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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.

Based upon an identified need for trauma education resources, we sought to create a unique video that delivers high yield information on community trauma management and transport. This project was a collaborative effort with input from a diverse group of community emergency physicians and academic pediatric and adult trauma care providers and covers important commonalities and differences when caring for diverse patient populations. Of note, the video briefly references Ontario specific trauma services, however, the core content of the video is applicable to trauma care across Canada.

This point of care algorithm is to guide initial management of pediatric multisystem trauma in the Emergency Department. Published online: June 2020, Version 1.0.

This order set is for management of pediatric multisystem trauma in the ED and is adaptable to your hospitals form policy. Published online: June 2020, Version 1.0.

This checklist is for management of pediatric multisystem in the ED pre-arrival and post-departure. Published online: June 2020, Version 1.0.

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.

This point of care algorithm is to guide initial management of pediatric multisystem trauma in the Emergency Department. Published online: June 2020, Version 1.0.

This checklist is for management of pediatric multisystem in the ED pre-arrival and post-departure. Published online: June 2020, Version 1.0.

This order set is for management of pediatric multisystem trauma in the ED and is adaptable to your hospitals form policy. Published online: June 2020, Version 1.0.

The purpose of this statement is to describe issues related to head trauma in infants, children and youth, including clinical manifestations, initial management priorities, guidelines for imaging, and subsequent observation and treatment.

The Multidisciplinary Guidelines on the Identification, Investigation and Management of Suspected Abusive Head Trauma have been prepared in order to provide community organizations with assistance in developing local protocols for managing cases of Abusive Head Trauma. The guidelines are intended to be generic enough that large or small communities can use them to help develop a resoinse appropriate to their specific circumstances.

Peripheral Neurovascular Checklist.

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.

Clinical guidelines on radiologic procedures for suspected spine trauma.

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.

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.

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.

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.

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.

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

OBJECTIVES: To assess the effectiveness and safety of once-daily versus multiple-daily dosing of intravenous aminoglycoside antibiotics for the management of pulmonary exacerbations in cystic fibrosis.

OBJECTIVES: To evaluate the efficacy and safety of antiepileptic treatments in patients with MS.

OBJECTIVES: To evaluate the benefits to both mother and infant of multiple-micronutrient supplements in pregnancy and to assess the risk of adverse events as a result of supplementation.

OBJECTIVES: To assess the effects of specialised diets or nutritional advice for women with multiple pregnancies (two or more fetuses).

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.

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?

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

Aim: To report the retinal signs that distinguish abusive head trauma (AHT) from non-abusive head trauma (nAHT).

Objective: To systematically review the literature to determine which clinical and radiographic characteristics are associated with abusive head trauma (AHT) and nonabusive head trauma (nAHT) in children.

Objective: To identify the evidence base behind the neuroradiological features that differentiate abusive head trauma (AHT) from non-abusive head trauma (nAHT).

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.

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

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

There is still a considerable amount of confusion when it comes to managing concussions. An excessive number of head computed tomographic scans are being obtained for concussions, resulting in unnecessary exposure to ionizing radiation. Clinicians should be aware of the most recent guidelines for the management of concussion, including the need for imaging, and should be able to differentiate mild from moderate and severe traumatic brain injury.

Monitoring of intracranial pressure (ICP) is an important and integrated part of the treatment algorithm for children with severe traumatic brain injury (TBI). Guidelines often recommend ICP monitoring with a treatment threshold of 20 mmHg. This focused review discusses; (1) different ICP technologies and how ICP should be monitored in pediatric patients with severe TBI, (2) existing evidence behind guideline recommendations, and (3) how we could move forward to increase knowledge about normal ICP in children to support treatment decisions.

Provides new and updated recommendations applicable to the emergency department management of children with severe traumatic brain injury. Practice-changing takeaways include specific recommendations for administration of 3% hypertonic saline, administration of seizure prophylaxis, and avoiding hyperventilation.

OBJECTIVES: To quantify the effects of antifibrinolytic drugs on mortality, vascular occlusive events, surgical intervention and receipt of blood transfusion after acute traumatic injury.

OBJECTIVES: The objective was to assess the safety and effectiveness of beta-2 receptor antagonists for TBI.

OBJECTIVES: To assess the effects of secondary decompressive craniectomy (DC) on outcome and quality of life in patients with severe TBI in whom conventional medical therapeutic measures have failed to control raised ICP.

OBJECTIVES: To quantify the effect of hyperventilation on death and neurological disability following head injury.

OBJECTIVES: To assess the effectiveness and safety of progesterone in people with acute TBI.

OBJECTIVES: To determine the effect on time to healing of primary closure versus delayed closure for non bite traumatic wounds presenting within 24 hours post injury. To explore the adverse effects of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours post injury.

