric & Adult Trauma Centers

▶ Ep 1 · 0:14
quote So these were seriously injured kids. ↗
▶ Ep 1 · 0:14
opinion Adult trauma centers need to achieve equivalent imaging and length of stay practices to pediatric trauma centers for adolescents, since 51% of this population presents to adult facilities. ↗
▶ Ep 1 · 0:14
epidemiological Adolescents treated at adult trauma centers were approximately 81% more likely to have an imaging study performed compared to those at pediatric trauma centers. ↗
▶ Ep 1 · 0:14
epidemiological Severely injured adolescents had shorter length of stay at pediatric trauma centers compared to adult trauma centers. ↗
▶ Ep 1 · 0:14
epidemiological Severely injured adolescents had shorter ICU length of stay at pediatric trauma centers compared to adult trauma centers. ↗
▶ Ep 1 · 0:14
epidemiological More adolescents were discharged to home (as opposed to rehab or skilled nursing facilities) when treated at pediatric trauma centers compared to adult trauma centers. ↗
▶ Ep 1 · 0:14
clinical There is substantial data showing pediatric trauma centers are better for young children, but evidence for adolescents aged 15-19 is less clear. ↗
▶ Ep 1 · 0:14
epidemiological The median injury severity score (ISS) in the study population was 33. ↗
▶ Ep 1 · 0:14
epidemiological 51% of severely injured adolescents in the study were treated at adult trauma centers and 49% at pediatric trauma centers. ↗
▶ Ep 1 · 0:14
epidemiological The National Trauma Data Bank study included patients aged 15-19 with injury severity scores greater than 25 over a 5-year period, totaling almost 13,000 patients. ↗
▶ Ep 1 · 0:14
opinion Mortality is not the most important or reliable outcome for pediatric trauma because most children survive once they reach a hospital. ↗
▶ Ep 1 · 0:14
opinion Pediatric trauma centers add value for children even up into the adolescent age range (15-19 years). ↗
▶ Ep 1 · 0:14
quote Hi everyone, I'm Rich Falcone, I'm professor of pediatric surgery at Cincinnati Children's ↗
▶ Ep 1 · 0:14
quote There's plenty of data that says pediatric trauma centers are certainly better for young kids, but that adolescent age, that 15 to 19 year olds are a little less less clear. ↗
▶ Ep 1 · 0:14
quote What they found, the big picture, no significant difference in outcomes, no difference in mortality, whether those kids. Care for an adult or a pediatric trauma center ↗
▶ Ep 1 · 0:14
quote looking at mortality for pediatric trauma is not the most important or not a reliable outcome since fortunately once they reach a hospital, most kids survive. ↗
▶ Ep 1 · 0:14
quote This article adds to the evidence that pediatric trauma centers add value for kids even up into that adolescent age range. ↗
▶ Ep 1 · 0:14
epidemiological A prior Ohio-only study showed no difference in outcomes for 15-19 year olds whether treated at adult or pediatric trauma centers. ↗
▶ Ep 1 · 0:14
epidemiological 45% of patients in the study had Glasgow Coma Scale scores less than 8, indicating severe brain injuries. ↗
▶ Ep 1 · 0:14
epidemiological There was no significant difference in mortality between severely injured adolescents treated at adult versus pediatric trauma centers. ↗
▶ Ep 1 · 3:15
clinical Pediatric trauma centers can achieve equivalent outcomes with less imaging by trusting clinical diagnosis and examination, avoiding unnecessary radiation exposure. ↗
▶ Ep 1 · 3:15
quote You can trust your clinical diagnosis. You can trust your clinical exam and evaluating these kids, and they don't need that radiation exposure. ↗

