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Train injuries in children
P E Blazar1, J P Dormans, C T Born
1Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, USA.
Insights
Pediatric train accident survivors often sustain severe lower extremity amputations requiring multiple surgeries and prolonged care. Prevention through public education and limiting access to railroad areas is crucial.
Area of Science:
- Trauma Surgery
- Pediatric Orthopedics
- Public Health
Background:
- Train accidents represent a significant cause of severe injury in children.
- Understanding the specific injury patterns is essential for effective treatment and prevention.
Purpose of the Study:
- To characterize the types and patterns of injuries in pediatric victims of train accidents.
- To identify the treatment outcomes and associated costs for these severe injuries.
Main Methods:
- Retrospective review of 17 pediatric patients treated for train accident injuries between 1984 and 1994.
- Exclusion of fatalities at the scene and those injured in car-train collisions.
- Analysis of injury types, surgical interventions, complications, and hospitalization costs.
Main Results:
- Eight patients had complete amputations and eight had near-complete amputations, primarily of the lower extremities.
- Survivors required an average of 5.7 operative procedures during initial hospitalization.
- 50% of survivors needed secondary surgical procedures, with substantial financial costs averaging $61,000 for acute hospitalization.
Conclusions:
- Pediatric train accident survivors frequently experience severe, isolated musculoskeletal injuries, predominantly lower extremity amputations.
- These injuries necessitate extensive surgical management, including multiple debridements and potential amputation revisions.
- Findings underscore the importance of public education and restricted access to railroad areas for injury prevention.
Objective:
To describe the pattern of injuries sustained in pediatric victims of train accidents.
Design:
Retrospective review of patients identified in a search of two trauma registries for the years 1984-1994.
Setting:
Two pediatric level one trauma centers in one metropolitan area.
Patients:
Between 1984 and 1994, seventeen children were identified as treated for injuries sustained in train accidents. Children pronounced dead at the scene and those injured when a car was struck by a train were excluded.
Intervention:
ATLS protocols were followed. All open musculoskeletal injuries were treated with multiple operative irrigation and debridement procedures and broad spectrum antibiotics.
Main Outcome Measurements:
Variables included the following: age, sex, mechanism of injury, circumstances surrounding the injuries, all injuries sustained, operations performed during the acute hospitalization, subsequent operations, level of amputation(s), complications, and cost and length of hospitalization.
Results:
Presenting injuries included eight patients with ten complete amputations and eight patients with ten near-complete amputations. The average number of operative procedures for the survivors during the initial hospitalization was 5.7 (range three to sixteen). Five patients (five extremities) required amputation revision to a more proximal level after the initial surgical intervention but prior to definitive wound closure. Secondary surgical procedures have been required in 50% of survivors to date. The financial cost of these injuries is substantial, with acute hospitalization costs averaging $61,000.
Conclusion:
Pediatric survivors of train-pedestrian accidents are likely to suffer isolated musculoskeletal injuries, the majority of which are amputations of the lower extremity. These injuries require multiple operative debridements and frequent revision to higher levels of amputation are expected. The percentage of these injuries in children at play around railroad tracks emphasizes the need for limitation of access to railroad areas and for prevention through public education.