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Thoracoabdominal Trauma

Trauma is the leading cause of morbidity and mortality in children. Children have unique injury patterns and substantial differences in their response to trauma when compared with adults; this requires special consideration when addressing the assessment and management of pediatric trauma.

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Key Resources English (2) French All (2)

Bottom Line Recommendations: Multisystem Trauma

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Beno S, TREKK Network

The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of multisystem trauma in children in the emergency department. Published online: January 14, 2021, Version 3.0.

Recommendations de Base: Polytrauma

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Beno S, TREKK Network

Le but du present document est de fournir aux professionnels de la sant les faits et recommandations cles pour le diagnostic et le traitement du polytrauma chez les enfants dans un service durgence. Published online: January 14, 2021, Version 3.0.

Bottom Line Recommendations: Multisystem Trauma

Download

Beno S, TREKK Network

The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of multisystem trauma in children in the emergency department. Published online: January 14, 2021, Version 3.0.

Recommendations de Base: Polytrauma

Download

Beno S, TREKK Network

Le but du present document est de fournir aux professionnels de la sant les faits et recommandations cles pour le diagnostic et le traitement du polytrauma chez les enfants dans un service durgence. Published online: January 14, 2021, Version 3.0.

Clinical guidelines English (9) French All (9)

Liver trauma: WSES 2020 guidelines

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Coccolini, F., Coimbra, R., Ordonez, C. et al.

Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.

Pediatric Trauma Society Clinical Practice Guidelines

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Pediatric Trauma Society

These guidelines have been supplied by a hospital as an example of a clinical practice guideline to provide clinicians at that institution with an analytical framework for the evaluation and treatment of a particular diagnosis or condition.

Advanced Trauma Life Support Update 2019: Management and Applications for Adults and Special Populations

Visit

Galvagno SM Jr, Nahmias JT, Young DA.

As the principal operating room resuscitationists, anesthesiologists must be familiar with the principles of Advanced Trauma Life Support, 10th edition. This edition recommends a highly structured approach to trauma patients and endorses several advances in trauma resuscitation. There are less stringent guidelines for crystalloid administration, references to video-assisted laryngoscopy, suggested use of viscoelastic methods to guide transfusion decisions, and other changes reflecting recent advances. This article discusses trauma team approach to resuscitation, greater focus on special populations, de-emphasis of spinal immobilization in favor of restriction of spinal motion, and other updates and technical advances.

Pediatric Cervical Spine Clearance: A Consensus Statement and Algorithm from the Pediatric Cervical Spine Clearance Working Group

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Herman MJ, Brown KO, Sponseller PD, et al.

The Pediatric Cervical Spine Clearance Working Group (PCSCWG), a subgroup of the Pediatric Cervical Spine Study Group, recognized the need for a consensus on comprehensive standardized guidelines for pediatric cervical spine clearance based on the best available evidence. We established a multidisciplinary group of practitioners with expertise in cervical spine clearance for injured children and applied the Delphi method and the nominal group technique to create consensus statements regarding pediatric cervical spine clearance in young patients who have experienced blunt trauma. The consensus statements were used to develop an algorithm to guide institutional protocols for cervical spine clearance.

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

Visit

Spahn DR, Bouillon B, Cerny V, et al.

Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were re-examined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated.

ACR Appropriateness Criteria: Suspected Spine Trauma [see section "Pediatric Patients" starting page 12]

Visit

American College of Radiology,

Clinical guidelines on radiologic procedures for suspected spine trauma.

Radiation Risks and Pediatric Computed Tomography (CT): A Guide for Health Care Providers

Visit

National Cancer Institute,

This page discusses the value of CT and the importance of minimizing the radiation dose, especially in children.

Spinal Motion Restriction in the Trauma Patient - A Joint Position Statement

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Fischer PE, Perina DG, Delbridge TR, et al.

The American College of Surgeons Committee on Trauma (ACS-COT), American College of Emergency Physicians (ACEP), and the National Association of EMS Physicians (NAEMSP) have previously offered varied guidance on the role of backboards and spinal immobilization in out-of-hospital situations. This updated consensus statement on spinal motion restriction in the trauma patient represents the collective positions of the ACS-COT, ACEP and NAEMSP. It has further been formally endorsed by a number of national stakeholder organizations. This updated uniform guidance is intended for use by emergency medical services (EMS) personnel, EMS medical directors, emergency physicians, trauma surgeons, and nurses as they strive to improve the care of trauma victims within their respective domains.

