Trauma is the number 1 cause of mortality and morbidity for children even in the developed world, and major resources are still needed to prevent and treat traumatic injuries. Between 1 month and 18 years of age, one-half of all deaths in children are the result of a traumatic injury. Trauma accounts for more deaths in children in this age range than all forms of cancer, heart disease, and infections combined. The objectives of this chapter will be to review the differences between adults and children in regard to mechanism of injury and physiologic response; discuss pathophysiology and the initial management of the trauma victim; and outline common injuries involving various organ systems.
Most infants and children with traumatic injuries are seen in the emergency department with nearly half of the facilities being adult centers rather than pediatric-specific trauma facilities. This underscores the importance of education of community emergency department, family, and pediatric specialists. Not surprisingly, the significantly injured child requires evaluation and management skills that may not be available in every emergency department. Caregivers may have less experience with their care and an understanding of the initial management and stabilization of these patients and their safe and timely transfer to the higher level of care needed for definitive management.
The often invoked maxim that children, and especially infants and young children, are not small adults applies also to understanding and treating traumatic injuries. The differences involve anatomical and physical characteristics, physiological and psychological responses, and even the very mechanisms by which trauma occurs. Adult practitioners often need to be reminded that, for instance, children have greater surface ratio of area to mass than do adolescents or adults. This results in greater dissipation of heat and water, which may compound the effects of other traumatic injuries. The head of an infant or small child encompasses a much larger percentage of the total body than that of adults and subjects children to higher rates of brain and skull injuries. The child’s skeleton exhibits greater elasticity than that of the adult and is therefore more likely to tolerate compression and visceral injury without fractures. A vast majority of childhood injuries are passive and result from blunt trauma and thus tend to involve multiple organs. Yet children tend to experience better outcomes compared to adults with the same mechanism of injury because of factors such as the occurrence of fewer bone fractures and the lack of comorbid disorders. It is important to remember that, while a recovery of function and quality of life after blunt injury is common, physical function tends to remain lower than age-matched norms at 6 months postinjury, and often the childhood trauma victim and his or her family bears the consequence of that injury for a lifetime.
A common language that objectively describes injuries and their consequences is very useful ...