1 00:00:00,000 --> 00:00:05,000 Global Cast MD, along with Cincinnati Children's Hospital, 2 00:00:05,000 --> 00:00:08,000 sharing knowledge to improve child health around the globe. 3 00:00:08,000 --> 00:00:15,000 Hello, Pediatric Surgery family. 4 00:00:15,000 --> 00:00:20,000 I'm Amgodi, a research fellow from Cincinnati Children's Hospital Medical Center. 5 00:00:20,000 --> 00:00:25,000 Our 11th annual update course in pediatric surgery was held past August. 6 00:00:25,000 --> 00:00:30,000 In this video series, we'll recap the sessions and share the main highlights with you. 7 00:00:30,000 --> 00:00:35,000 Today we'll review updates in screening for Blonde Cerebrovascular Injury, or BTVI, 8 00:00:35,000 --> 00:00:40,000 with doctors Katie Russell and Miral Kottigal. 9 00:00:40,000 --> 00:00:45,000 We've got an 11-year-old female who got hit by a truck when she was crossing the street. 10 00:00:45,000 --> 00:00:49,000 She's GCS of 3 and she's got obvious chest trauma. 11 00:00:49,000 --> 00:00:59,000 What criteria do you guys use to figure out if she needs screening for a BCVI or Blonde Cerebrovascular Injury? 12 00:00:59,000 --> 00:01:04,000 The people who are the biggest advocates for us in our system about BCVI screening were our neurologists. 13 00:01:04,000 --> 00:01:10,000 And we had a couple of patients, one with a delayed diagnosis stroke from a BCVI that was missed, 14 00:01:10,000 --> 00:01:15,000 that really prompted us last year to make a routine protocol for BCVI 15 00:01:15,000 --> 00:01:20,000 and to determine that all of these patients should get CTA head and neck because of concern. 16 00:01:20,000 --> 00:01:26,000 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. 17 00:01:26,000 --> 00:01:31,000 This has been a hot topic in adult trauma for several years now and I think we're behind the ball. 18 00:01:31,000 --> 00:01:36,000 According to Dr. Russell, this is one of those times where pediatric surgeons can follow the adult trauma surgeons 19 00:01:36,000 --> 00:01:39,000 to not miss kids with these injuries. 20 00:01:39,000 --> 00:01:43,000 And they need to figure out what they're going to do as a community to screen them. 21 00:01:43,000 --> 00:01:50,000 We implemented our screening about a year ago now and what we have found is that we haven't had an increase in incidents, 22 00:01:50,000 --> 00:01:56,000 but we have not had any delayed diagnoses. So we had prior to that at least two children in the previous year 23 00:01:56,000 --> 00:02:00,000 who had strokes which then led to identification of their BCVI. 24 00:02:00,000 --> 00:02:07,000 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. 25 00:02:07,000 --> 00:02:12,000 We'll know more as we gather more data. So lots of variation in what people are doing. 26 00:02:12,000 --> 00:02:18,000 So there is a PTS guideline hopefully coming out at PTS this November. So we will report back. 27 00:02:18,000 --> 00:02:26,000 1.3 percent of the trauma patients will have BCVI. It's the same number of kids that have cervical spine injuries. 28 00:02:26,000 --> 00:02:32,000 Pediatric surgeons are screening nearly everyone for cervical spine injuries, but they're now screening kids for BCVIs. 29 00:02:32,000 --> 00:02:36,000 And about a third of them will have a stroke. 30 00:02:36,000 --> 00:02:39,000 And then if you have a stroke, your mortality can be as high as 20 percent. 31 00:02:39,000 --> 00:02:47,000 The Atomic Group just did a study and basically said exactly what we said in this poll, that screening is all over the place. 32 00:02:47,000 --> 00:02:50,000 More info to come, but I think it's important that we all think about it. 33 00:02:50,000 --> 00:02:56,000 In this Atomic paper, the Memphis score is what they use and it is the most sensitive score. 34 00:02:56,000 --> 00:03:03,000 If Dr. Russell was going to make a recommendation based on everything they know, she would tell everyone to use the Memphis score. 35 00:03:03,000 --> 00:03:06,000 Those are all the options for screening protocols. 36 00:03:06,000 --> 00:03:10,000 When you have this many different tools, it means we don't know what to do. 37 00:03:10,000 --> 00:03:16,000 So there are so many different tools that different people are using and certainly an opportunity for improvement. 38 00:03:16,000 --> 00:03:21,000 In conclusion, BCVI screening is essential in pediatric trauma care. 39 00:03:21,000 --> 00:03:26,000 Previous misdiagnoses resulted in strokes, emphasizing the need for routine protocols. 40 00:03:26,000 --> 00:03:33,000 While practices vary, the Memphis score is recommended as the most sensitive tool for BCVI screening. 41 00:03:33,000 --> 00:03:41,000 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. 42 00:03:41,000 --> 00:03:46,000 The numerous tools available indicate a pressing need for standardized guidelines. 43 00:03:46,000 --> 00:03:48,000 Thank you for watching this video. 44 00:03:48,000 --> 00:03:52,000 Don't forget to subscribe to the Stay Current MD YouTube channel. 45 00:03:52,000 --> 00:03:59,000 Follow our social media channels and download the Stay Current MD app for tons of content in pediatric surgery. 46 00:03:59,000 --> 00:04:07,000 GlobalCastMD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.