Trauma Association of Canada pediatric subcommittee national pediatric cervical spine evaluation pathway: consensus guidelines

Visit

Chung S, Mikrogianakis A, Wales PW, et al.

The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote "best practices" and improve patient outcomes. In 2006, The Trauma Association of Canada Pediatric Committee set out to create an evidence-based, national pediatric cervical spine (c-spine) clearance guideline based on the literature, existing algorithms from each pediatric trauma center and from expert opinion from across Canada. A review of the literature took place in September 2006 using the PubMed database. A consensus was reached on two pathways to evaluate the pediatric cervical spine: a patient with a reliable clinical examination and a patient with an unreliable examination. Presented herein are the consensus Trauma Association of Canada, National Pediatric Cervical Spine Evaluation Pathways for the patient with a reliable clinical examination, and the patient with and unreliable clinical examination.

Liver trauma: WSES 2020 guidelines

Visit

Coccolini, F., Coimbra, R., Ordonez, C. et al.

Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.

Pediatric Trauma Society Clinical Practice Guidelines

Visit

Pediatric Trauma Society

These guidelines have been supplied by a hospital as an example of a clinical practice guideline to provide clinicians at that institution with an analytical framework for the evaluation and treatment of a particular diagnosis or condition.

Advanced Trauma Life Support Update 2019: Management and Applications for Adults and Special Populations

Visit

Galvagno SM Jr, Nahmias JT, Young DA.

As the principal operating room resuscitationists, anesthesiologists must be familiar with the principles of Advanced Trauma Life Support, 10th edition. This edition recommends a highly structured approach to trauma patients and endorses several advances in trauma resuscitation. There are less stringent guidelines for crystalloid administration, references to video-assisted laryngoscopy, suggested use of viscoelastic methods to guide transfusion decisions, and other changes reflecting recent advances. This article discusses trauma team approach to resuscitation, greater focus on special populations, de-emphasis of spinal immobilization in favor of restriction of spinal motion, and other updates and technical advances.

Pediatric Cervical Spine Clearance: A Consensus Statement and Algorithm from the Pediatric Cervical Spine Clearance Working Group

Visit

Herman MJ, Brown KO, Sponseller PD, et al.

The Pediatric Cervical Spine Clearance Working Group (PCSCWG), a subgroup of the Pediatric Cervical Spine Study Group, recognized the need for a consensus on comprehensive standardized guidelines for pediatric cervical spine clearance based on the best available evidence. We established a multidisciplinary group of practitioners with expertise in cervical spine clearance for injured children and applied the Delphi method and the nominal group technique to create consensus statements regarding pediatric cervical spine clearance in young patients who have experienced blunt trauma. The consensus statements were used to develop an algorithm to guide institutional protocols for cervical spine clearance.

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

Visit

Spahn DR, Bouillon B, Cerny V, et al.

Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were re-examined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated.

ACR Appropriateness Criteria: Suspected Spine Trauma [see section "Pediatric Patients" starting page 12]

Visit

American College of Radiology,

Clinical guidelines on radiologic procedures for suspected spine trauma.

Radiation Risks and Pediatric Computed Tomography (CT): A Guide for Health Care Providers

Visit

National Cancer Institute,

This page discusses the value of CT and the importance of minimizing the radiation dose, especially in children.

Spinal Motion Restriction in the Trauma Patient - A Joint Position Statement

Visit

Fischer PE, Perina DG, Delbridge TR, et al.

The American College of Surgeons Committee on Trauma (ACS-COT), American College of Emergency Physicians (ACEP), and the National Association of EMS Physicians (NAEMSP) have previously offered varied guidance on the role of backboards and spinal immobilization in out-of-hospital situations. This updated consensus statement on spinal motion restriction in the trauma patient represents the collective positions of the ACS-COT, ACEP and NAEMSP. It has further been formally endorsed by a number of national stakeholder organizations. This updated uniform guidance is intended for use by emergency medical services (EMS) personnel, EMS medical directors, emergency physicians, trauma surgeons, and nurses as they strive to improve the care of trauma victims within their respective domains.

Trauma Association of Canada pediatric subcommittee national pediatric cervical spine evaluation pathway: consensus guidelines

Visit

Chung S, Mikrogianakis A, Wales PW, et al.

