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Multiple trauma in children patterns of injury--treatment strategy--outcome
M N Magin1, H J Erli, K Mehlhase
1Department of Trauma Surgery, University Hospital, Rhenish-Westfalian Technical University, Aachen, Germany.
Insights
Multiple trauma in children is a significant concern, with head injuries being the primary cause of death and long-term disability. Prevention and aggressive treatment are crucial for improving outcomes in pediatric road accident victims.
Area of Science:
- Pediatric Trauma Care
- Road Safety Research
- Injury Epidemiology
Background:
- Road accidents in Germany in 1994 involved over 50,000 children under 15, with a third sustaining major injuries and 431 fatalities.
- These statistics highlight the critical issue of multiple trauma in children within developed nations.
Purpose of the Study:
- To evaluate the long-term outcomes of multi-traumatized children treated at Aachen University Hospital.
- To identify key injury types influencing mortality and long-term prognosis in pediatric trauma.
Main Methods:
- A cohort of 64 multi-traumatized children treated between 1985 and 1990 was assessed.
- Follow-up evaluations were conducted at 1 and 5 years post-treatment for 66% of patients.
- Outcomes were measured using the Aachen Long-Term Outcome Score (ALOS) and Glasgow Outcome Score (GOS).
Main Results:
- Mortality rate was 12.5%, predominantly due to cerebral injuries.
- 25% of patients developed complications, with craniocerebral trauma significantly impacting long-term outcomes.
- Limb injuries were manageable with appropriate pediatric osteosynthesis, and thoracic/abdominal trauma responded well to aggressive treatment.
Conclusions:
- Craniocerebral trauma is the leading cause of death and poor long-term outcome in multi-traumatized children.
- Prevention of head injuries in pediatric road accidents is paramount.
- Aggressive management of thoracic, abdominal, and limb injuries can lead to favorable outcomes.
Topic Of The Study:
In 1994 more than 50,000 children under 15 years were involved in a road accident in Germany. About one third of them received major injuries and 431 children died. These data obviously show the importance of multiple trauma in children in a developed country.
Methods:
Between 1985 and 1990, 64 multi-traumatized children were evaluated after receiving treatment at the Aachen University Hospital. It was possible to evaluate 66% of the patients at the follow-up examination after 1 and 5 years. The results have been measured with the ALOS (Aachen long-term outcome score) and the GOS (Glasgow outcome score) in relation to the degree of trauma. OWN RESULTS: 12.5% died mainly from the effects of a cerebral injury. 25% developed different complications. Again the effects of craniocerebral trauma determined the long-term outcome. All other injuries can be managed by aggressive treatment without major consequences.
Conclusions:
In multi-traumatized children, craniocerebral trauma is the key injury regarding both lethality and long-term outcome. Therefore, prevention is of primary importance. Aggressive treatment of thoracic and abdominal trauma can usually help to cure completely these injuries. Especially osteosynthetic procedures, exerting little strain and performed as appropriate for children, have made injuries of the limbs less critical.