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Chapter 12: Pediatric Trauma

EPIDEMIOLOGY

  • Approximately 17,000 children and adolescents die from injuries, intentional and unintentional, each year.1

  • Injury is the leading cause of death and disability in children.

EVALUATION AND ASSESSMENT

ADVANCED TRAUMA LIFE SUPPORT (ATLS)

  • ATLS Sequence:2–3 Outlines a standard approach to trauma patients that reduces mortality and morbidity. The evaluation and assessment are critical for appropriate triage, diagnosis, and treatment of the trauma patient.

  • Primary survey and resuscitation: Serves to identify life-threatening conditions and should take only a few minutes.

    • Assess for a pulse: if no pulse is present, initiate cardiopulmonary resuscitation (CPR).

    • Assess the airway: determine if blood, stomach contents, edema, foreign bodies, or facial trauma is present; the presence of a closed head injury may lead to airway instability and be signified by the presence of stridor or inability to maintain a patent airway.

    • Assess breathing: breathing may be impaired by neurologic process, airway obstruction, chest wall, or respiratory pathology.

    • Major hemorrhage: all efforts should be made to control bleeding.

    • Assess disability and exposure: by evaluating neurologic status using the Glasgow Coma Scale (GCS) (Table 12-1)

      • Assess pupil size and reactivity to help ascertain underlying neurologic injury

      • Patient's clothes should be fully removed to facilitate a full exam

      • Remove any hazardous material

      • Reduce risk of hypothermia from saturated clothing; avoid hyperthermia

    • Inline stabilization: should be used to avoid worsening of potential cervical cord injury; cervical spine injury should be assumed; even though the incidence is rare, the consequences are devastating.

  • Secondary survey: goal is to identify any other injury

    • More thorough history and examination; the practitioner can determine which laboratory and diagnostic tests are indicated to rule out underlying injury

    • “Pan-scanning” of pediatric trauma patients is not recommended, but further imaging is recommended when history and physical examination indicate suspicion for injury

TABLE 12-1

Glasgow Coma Scale8

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TABLE 12-1

Glasgow Coma Scale8
Behavior Response Score
Eye Opening Response Spontaneously 4
To speech 3
To pain 2
No response 1
Verbal Response Oriented to time, place, and person 5
Confused 4
Inappropriate words 3
Incomprehensible sounds 2
No response 1
Best Motor Response Obeys commands 6
Moves to localized pain 5
Flexion withdrawal from pain 4
Abnormal flexion (decorticate) 3
Abnormal extension (decerebrate) 2
No response 1

IMAGING STUDIES (SEE TABLE 12-2)

TABLE 12-2

Imaging modalities in pediatric trauma with indications for use

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TABLE 12-2

Imaging modalities in pediatric trauma with indications for use
Modality Anatomic Location Timing
Plain X-Rays C-spine If clinical clearance of C-spine is unable to be determined, films can be done when patient is hemodynamically stable
Chest, pelvic, extremity External signs of injury over the ...

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