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Between age 1 month and 18 years, 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. If trauma were a disease entity, its incidence would be considered to be epidemic, and major resources would be put in play to prevent and treat traumatic injuries.1-16

Most infants and children with traumatic injuries are seen in the emergency department. In contrast, the significantly injured child, from a motor vehicle accident or a burn victim, requires evaluation and management skills that may not be available in every emergency department, and caregivers may have less experience with their care.

The often invoked axiom 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 child’s skeleton exhibits greater elasticity than the adult’s and is therefore more likely to allow 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 the adult with the same mechanism of injury because of factors such as the occurrence of fewer bone fractures and the lack of comorbid disorders. Yet, 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.

Trauma Scores

A common language that describes injuries and their consequences is very useful in the frenzied circumstances that are the norm in the trauma management process. The Glasgow Coma Scale (GCS, see Chapter 104) and Injury Severity Scale (ISS) have been mainstays in the assessment and subsequent review of outcomes in pediatric trauma patients. The New Injury Severity Score (NISS) has been shown to have an improved predictive value in adult trauma victims compared to the ISS, but this superiority has not been corroborated in children. Likewise, trauma scores specifically designed for children have not been found to be superior to ...

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