Katie W. Russell

INTRODUCTION: The optimal imaging strategy for pediatric cervical spine clearance remains controversial. The primary objective of this study was to determine the sensitivity of computed tomography (CT) in detecting clinically significant cervical spine injury in children. We hypothesized that CT is sufficiently sensitive to allow for definitive clearance of the pediatric cervical spine after blunt trauma. METHODS: We conducted a prospective, multicenter, observational study from March 1, 2022, to July 31, 2025, at 72 diverse adult, mixed, and pediatric trauma centers across the United States. All children J Trauma Acute Care Surg . 2026;101: 844–857.) LEVEL OF EVIDENCE: Diganostic Tests/Criteria; Level III.

Background Infants with congenital diaphragmatic hernia (CDH) remain at high risk for ECMO and mortality. We previously reported improved outcomes after implementing new CDH care guidelines. This study reassesses ECMO rates, survival, and guideline adherence to determine if improvements persisted. Methods Retrospective review of all neonatal CDH cases at a single center during pre-guideline (2003–2015, n = 229) and post-guideline (2016–2024, n = 160) periods, with post-guideline subdivided into two epochs: post-1 (2016–2019, n = 70) and post-2 (2020–2024, n = 90). Results Survival without ECMO improved (pre-53%; post-1 74%; post-2 82%; p < 0.001), as did overall survival (72% vs. 83% vs. 86%; p = 0.006). ECMO use decreased (31% vs. 14% vs. 6%; p < 0.001). Inhaled nitric oxide use remained low, and vasoactive medication use dropped significantly in post-2. Conclusion Sustained survival improvement and reduced ECMO use followed guideline changes emphasizing minimal stimulation, gentle ventilation, delayed transfer, pre-ductal saturation monitoring, and limited vasoactive therapy.

BACKGROUND: The Utah Pediatric Trauma Network (UPTN), established in 2019, is a collaboration of hospitals in Utah that have implemented evidence-based guidelines to optimize pediatric trauma care. This study aimed to determine whether the establishment of the UPTN correlated with a change in the amount and character of preventable transfers (PTs) to the state’s only Level I pediatric trauma center. METHODS: Children with traumatic injuries transferred between 2013 and 2023 were retrospectively analyzed. The exposure was a transfer that occurred after the establishment of the UPTN on January 1, 2019. A PT was a child discharged within 48 hours of arrival without surgical intervention or advanced imaging studies. RESULTS: During this period, 6,036 children were transferred. There were 3,025 transferred pre-UPTN, while 3,011 were transferred post-establishment. The rate of preventable transfer before the establishment was 36% versus 29% after ( p < 0.001). Following the establishment of the UPTN, there was a significant change in the proportion of each injury type that was transferred. A lower percentage of patients had an intracranial bleed (15% vs. 20%, p < 0.001), isolated skull fracture (6.8% vs. 8.8%; p = 0.004), or a blunt solid organ injury (4.3% vs. 5.5%, p = 0.031). There was an increase in the proportion of transferred patients that had an orthopedic injury (36% vs. 28%, p < 0.001) with a significant decrease in PT rate (10% vs. 15%, p = 0.003). In addition, after the UPTN was established, the preventable transfer rate for intracranial bleed significantly decreased from 47% to 37% ( p < 0.001). CONCLUSION: In this study, we found that following the establishment of a trauma network that standardized pediatric trauma guidelines across a region, the rate of preventable transfer decreased. Traumatic brain injuries saw the largest decrease in the proportion of transfers and the rate of preventable transfers. These findings give evidence of trauma networks being a practical tool for decreasing overtriage. LEVEL OF EVIDENCE: Prognostic/Epidemiological; Level III.

Background: In pediatric patients presenting after blunt trauma, the incidence of clinically significant cervical spine injury (CSI) is approximately 1%. Although multidetector CT (MDCT) is widely accepted for cervical spine clearance in adults, its utility in children remains uncertain. The purpose of this study is to evaluate the sensitivity of MDCT in identifying clinically significant CSI in pediatric patients, stratified by age groups: adolescents (12 years to 17 years) and children (0 years to 11 years). Methods: We designed a national, multicenter, prospective observational study to assess the diagnostic performance of MDCT in detecting clinically significant CSI in pediatric trauma patients. Data are being collected from participating centers on imaging findings, clinical outcomes, and the presence of confirmed CSIs after blunt trauma. The analysis plan includes stratification by age group and calculation of sensitivity, specificity, and predictive values of MDCT for CSI. Results: This abstract outlines the background, methodology, and analytical framework of the study. Data collection and analysis are ongoing. This study represents the largest known cohort of pediatric patients undergoing cervical spine imaging after blunt trauma and is the first prospective study of its kind focused exclusively on this population. Conclusions: This study will provide critical data to inform guidelines for pediatric cervical spine clearance after blunt trauma. By evaluating the sensitivity of MDCT in detecting clinically significant CSI, the findings aim to support evidence-based imaging strategies and improve the safety and efficiency of pediatric trauma care.