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Pediatric Trauma: Management and Lessons Learned
Shalini Hegde1, Monika Bawa1, Ravi P Kanojia1
1Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Pediatric trauma patients, primarily from road accidents, showed good recovery despite severe injuries. Close monitoring is crucial for timely intervention, as some children require delayed surgery.
Area of Science:
- Pediatric Surgery
- Trauma Care
- Emergency Medicine
Background:
- Trauma remains a significant cause of morbidity and mortality in children.
- Understanding the injury profile and outcomes in pediatric trauma is essential for improving care.
Purpose of the Study:
- To prospectively analyze the injury patterns, surgical interventions, and outcomes of 125 pediatric trauma patients.
- To identify specific injury types and factors influencing prognosis in young trauma victims.
Main Methods:
- Inclusion of 125 pediatric patients admitted to a surgical ward post-resuscitation.
- Exclusion of isolated neurosurgical and orthopedic injuries.
- Utilization of X-rays, focused assessment with sonography for trauma (FAST) ultrasound, and CT scans for diagnosis.
- Analysis of injury profiles and surgical management.
Main Results:
- Road traffic accidents and falls from height were the leading causes (73.6%).
- School-going children (60.8%) were most affected, with notable injuries including abdominal hernias and delayed bladder perforations.
- Forty percent of patients required surgical intervention, with some needing delayed surgery (≥1 week).
- Five patients presented with trauma-unrelated surgical conditions, and five had injuries secondary to sexual abuse.
Conclusions:
- Pediatric trauma patients exhibit a good prognosis even with extensive injuries and multiple surgeries.
- Close observation during admission and follow-up is vital due to the potential for delayed surgical needs.
- Early identification and management of trauma-related and incidental surgical conditions are key.
Aim:
The aim is to prospectively study 125 trauma patients admitted in the pediatric surgery ward in our institute.
Materials And Methods:
Pediatric patients admitted in the ward after initial resuscitation in the triage room were included. Isolated neurosurgical and orthopedic injuries were excluded. X-ray cervical spine, hip, and chest and a focused assessment with sonography in trauma ultrasound were done for all patients. Computed tomography of the abdomen or chest was done where relevant. Injury profile and surgical intervention when needed were analyzed.
Results:
Road traffic accidents and fall from height caused 73.6% of the injuries. School-going children were most commonly affected (60.8%). Distinctive injuries were noted such as abdominal wall hernias and delayed bladder perforation. All solid organ injury irrespective of grade treated conservatively. Forty percent of the children required surgical intervention. Five patients after laparotomy were found to have surgical conditions unrelated to trauma, whereas another 14 required delayed surgery. Five patients had injuries secondary to sexual abuse. All except two patients were discharged in a satisfactory condition and are doing well in the follow-up.
Conclusion:
In spite of extensive injuries and the need for multiple surgeries, children with trauma have a good prognosis. Close observation during admission and also in follow-up are essential, as many patients may require delayed surgery ≥1 week from injury.
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