The multiply injured child: Other systems
Objectives- Discuss the optimum initial management of the multiply injured child
- Describe the demographics of children most at risk for injury
Discussion points
- Describe step by step the immediate evaluation of the multiply injured child. At what point does the orthopaedist assume a role?
- What factor( s) contribute to the long-term outcome of the multiply injured child. What role does the orthopaedist have in managing these factors?
Discussion
The development of trauma centers over the last 20 years has [Maio, 2000 #9] been responsible for an increase in the quality of trauma care. It is apparent that the pediatric patient has also been a beneficiary; as care in adult trauma units has compared favorably with that rendered in pediatric units. The principles of airway control, bleeding control, and correction of hypovolemia are universal regardless of age. Maintenance of adequate circulation is mandatory to prevent secondary brain ischemia, which is an important contributor to long-term morbidity. Visceral trauma is managed by the pediatric (or general surgeon), with an increasing tendency toward nonoperative management, especially in the younger child. It is only at this point that fracture management steps forward. Of course, circulatory compromise to a limb reorders the usual priorities.
A number of trauma grading scales are presently in use. The Glasgow Coma Scale has been used to assess the level of consciousness necessary to clinically evaluate for cervical spine injury. Other trauma scales have been evaluated, and are predictive of mortality, but are not particularly relevant to the primary interest of the orthopaedist, long term outcome. It is anticipated that future efforts will be made toward development of evaluative scales for residual disability. Craniocerebral injury is the major factor affecting both morbidity and long term outcome.
Both in North America and Europe, socioeconomic status has been found to be related to the risk of serious injury for children. Alcohol is also involved in a considerable number of injuries sustained by adolescents. These factors are societal, but the orthopaedist should be aware of their importance.
References
- Armstrong PF. Initial management of the multiply injured child. Instruct Course Lect 1992; 41: 347-50.
- Buckley SL, Gotshall C, Robertson WR, Jr. The relationships of skeletal injuries with trauma score, injury severity socore, length of hospital stay, hospital charges, and mortality in children admitted to a regional pediatric trauma center. J Pediatr Orthop 1994; 14: 449-53.
- Furnival RA, Schunk JE. ABCs of scoring systems for pediatric trauma. Pediatric Emergency Care 1999; 15( 3): 215-23.
- Geyer S, Peter R. [Accident-related hospital admission of children and adolescents in relation to their social status--findings with data from North Rhine-Westphalia federal health insurance]. Gesundheitswesen 1998; 60( 8-9): 493-
- Gonzalez RP, Fried PO, Bukhalo M, Holevar MR, Falimirski ME. Role of clinical examination in screening for blunt cervical spine injury. Journal of the American College of Surgeons 1999; 189( 2): 152-7.
- Hulka F. Pediatric trauma systems: critical distinctions. Journal of Trauma-Injury Infection & Critical Care 1999; 47( 3 Suppl): S85-9.
- Laing GJ, Logan S. Patterns of unintentional injury in childhood and their relation to socio-economic factors. Public Health 1999; 113( 6): 291-4.
- Magin MN, Erli HJ, Mehlhase K, Paar O. Multiple trauma in children patterns of injury--treatment strategy--outcome. European Journal of Pediatric Surgery 1999; 9( 5): 316-24.
- Maio RF, Shope JT, Blow FC, Copeland LA, Gregor MA, Brockmann LM, et al. Adolescent injury in the emergency department: opportunity for alcohol interventions? Annals of Emergency Medicine 2000; 35( 3): 252-7.
- Partrick DA, Moore EE, Bensard DD, Karrer FM. Operative management of injured children at an adult level I trauma center. Journal of Trauma-Injury Infection & Critical Care 2000; 48( 5): 894-901.
- Sanchez JI, Paidas CN. Childhood trauma. Now and in the new millennium. Surgical Clinics of North America 1999; 79( 6): 1503-35.
May 11-14, 2011 in Montreal, Quebec, Canada
