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Penetrating injuries in children: is there a message?
A J A Holland1, R Kirby, G J Browne
1Department of Academic Surgery, The Children's Hospital at Westmead, The University of Sydney, Westmead, New South Wales, Australia. andrewh3@chw.edu.au
Insights
Penetrating trauma in children is rare but serious, often resulting from falls onto sharp objects or assaults. Prevention is key, especially for severe cases, and prompt surgical exploration is recommended for stable patients.
Area of Science:
- Pediatric Trauma Surgery
- Injury Prevention
- Forensic Pediatrics
Background:
- Penetrating trauma in children is an uncommon but significant cause of severe injury and mortality.
- Understanding the epidemiology, management, and outcomes is crucial for improving care and prevention strategies.
Observation:
- A 13-year study of children under 16 admitted to the Children's Hospital at Westmead (CHW) and reported to the New South Wales Paediatric Trauma Death (NPTD) Registry identified 34 trauma admissions and 30 trauma deaths.
- The typical patient was a male school-aged child injured by falls onto sharp objects or assaults with knives or firearms.
- A significant minority of fatal cases involved injuries from agricultural machinery like mowers and tractors.
Findings:
- Penetrating injuries accounted for 0.2% of all trauma admissions and 3% of major trauma admissions at CHW.
- 75% of injured children required operative intervention, and 42% of survivors experienced long-term morbidity.
- Penetrating trauma represented 2.3% of all pediatric trauma deaths in New South Wales.
Implications:
- Penetrating injuries in children necessitate prompt surgical exploration to rule out major internal damage.
- Prevention strategies should focus on reducing assaults and implementing safety measures around agricultural equipment for young children.
- Two distinct patient groups emerge: those with fatal or near-fatal injuries requiring immediate prevention focus, and those with stable vital signs who benefit from surgical intervention.
Objectives:
To determine the frequency, management and outcome of penetrating trauma in children.
Methods:
A retrospective review of penetrating injuries in children under 16 years of age admitted to the Children's Hospital at Westmead (CHW), and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry, from January 1988 to December 2000. Patient details, circumstances of trauma, injuries identified, management and outcome were recorded.
Results:
Thirty-four children were admitted to the CHW with penetrating injuries during the 13-year period. This represented 0.2% of all trauma admissions, but 3% of those children with major trauma. The injury typically involved a male, school-age child that fell onto a sharp object or was assaulted with a knife or firearm by a parent or person known to them. Twenty-five children (75%) required operative intervention for their injuries and 14 survivors (42%) suffered long-term morbidity. Thirty children were reported to the NPTD Registry over the same interval, accounting for 2.3% of all trauma deaths in New South Wales. Of these, a significant minority was injured by falls from a mower or a tractor towing a machine with blades.
Conclusions:
Penetrating injuries are uncommon, but cause serious injury in children. There are two clear groups: (i) those dead at the scene or moribund on arrival, in whom prevention must be the main aim; and (ii) those with stable vital signs. Penetrating wounds should be explored in the operating theatre to exclude major injury. Young children should not ride on mowers or tractors.
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