Differences Between Pediatric & Adult Trauma Centers

▶ Ep 3 · 0:14
opinion Pediatric trauma centers add value for children even up into the adolescent age range (15-19 years). ↗
▶ Ep 3 · 0:14
quote Hi everyone, I'm Rich Falcone, I'm professor of pediatric surgery at Cincinnati Children's ↗
▶ Ep 3 · 0:14
epidemiological There is plenty of data showing pediatric trauma centers are better for young children, but evidence for adolescents aged 15-19 is less clear. ↗
▶ Ep 3 · 0:14
opinion Mortality is not the most important or reliable outcome for pediatric trauma because most children survive once they reach a hospital. ↗
▶ Ep 3 · 0:14
opinion 51% of severely injured adolescents are going to adult trauma centers, so adult centers need to achieve equivalent imaging practices and length of stays to pediatric trauma centers. ↗
▶ Ep 3 · 3:15
clinical Clinical diagnosis and clinical examination can be trusted in evaluating severely injured adolescents without requiring extensive imaging. ↗
▶ Ep 3 · 3:15
clinical Severely injured adolescents do not need radiation exposure from extensive imaging when clinical evaluation is adequate. ↗
▶ Ep 3 · 3:15
quote You can trust your clinical diagnosis. You can trust your clinical exam and evaluating these kids, and they don't need that radiation exposure. ↗
▶ Ep 3 · 3:15
clinical Pediatric trauma centers can care for severely injured adolescents using less imaging while achieving the same outcomes and shorter lengths of stay. ↗

ATLS 2021 Pediatric Surgery Update

▶ Ep 7 · 2:44
quote The answer is actually a lot more simple than you think. Just go back to your ABC's. The key message though is it's the same. It's the same as you would do for an adult patient. ↗
▶ Ep 7 · 2:44
clinical The priorities when evaluating a small child with multi-system trauma are the same as for an adult patient: airway, breathing, circulation ↗
▶ Ep 7 · 3:58
clinical Pediatric patients have more pliable chests so the ribs don't necessarily break, but they can have a lot of pulmonary contusions and other injuries ↗
▶ Ep 7 · 4:20
clinical Pediatric patients are more susceptible to tension pneumothorax because their mediastinum is more mobile and will shift more easily in response to that tension ↗
▶ Ep 7 · 5:06
quote I love that rule, ear in line with the shoulder because little kids like this, they just got big heads. ↗
▶ Ep 7 · 5:06
clinical For pediatric airway management, start with simple maneuvers like a jaw thrust because children have big tongues and big heads ↗
▶ Ep 7 · 5:06
clinical When children are laid on a backboard, their large occiput causes head flexion which can obstruct the airway; pediatric backboards have a cutout for the head or a bump to keep the torso higher and maintain ear in line with shoulder ↗
▶ Ep 7 · 6:13
guideline Needle cricothyroidotomy is recommended for children under 10 years old, while surgical cricothyroidotomy is for children over 10, according to ATLS guidelines ↗
▶ Ep 7 · 6:13
quote You save the kid's life, but you give them a little, you know, tracheal ring damage and Subglottic stenosis, well, that's a lot better choice than being dead because you didn't do something. ↗
▶ Ep 7 · 10:15
clinical Pediatric blood volume is calculated as weight in kilos times 80 mLs ↗
▶ Ep 7 · 10:15
clinical A 12 kg child's entire blood volume is about a liter, and a 25 kg child has about 2 liters ↗
▶ Ep 7 · 10:15
quote A 12 kg kid's entire blood volume is gonna be about a liter. ↗
▶ Ep 7 · 12:09
clinical Glasgow Coma Scale can be performed in a nonverbal child; if they cannot talk normally, they do not lose points for the verbal component ↗
▶ Ep 7 · 12:09
clinical For verbal GCS scoring in nonverbal children: if they babble and say nonsense normally, they get full score; if irritable and crying, they get a 4; if just moaning, a 2; if doing nothing, that is most concerning ↗
▶ Ep 7 · 12:09
opinion A child who does not respond to IV stick or IO placement, or a child who is crying a lot and then suddenly stops crying, is most concerning from a neurostatus perspective in the trauma bay ↗
▶ Ep 7 · 12:09
quote I mean, I'm most scared when you have a kid this age that's not crying, right? I mean, a kid that doesn't respond to their IV stick or their IO is, or a kid that's crying a lot and then suddenly stops crying, that's who I'm most worried about in the trauma bay from a neurostatus. ↗
▶ Ep 7 · 12:57
clinical Kids are more at risk for head injury because of big heads, soft skulls, and they often fall on their head ↗
▶ Ep 7 · 12:57
clinical Kids have more diffuse brain injuries in general than the adult population ↗
▶ Ep 7 · 12:57
epidemiological Child abuse is the most common cause of severe head injury in kids less than 2 years old ↗

