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EPIDEMIOLOGY

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  • 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.

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EVALUATION AND ASSESSMENT

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ADVANCED TRAUMA LIFE SUPPORT (ATLS)

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  • ATLS Sequence:23 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

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Table Graphic Jump Location
TABLE 12-1

Glasgow Coma Scale8

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IMAGING STUDIES (SEE TABLE 12-2)

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Table Graphic Jump Location
TABLE 12-2

Imaging modalities in pediatric trauma with indications for use

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