Ep 42 - Paediatric Major Trauma with Ross Fisher (LTC 2014)

  Title: Rethinking Pediatric Trauma: Insights from the London Trauma Conference Welcome to another insightful post from St Emlyns, where we dive into the latest discussions and research in emergency medicine. In this post, we recap a conversation with Rosfisher, a pediatric surgeon from Sheffield, who recently presented at the London Trauma Conference. Rosfisher shared his perspectives on pediatric trauma management, the challenges of research in this field, and the art of effective presentation. Let's explore these critical topics and their implications for emergency care. Pediatric Trauma: A Unique Challenge Pediatric trauma is an infrequent yet crucial area in emergency medicine, necessitating a distinct approach. Rosfisher emphasized that children are not simply "small adults." This fundamental concept underlines the need for specialized knowledge and skills when managing pediatric trauma. Despite the rarity of severe pediatric trauma cases, healthcare professionals must understand that children's anatomical, physiological, and pathological differences require tailored treatment strategies. Understanding the Differences One of the key points Rosfisher highlighted is the unique nature of pediatric anatomy and physiology. Unlike adults, children have different injury patterns, and their bodies respond differently to trauma. This distinction is crucial for emergency physicians, pediatric surgeons, and anesthetists, who must adjust their standard protocols to suit pediatric needs. The importance of recognizing these differences cannot be overstated, as it directly impacts the outcomes of pediatric trauma cases. The Debate on FAST Scanning in Pediatric Trauma A significant portion of Rosfisher's discussion focused on the use of Focused Assessment with Sonography for Trauma (FAST) in pediatric cases. While FAST scanning is a well-established practice in adult trauma, its efficacy in pediatric patients remains controversial. Rosfisher pointed out the lack of robust evidence supporting the reliability of FAST scans in children, citing a 50% sensitivity and specificity rate—equivalent to flipping a coin. Limitations and Concerns The concerns surrounding FAST scanning in pediatric trauma revolve around its diagnostic accuracy and the subsequent decision-making process. Rosfisher noted that even if healthcare professionals are skilled in using FAST scans on adults, this expertise does not necessarily translate to pediatric patients. The anatomical and physiological differences mean that the interpretation of FAST scans in children is more complex and less reliable. As a result, the decisions based on these scans carry a high risk of error. The Role of CT Scans In light of the limitations of FAST scanning, Rosfisher advocated for the use of computed tomography (CT) scans for pediatric blunt abdominal trauma. He referenced guidelines from the Royal College of Radiology, which recommend CT scans as the gold standard for imaging in these cases. The higher accuracy and reliability of CT scans make them a preferable option, providing clearer insights into the child's condition and guiding appropriate treatment. Challenges in Pediatric Trauma Research Pediatric trauma research is significantly underrepresented compared to adult trauma research. Rosfisher highlighted the stark contrast in research volume, with pediatric studies comprising less than half a percent of the total trauma research. This disparity poses a considerable challenge, as the lack of data hampers the development of evidence-based practices in pediatric trauma care. Barriers to Research Several factors contribute to the limited research in pediatric trauma. One major issue is the misconception that pediatric trauma is simply a scaled-down version of adult trauma. This oversimplification overlooks the complexities unique to children and the necessity for dedicated research in this area. Additionally, the relatively low incidence of pediatric t