ATLS 2021 Pediatric Surgery Update

▶ Ep 10 · 2:51
quote The key message though is it's the same. It's the same as you would do for an adult patient. Don't get hyper acute that well this is a 3 year old and not a 30-year-old drunk guy who was in a car accident. Your priorities are going to be, it's going be the same. ↗
▶ Ep 10 · 2:51
guideline The priorities for evaluating a small child with multi-system trauma are the same as for an adult patient - ensure airway, breathing, and circulation. ↗
▶ Ep 10 · 3:58
clinical Pediatric patients have more pliable chests, so ribs don't necessarily break, but they can have significant pulmonary contusions and other injuries without obvious chest wall findings. ↗
▶ Ep 10 · 4:16
clinical Pediatric patients are more susceptible to tension pneumothorax because their mediastinum is more mobile and shifts more easily in response to tension. ↗
▶ Ep 10 · 5:17
clinical Children have large tongues and large heads; when placed on a backboard, the large occiput flexes the head forward and can obstruct the airway. ↗
▶ Ep 10 · 5:29
clinical Pediatric backboards should have a cutout for the head or a bump to keep the torso higher, maintaining the ear in line with the shoulder to prevent airway obstruction. ↗
▶ Ep 10 · 6:13
guideline ATLS recommends needle cricothyroidotomy for children under 10 years and surgical cricothyroidotomy for those over 10 years. ↗
▶ Ep 10 · 6:25
quote But at the same time, some of it is what you're most comfortable with. I mean we're also fortunate here that we have amazing ENT folks, so you save the kid's life, but you give them a little tracheal ring damage and Subglottic stenosis, well, that's a lot better choice than being dead because you didn't do something. ↗
▶ Ep 10 · 6:57
clinical A needle or surgical cricothyroidotomy is not a definitive airway; it buys time to get to the OR for a formal tracheostomy. ↗
▶ Ep 10 · 7:09
clinical For needle cricothyroidotomy, a 10 mL syringe with IV catheter can be used, and the IV catheter connects directly to an Ambu bag. ↗
▶ Ep 10 · 8:54
quote The old ATLS was you give 20 per kilo, you see how they respond, then you give another 20 per kilo and see how they respond, and then you can just, you know, and only after that can you use blood. The the teaching, even in ATLS, ATLS is a little soft on saying go straight to blood, although I think that's the right thing in a situation like this if you have blood available, but they're very clear on now saying it's one, and if you get either transient or no response, you can go right to blood as the next, the next step. ↗
▶ Ep 10 · 8:54
guideline The updated ATLS guideline recommends giving one 20 cc/kg crystalloid bolus, and if the patient shows transient or no response, proceeding directly to blood products (10 cc/kg) rather than giving a second crystalloid bolus. ↗
▶ Ep 10 · 10:21
clinical Pediatric blood volume is calculated as weight in kilograms times 80 mL. ↗
▶ Ep 10 · 10:55
clinical Massive transfusion protocols have been proven to help, with more data in adults but also supporting data in pediatrics. ↗
▶ Ep 10 · 12:11
clinical Glasgow Coma Scale can be assessed in nonverbal children; if a child cannot talk normally for their age, they do not lose verbal points. A normally babbling infant receives full verbal score; irritable crying scores 4; moaning scores 2; no response scores lowest. ↗
▶ Ep 10 · 12:42
clinical The most concerning neurologic sign in a young trauma patient is a child who does not cry or respond to painful stimuli like IV or IO placement, or a child who stops crying suddenly. ↗
▶ Ep 10 · 12:42
quote I mean, I'm most scared when you have a kid this age that's not crying, right? I mean a kid that doesn't respond to their IV stick or their IO or a kid that's crying a lot and then suddenly stops crying, that's who I'm most worried about in the trauma bay from a neurostatus. ↗
▶ Ep 10 · 13:05
clinical Children have more diffuse brain injuries in general than adults. ↗
▶ Ep 10 · 13:10
epidemiological Child abuse is the most common cause of severe head injury in children less than 2 years old. ↗
▶ Ep 10 · 13:11
clinical Children are more at risk for head injury because of large heads, soft skulls, and tendency to fall on their heads, resulting in diffuse rather than focal injuries. ↗
▶ Ep 10 · 14:22
clinical For blunt abdominal trauma, a validated multi-institutional algorithm uses five criteria: abdominal pain, abdominal wall trauma/tenderness/distension, abnormal chest X-ray, AST greater than 200, or abnormal pancreatic enzymes. Patients with none of these criteria (about 35% of the population) have 0.6% risk of intra-abdominal injury and 0.0% risk of requiring intervention. ↗
▶ Ep 10 · 15:16
clinical Having more than one positive criterion on the abdominal trauma algorithm increases risk of intra-abdominal injury; having all four criteria confers even higher risk. ↗

