Global Cast MD, along with Cincinnati Children's Hospital,
sharing knowledge to improve child health around the globe.
Hello, Pediatric Surgery family.
I'm Amgodi, a research fellow from Cincinnati Children's Hospital Medical Center.
Our 11th annual update course in pediatric surgery was held past August.
In this video series, we'll recap the sessions and share the main highlights with you.
Today we'll review updates in screening for Blonde Cerebrovascular Injury, or BTVI,
with doctors Katie Russell and Miral Kottigal.
We've got an 11-year-old female who got hit by a truck when she was crossing the street.
She's GCS of 3 and she's got obvious chest trauma.
What criteria do you guys use to figure out if she needs screening for a BCVI or Blonde Cerebrovascular Injury?
The people who are the biggest advocates for us in our system about BCVI screening were our neurologists.
And we had a couple of patients, one with a delayed diagnosis stroke from a BCVI that was missed,
that really prompted us last year to make a routine protocol for BCVI
and to determine that all of these patients should get CTA head and neck because of concern.
We use the Utah score and I hope nobody says they use that because it's the worst score out there and we need to switch.
This has been a hot topic in adult trauma for several years now and I think we're behind the ball.
According to Dr. Russell, this is one of those times where pediatric surgeons can follow the adult trauma surgeons
to not miss kids with these injuries.
And they need to figure out what they're going to do as a community to screen them.
We implemented our screening about a year ago now and what we have found is that we haven't had an increase in incidents,
but we have not had any delayed diagnoses. So we had prior to that at least two children in the previous year
who had strokes which then led to identification of their BCVI.
And now they're catching kids up front and interviewing early, which made a difference at least in the very small series that Dr. Kodagal has.
We'll know more as we gather more data. So lots of variation in what people are doing.
So there is a PTS guideline hopefully coming out at PTS this November. So we will report back.
1.3 percent of the trauma patients will have BCVI. It's the same number of kids that have cervical spine injuries.
Pediatric surgeons are screening nearly everyone for cervical spine injuries, but they're now screening kids for BCVIs.
And about a third of them will have a stroke.
And then if you have a stroke, your mortality can be as high as 20 percent.
The Atomic Group just did a study and basically said exactly what we said in this poll, that screening is all over the place.
More info to come, but I think it's important that we all think about it.
In this Atomic paper, the Memphis score is what they use and it is the most sensitive score.
If Dr. Russell was going to make a recommendation based on everything they know, she would tell everyone to use the Memphis score.
Those are all the options for screening protocols.
When you have this many different tools, it means we don't know what to do.
So there are so many different tools that different people are using and certainly an opportunity for improvement.
In conclusion, BCVI screening is essential in pediatric trauma care.
Previous misdiagnoses resulted in strokes, emphasizing the need for routine protocols.
While practices vary, the Memphis score is recommended as the most sensitive tool for BCVI screening.
More than 1 percent of the trauma patients have BCVI, and a third might suffer a stroke with a potential mortality rate of 20 percent.
The numerous tools available indicate a pressing need for standardized guidelines.
Thank you for watching this video.
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GlobalCastMD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.