To measure the effectiveness of a set of interventions in improving the rate and timeliness of analgesic medication administration, as well as appropriate backslab immobilization (application of a moldable plaster or fiberglass splint), in a pediatric ED.

Objective: To assess the diagnostic accuracy of bedside ultrasound for fractures in pediatric trauma patients.

To assess whether pediatrictraumapatientsinitially evaluated at referring institutions met Massachusetts statewidetraumafield triage criteria for stabilization and immediate transfer to a PediatricTraumaCenter (PTC) without pre-transfer CT imaging.

To reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population.

To determine whether early coagulopathy affects the mortality associated with severe civilian pediatrictrauma,traumapatientsyounger than 18 years admitted to a pediatric intensive care unit from 2001 to 2010 were evaluated.

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

Objective: To determine whether there are differences in fracture patterns and femur fracture treatment choices in obese versus nonobese pediatric trauma patients.

Our objective was to conduct a pilot study to identify discriminating bruising characteristics and to model those findings into a decision tool for screening children at high risk forabuse.

Infants with minor abusive injuries are at risk for more serious abusive injury, including abusive head trauma (AHT). Our study objective was to determine if children with AHT had prior opportunities to detect abuse and to describe the opportunities.

This article describes the evidence base behind the associated historical, clinical and neuroradiological features of abusive head trauma and spinal injury in physical abuse and sets out an algorithm of essential investigations that should be performed in any infant or young child where abusive head trauma is suspected.

We sought to determine whether accidental femur fractures in pediatric patients younger than age 4 could be distinguished from child abuse using a combination of presumed risk factors from the history, physical examination findings, radiographic findings, and age.

The purpose of our study was to describe the patterns of orthopaedic injury for child abuse cases detected in the large urban area that our institution serves, and to compare the injury profiles of these victims of child abuse to that of general (accidental) trauma patients seen in the emergency room and/or hospitalized during the same time period.

Objectives: To determine how frequently AHT was previously missed by physicians in a group of abused children with head injuries and to determine factors associated with the unrecognized diagnosis.

The primary aim of this study was to provide an overview of all existing non-validated clinical decision rules for wrist trauma in children and to externally validate these rules in a different cohort of patients.

This study evaluated the diagnostic contribution of ultrasonography in the treatment of acute elbow injuries in children and the strategic and economic impact of using this tool alongside radiography.

The hand is a common site of injury in children; however, little is known regarding adherence to hand trauma management in this population.

CT imaging ofhead-injured children has risks of radiation-induced malignancy. Our aim was to identify children at very low risk of clinically-important traumatic brain injuries (ciTBI) for whom CT might be unnecessary.

The purpose of this study was to characterize management of supracondylar humerus fractures (SCHFs) at a level 1 trauma center and identify factors contributing to divergence in management from American Academy of Orthopedic Surgeons (AAOS) the Appropriate Use Criteria (AUC) recommendations.

To assess the utility of trauma series radiographs in the management of alert pediatric patients with traumatic injury and to ascertain whether it is necessary to acquire the entire trauma series in these children.

To determine which of 3 analgesics, acetaminophen, ibuprofen, or codeine, given as a single dose, provides the most efficacious analgesia for children presenting to the emergency department with pain from acute musculoskeletal injuries.

This article will describe the pharmacology of cannabis, effects of various dosage formulations, therapeutics benefits and risks of cannabis for pain and muscle spasm, and safety concerns of medical cannabis use.

To determine if there is a significant prevalence of drug or alcohol use among adolescents evaluated for significant acute trauma.

The purpose of this study was to determine the association of non-routine events (NREs) during the initial resuscitation phase with these physiological disturbances.

Pediatric head trauma management varies between emergency departments globally. Here we aim to compare the pediatric minor head trauma management between a US and Italian hospital.

Management of the pediatric trauma patient is challenging regardless of where you work. In this EM Cases episode, two leading pediatric trauma experts, Dr. Sue Beno from Hospital for Sick Children in Toronto and Dr. Faud Alnaji from Children’s Hospital of Eastern Ontario in Ottawa answer such questions as: what are the most important physiologic and anatomic differences between children and adults that are key to managing the trauma patient? How much fluid should be given prior to blood products? What is the role of POCUS in abdominal trauma? Which patients require abdominal CT?

This transport checklist is to guide preparation for patient transport to a tertiary site. Included in the checklist are equipment considerations and important information to communicate to the receiving site. Published online: July 2018, Version 2.0.

This transport checklist is to guide preparation for patient transport to a tertiary site. Included in the checklist are equipment considerations and important information to communicate to the receiving site. Published: July 2018, Version 2.0.