Summaries Rich gave as host · 75 summaries

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

Summaries Rich gave as host · Blunt Abdominal Trauma 4 summaries

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Abdominal Trauma with Dr. Richard Falcone

▶ Ep 5 · 3:12
host summary Rich Falcone summarizing a resource: In one study of 125 patients scanned after blunt abdominal trauma, 78% were scanned but only 15% had an identifiable injury. ↗
▶ Ep 5 · 7:44
host summary Rich Falcone summarizing a resource: ATOMIC guidelines for splenic injury, published in 2015, allow discharge when hemoglobin is greater than 7, patient can ambulate and tolerate regular diet, and hemoglobin is stable after two checks, regardless of injury grade. ↗
▶ Ep 5 · 11:30
host summary Rich Falcone summarizing a resource: AAST guidelines recommend observation for grade 1-2 pancreatic injuries and specific therapies for grade 4-5 injuries, but grade 3 injuries have ambiguous recommendations between observation and distal pancreatectomy. ↗
▶ Ep 5 · 13:23
host summary Rich Falcone summarizing a resource: A 20-institution study including Cincinnati Children's Hospital found that non-operative management of grade 3-5 pancreatic injuries produced good outcomes. ↗
Summaries Rich gave as host · Cervical Spine Injury 29 summaries

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Trauma

▶ Ep 3 · 6:04
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 7:20
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 16:07
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 18:48
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 22:00
host summary Rich Falcone summarizing a resource: There is increasing evidence that true pancreatic duct disruption is better treated with early distal pancreatectomy, ideally splenic-preserving, for grade 3 injuries. ↗
▶ Ep 3 · 24:00
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 26:45
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 28:40
host summary Rich Falcone summarizing a resource: If I see someone who looks like me and, um, is from the same neighborhood as me, um, I'm less likely to, to be suspicious of them as, as abusing their child, even with the same injury pattern. As someone who may be from more typically is from a lower SES group looks different than me from different racial or ethnic background, folks are, whether we admit it or not, are more likely to screen those kids. ↗
▶ Ep 3 · 29:20
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 34:48
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 36:24
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 37:00
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 38:30
host summary Rich Falcone summarizing a resource: Eric Scaife from Utah published that using FAST to screen low-risk children was giving false security due to the test's low sensitivity. ↗
▶ Ep 3 · 38:30
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 39:39
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 42:10
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 43:00
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 44:00
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 44:50
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 45:50
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 46:30
host summary Rich Falcone summarizing a resource: Very few grade 1 solid organ injuries require transfusion, so the lab draws initially outlined in Stylianos' paper are probably unnecessary. ↗
▶ Ep 3 · 47:00
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 47:50
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 48:32
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 49:40
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 50:30
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 51:20
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 52:30
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 3 · 53:20
host summary Rich Falcone summarizing a resource: 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. ↗
Summaries Rich gave as host · Cervical Spine Injury 29 summaries

