Minor Trauma in Pediatrics

Question 1

What are the high risk indications in the CATCH CT criteria? Medium risk indications?

Answer 1

High risk findings:
-GCS <15 at two hours post injury
-Suspected open or depressed skull fracture
-History of worsening headache
-Irritability on examination
These findings warrant a CT.
Medium risk findings:
-Any sign of basal skull fracture (hemotympanum, raccoon eyes, Battle’s sign)
-Large, boggy hematoma of the scalp
-Dangerous mechanism of injury (MVA, fall from >/=3 ft or 5 stairs, fall from bicycle with no helmet)

Question 2

What are the Ottawa Ankle Rules for an ankle X-ray?

Answer 2

An ankle X-ray series is only required if there is pain in malleolar zone plus >/=1 of:

• Bone tenderness at posterior edge or tip of lateral malleolus
• Bone tenderness at posterior edge or tip of medial malleolus
• Inability to weight bear (both immediately after injury & in ED)

Question 3

What are the Ottawa Ankle Rules for a foot X-ray?

Answer 3

A foot X-ray series is only required if there is any pain in mid foot zone plus >/=1 of:

• Bone tenderness at base of 5th metatarsal
• Bone tenderness at navicular bone
• Inability to weight bear (both immediately after injury and in ED)

Question 4

What are the indications for skin glue?

Answer 4

Short laceration (<5cm)
Shallow (2-layer closure not required)
<5mm gap between would edges 
Straight
Not over joint
Not over mucosal surface, in axilla or groin 
Not due to bite or puncture