The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote "best practices" and improve patient outcomes. In 2006, The Trauma Association of Canada Pediatric Committee set out to create an evidence-based, national pediatric cervical spine (c-spine) clearance guideline based on the literature, existing algorithms from each pediatric trauma center and from expert opinion from across Canada. A review of the literature took place in September 2006 using the PubMed database. A consensus was reached on two pathways to evaluate the pediatric cervical spine: a patient with a reliable clinical examination and a patient with an unreliable examination. Presented herein are the consensus Trauma Association of Canada, National Pediatric Cervical Spine Evaluation Pathways for the patient with a reliable clinical examination, and the patient with and unreliable clinical examination.

Overviews of systematic reviews English (2) French All (2)

Treatment of severe blunt pancreatic lesions in children

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Haugaard MV, Wettergren A, Hillings JG, Gluud C, Penninga L,

This review shows that strategies regarding non-operative versus operative treatment of severe blunt pancreatic trauma in children are not based on randomised clinical trials.

Should prophylactic antibiotics be used in patients with penetrating abdominal trauma?

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Brand M, Grieve A,

No randomised controlled trials could be found that met the inclusion criteria for this review.

Treatment of severe blunt pancreatic lesions in children

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Haugaard MV, Wettergren A, Hillings JG, Gluud C, Penninga L,

This review shows that strategies regarding non-operative versus operative treatment of severe blunt pancreatic trauma in children are not based on randomised clinical trials.

Should prophylactic antibiotics be used in patients with penetrating abdominal trauma?

Visit

Brand M, Grieve A,

No randomised controlled trials could be found that met the inclusion criteria for this review.

Systematic reviews English (9) French All (9)

Pediatric trauma triage: A Pediatric Trauma Society Research Committee systematic review

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Mora MC, Veras L, Burke RV, et al.

This study evaluated existing evidence for pediatric trauma triage. Questions defined a priori were as follows: (1) Do prehospital trauma triage criteria reduce mortality? (2) Do prehospital trauma scoring systems predict outcomes? (3) Do trauma center activation criteria predict outcomes? (4) Do trauma center activation criteria predict need for procedural or operative interventions? (5) Do trauma bay pediatric trauma scoring systems predict outcomes? (6) What secondary triage criteria for transfer of children exist?

Non-operative management of solid organ injuries in children: An American Pediatric Surgical Association outcomes and evidence based practice committee systematic review.

Visit

Gates RL, Price M, Cameron DB, et al.

The American Pediatric Surgical Association (APSA) guidelines for the treatment of isolated solid organ injury (SOI) in children were published in 2000 and have been widely adopted. The aim of this systematic review by the APSA Outcomes and Evidence Based Practice Committee was to evaluate the published evidence regarding treatment of solid organ injuries in children.

Pointofcare ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma

Visit

Stengel D, Leisterer J, Ferrada P, et al.

To determine the diagnostic accuracy of POCS for detecting and excluding free fluid, organ injuries, vascular lesions, and other injuries (e.g. pneumothorax) compared to a diagnostic reference standard (i.e. computed tomography (CT), magnetic resonance imaging (MRI), thoracoscopy or thoracotomy, laparoscopy or laparotomy, autopsy, or any combination of these) in patients with blunt trauma.

Pediatric Massive Transfusion: A Systematic Review

Visit

Maw G, Furyk C.

Balanced resuscitation of plasma, platelets, and red blood cells is now recognized as improving outcomes in traumatic bleeding in adults. The correct approach in children has yet to be determined. We performed a systematic review of the literature into transfusion protocols in traumatic hemorrhage in children by conducting an article search of significant databases to identify relevant articles.

Avoiding Errors in the Management of Pediatric Polytrauma Patients

Visit

Chin K, Abzug JM, Bae DS, Horn BD, Herman M, Eberson CP,

Lecture on management of pediatric polytrauma patients.

Antifibrinolytic drugs for acute traumatic injury

Visit

Ker K, Roberts I, Shakur H, Coats TJ,

Review to assess the effect of antifibrinolytic drugs in patients with acute traumatic injury.

Thromboprophylaxis for trauma patients

Visit

Barrera LM, Perel P, Ker K, Cirocchi R, Farinella E, Morales Uribe CH,

Review to assess the effects of thromboprophylaxis in trauma patients on mortality and incidence of deep vein thrombosis and pulmonary embolism and to compare the effects of different thromboprophylaxis interventions and their effects according to the type of trauma.

Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma

Visit

Stengel D, Bauwens K, Rademacher G, Ekkernkamp A, Gthoff C,

Review to assess the effects of trauma algorithms that include ultrasound examinations in patients with suspected blunt abdominal trauma.