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Trauma

▶ Ep 4 · 6:04
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 7:20
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 16:07
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 18:48
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 22:00
host summary Rich Falcone summarizing a resource: There is increasing evidence that true pancreatic duct disruption is better treated with early distal pancreatectomy, ideally splenic-preserving, for grade 3 injuries. ↗
▶ Ep 4 · 24:00
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 26:45
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 28:40
host summary Rich Falcone summarizing a resource: If I see someone who looks like me and, um, is from the same neighborhood as me, um, I'm less likely to, to be suspicious of them as, as abusing their child, even with the same injury pattern. As someone who may be from more typically is from a lower SES group looks different than me from different racial or ethnic background, folks are, whether we admit it or not, are more likely to screen those kids. ↗
▶ Ep 4 · 29:20
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 34:48
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 36:24
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 37:00
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 38:30
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 38:30
host summary Rich Falcone summarizing a resource: Eric Scaife from Utah published that using FAST to screen low-risk children was giving false security due to the test's low sensitivity. ↗
▶ Ep 4 · 39:39
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 42:10
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 43:00
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 44:00
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 44:50
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 45:50
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 46:30
host summary Rich Falcone summarizing a resource: Very few grade 1 solid organ injuries require transfusion, so the lab draws initially outlined in Stylianos' paper are probably unnecessary. ↗
▶ Ep 4 · 47:00
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 47:50
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 48:32
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 49:40
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 50:30
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 51:20
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 52:30
host summary Rich Falcone summarizing a resource: 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. ↗
▶ Ep 4 · 53:20
host summary Rich Falcone summarizing a resource: 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. ↗
Summaries Rich gave as host · Early Assessment and Management of Trauma 1 summary

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ATLS 2021 Pediatric Surgery Update

▶ Ep 9 · 0:40
host summary Rich Falcone summarizing a resource: Rich Falcone is a pediatric surgeon and the director of trauma services at Cincinnati Children's Hospital Medical Center ↗
Summaries Rich gave as host · Trauma 12 summaries

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Differences Between Pediatric & Adult Trauma Centers

▶ Ep 3 · 0:14
host summary Rich Falcone summarizing a resource: A previous study looking at Ohio data showed no difference in outcomes for adolescents aged 15-19 whether treated at adult or pediatric trauma centers. ↗
▶ Ep 3 · 0:14
host summary Rich Falcone summarizing a resource: The study by Ashley Walther et al. used the National Trauma Data Bank and included patients aged 15-19 with injury severity scores greater than 25. ↗
▶ Ep 3 · 0:14
host summary Rich Falcone summarizing a resource: Over a 5-year period, the study identified almost 13,000 patients meeting the inclusion criteria, with 51% treated at adult trauma centers and 49% at pediatric trauma centers. ↗
▶ Ep 3 · 0:14
host summary Rich Falcone summarizing a resource: The patient groups at adult and pediatric trauma centers were demographically very similar without significant differences. ↗
▶ Ep 3 · 0:14
host summary Rich Falcone summarizing a resource: The median injury severity score (ISS) for the study population was 33. ↗
▶ Ep 3 · 0:14
host summary Rich Falcone summarizing a resource: 45% of patients in the study had a Glasgow Coma Score of less than 8, indicating severe brain injuries. ↗
▶ Ep 3 · 0:14
host summary Rich Falcone summarizing a resource: There was no significant difference in mortality between adolescents treated at adult versus pediatric trauma centers. ↗
▶ Ep 3 · 0:14
host summary Rich Falcone summarizing a resource: Adolescents treated at adult trauma centers were approximately 81% more likely to have an imaging study performed compared to those at pediatric trauma centers. ↗
▶ Ep 3 · 0:14
host summary Rich Falcone summarizing a resource: Patients at pediatric trauma centers had shorter length of stay compared to those at adult trauma centers. ↗
▶ Ep 3 · 0:14
host summary Rich Falcone summarizing a resource: Patients at pediatric trauma centers had shorter ICU length of stay compared to those at adult trauma centers. ↗
▶ Ep 3 · 0:14
host summary Rich Falcone summarizing a resource: More patients were discharged to home (as opposed to rehab or skilled nursing facilities) when cared for at pediatric trauma centers compared to adult trauma centers. ↗

ATLS 2021 Pediatric Surgery Update

▶ Ep 7 · 0:40
host summary Rich Falcone summarizing a resource: Rich Falcone is a pediatric surgeon and the director of trauma services at Cincinnati Children's Hospital Medical Center ↗