Traumatic injuries are the leading cause of death, disability, and hospitalization among children in the United States. Each year, more than 20,000 children suffer traumatic deaths, resulting in more than 3 million years of potential life lost.1 In addition, nonfatal injuries in individuals younger than 20 years lead to approximately 10 million emergency department visits, 10 million urgent care visits, and 300,000 hospitalizations each year.2,3 The annual cost of unintentional injuries to children younger than 14 years is estimated to be $5 billion.4
Fatalities from traumatic injury are most commonly caused by head injuries; however, thoracic and abdominal injuries are the direct cause of death in 20% and 10% of pediatric trauma cases, respectively.3 The majority (85%) of injuries sustained by children and adolescents are from blunt trauma, many of which can be managed non-operatively.5,6 Because of their anatomy, children are more vulnerable than adults to blunt trauma. For example, a child’s cranial vault is larger and heavier than an adult’s, predisposing the brain to injury. In addition, the pediatric brain is less myelinated, making it especially susceptible to shearing forces. The pediatric abdomen is also at high risk of injury secondary to the immature musculoskeletal system and body habitus.7 Solid organs in children are comparatively larger than in adults, and there is little fat or connective tissue to protect them from injury. Further, owing to a child’s smaller size, more force is applied per body surface area, resulting in a higher likelihood of internal injury than in adults.
Because many traumatic injuries in children are managed nonoperatively, it is imperative that the pediatric emergency physician, hospitalist, and intensivist understand the diagnostic approach and management of the most common pediatric injuries. This chapter reviews the most common injury patterns seen in children.
The approach to trauma victims is standardized, independent of age. The American College of Surgeons has created the ATLS (Advanced Trauma Life Support) program that outlines the medical and surgical management of trauma. The initial assessment of any trauma patient includes a primary survey, resuscitation, secondary survey, and triage. The goal of the primary survey is to assess the patient’s airway, breathing, and circulation (ABCs) while maintaining cervical spine immobilization until that injury can be ruled out. The secondary survey is a systematic assessment of the patient from head to toe to establish the presence of other injuries. Once the patient is stable, he or she may be triaged or transferred to the intensive care unit, general ward, or an outside institution. It is imperative that the receiving medical team perform its own secondary survey, regardless of the injuries found previously; nonlife-threatening injuries such as fractures and lacerations can be missed during the initial assessment.
Head trauma is the most common pediatric injury. Each year ...