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Isolated head injury is a cause of shock in pediatric trauma patients

Alison Gardner1, Katherine A Poehling, Chadwick D Miller

  • 1Departments of Pediatrics, Wake Forest Health Sciences, Winston-Salem, NC 27157, USA. agardner@wakehealth.edu

Pediatric Emergency Care
|August 2, 2013
PubMed

Insights

Severe shock in pediatric trauma patients can result from isolated head injuries, not just hemorrhage. This is especially common in children under five years old, challenging current trauma resuscitation assumptions.

Area of Science:

  • Pediatric Emergency Medicine
  • Trauma Surgery
  • Pediatric Critical Care

Background:

  • Current trauma resuscitation protocols often assume hemorrhage is the cause of shock.
  • This assumption may not accurately reflect the etiology of shock in all pediatric trauma cases.

Purpose of the Study:

  • To determine the proportion of pediatric trauma patients in severe shock who present with isolated head injury versus hemorrhagic injury.
  • To investigate the role of head injury as a cause of severe shock in children.

Main Methods:

  • Retrospective review of pediatric trauma patients (0-15 years) over a 5-year period.
  • Severe shock defined by elevated blood lactate and low blood pressure for age.
  • Injury classification using International Classification of Diseases, Ninth Revision codes.

Main Results:

  • 31 (5%) of 680 patients had severe shock.
  • Isolated head injury accounted for 29% of severe shock cases in pediatric trauma patients.
  • Head injury was the cause of shock in 50% of children under 5 years old.

Conclusions:

  • Isolated head injury is a significant cause of severe shock in pediatric trauma patients, accounting for 29% of cases.
  • Head injury is a particularly important cause of shock in younger children (under 5 years).
  • Findings suggest a need to consider non-hemorrhagic causes like head injury in pediatric shock resuscitation.
Abstract

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