Selective computed tomography (CT) versus routine thoracoabdominal CT for high-energy blunt-trauma patients

Visit

Van Vugt R, Keus F, Kool D, Deunk J, Edwards M,

Review to assess the effects of routine thoracoabdominal CT compared with selective thoracoabdominal CT on mortality in blunt high-energy trauma patients.

Pediatric trauma triage: A Pediatric Trauma Society Research Committee systematic review

Visit

Mora MC, Veras L, Burke RV, et al.

This study evaluated existing evidence for pediatric trauma triage. Questions defined a priori were as follows: (1) Do prehospital trauma triage criteria reduce mortality? (2) Do prehospital trauma scoring systems predict outcomes? (3) Do trauma center activation criteria predict outcomes? (4) Do trauma center activation criteria predict need for procedural or operative interventions? (5) Do trauma bay pediatric trauma scoring systems predict outcomes? (6) What secondary triage criteria for transfer of children exist?

Non-operative management of solid organ injuries in children: An American Pediatric Surgical Association outcomes and evidence based practice committee systematic review.

Visit

Gates RL, Price M, Cameron DB, et al.

The American Pediatric Surgical Association (APSA) guidelines for the treatment of isolated solid organ injury (SOI) in children were published in 2000 and have been widely adopted. The aim of this systematic review by the APSA Outcomes and Evidence Based Practice Committee was to evaluate the published evidence regarding treatment of solid organ injuries in children.

Pointofcare ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma

Visit

Stengel D, Leisterer J, Ferrada P, et al.

To determine the diagnostic accuracy of POCS for detecting and excluding free fluid, organ injuries, vascular lesions, and other injuries (e.g. pneumothorax) compared to a diagnostic reference standard (i.e. computed tomography (CT), magnetic resonance imaging (MRI), thoracoscopy or thoracotomy, laparoscopy or laparotomy, autopsy, or any combination of these) in patients with blunt trauma.

Pediatric Massive Transfusion: A Systematic Review

Visit

Maw G, Furyk C.

Balanced resuscitation of plasma, platelets, and red blood cells is now recognized as improving outcomes in traumatic bleeding in adults. The correct approach in children has yet to be determined. We performed a systematic review of the literature into transfusion protocols in traumatic hemorrhage in children by conducting an article search of significant databases to identify relevant articles.

Avoiding Errors in the Management of Pediatric Polytrauma Patients

Visit

Chin K, Abzug JM, Bae DS, Horn BD, Herman M, Eberson CP,

Lecture on management of pediatric polytrauma patients.

Antifibrinolytic drugs for acute traumatic injury

Visit

Ker K, Roberts I, Shakur H, Coats TJ,

Review to assess the effect of antifibrinolytic drugs in patients with acute traumatic injury.

Thromboprophylaxis for trauma patients

Visit

Barrera LM, Perel P, Ker K, Cirocchi R, Farinella E, Morales Uribe CH,

Review to assess the effects of thromboprophylaxis in trauma patients on mortality and incidence of deep vein thrombosis and pulmonary embolism and to compare the effects of different thromboprophylaxis interventions and their effects according to the type of trauma.

Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma

Visit

Stengel D, Bauwens K, Rademacher G, Ekkernkamp A, Gthoff C,

Review to assess the effects of trauma algorithms that include ultrasound examinations in patients with suspected blunt abdominal trauma.

Selective computed tomography (CT) versus routine thoracoabdominal CT for high-energy blunt-trauma patients

Visit

Van Vugt R, Keus F, Kool D, Deunk J, Edwards M,

Review to assess the effects of routine thoracoabdominal CT compared with selective thoracoabdominal CT on mortality in blunt high-energy trauma patients.

Key studies English (1) French All (1)

Key Study: Coagulopathy is prevalent and associated with adverse outcomes in transfused pediatric trauma patients

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Hendrickson JE, Shaz BH, Pereira G, Atkins E, Johnson KK, Bao G, Easley KA, J...

A study to evaluate coagulopathy in pediatric trauma patients on presentation to the emergency department, and to quantify the relationship with mortality.

Key Study: Coagulopathy is prevalent and associated with adverse outcomes in transfused pediatric trauma patients

Visit

Hendrickson JE, Shaz BH, Pereira G, Atkins E, Johnson KK, Bao G, Easley KA, J...

A study to evaluate coagulopathy in pediatric trauma patients on presentation to the emergency department, and to quantify the relationship with mortality.