Clinically important traumatic brain injuries are rare in children. The PECARN study provides decision rules for when to avoid unnecessarily obtaining a CT for children who have suffered head trauma.
For children < 2 years old: <0.02% risk of clinically important TBI
For children > 2 years old: <0.05% risk of clinically important TBI
Kuppermann N, et al. Pediatric Emergency Care Applied Research Network. Identification of childrent at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009 Oct 3;374(9696):1160-70.
Risk stratisfication score introducted by Maden Samuel in 2002.
The Pediatric Appendicitis Score had a sensitivity of 1, speciificity of 0.92, positive predictive value of 0.96, and negative predictive value of 0.99
Scores of 4 or less are least likely to have acute appendicitis, while scores of 8 or more are most likely.
Pediatric Appendicits Score. Samuel, M. J Pedia Surg.37:877-888. 2002.
Pediatrics Text 19th edition, Nelson
MedStudy Pediatrics Board Review Core Curriculum
CDC MMWR 1/2011
Glaser N, Barnett P, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med 2001;344:264.
NMS Pediatrics, 4th edition
Submitted by Dr. Lauren Rice
The summertime can be full of lots of fun activities (beach, fireworks, cookouts, and campfires) that can put children at risk of burns.
Burn depth classification:
1. Superficial (first-degree): red and blanching with minor pain, resolves in 5-7 days
2. Partial thickness (second-degree): red and wet with blisters, very painful, resolves in 2-5 weeks
Treatment: clean with soap and water twice daily, and apply silvadene wrap with gauze, kerlex
3. Full thickness (third-degree): dry and leathery without pain, no resolution after 5-6 weeks, may require graft
Treatment: wound debridement and dressings as above
Parkland formula: 4ml/kg/%TBSA in 1st 24 hours with 50% of total volume in 1st 8 hours
Calculate burn surface area:
-SAGE: free computerized burn diagram available at www.sagediagram.com
-Rule of Nines > 14 years old
-Rule of Palm <10 years old
Burn Center Referral
-Extent: partial thickness of >30% TBSA or full thickness of >10-20%
-Site: hands, feet, face, perineum, major joints
-Type: electrical, chemical, inhalation
1. Cross, J.T. and Hannaman, R.A. MedStudy Pediatrics Board Review Core Curriculum, 5th edition, p. 3-11, 3-12.
2. Children’s National Medical Center, Department of Trauma and Burn Surgery. Trauma Cheat Sheet.
AAP Prep Curriculum
2012 Pediatrics Review and Education Program
American Academy of Pediatrics PREP Curriculum
Emergency Medicine Clinics of North America
November 2010, Volume 28, Number 4
Pediatrics Board Review, MedStudy
MedStudy Pediatrics Board Review
MedStudy Pedatrics Board Review, Core Curriculum, Book 3 2004