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[Severe trauma in children]
O Paut1, T Jouglet, J Camboulives
1Département d'anesthésie réanimation pédiatrique, hôpital de la Timone-enfants, Marseille, France.
Insights
Pediatric trauma causes half of all deaths in children aged 1-15. Effective management requires a two-step approach focusing on rapid assessment, resuscitation, and advanced imaging to prevent secondary injury.
Area of Science:
- Pediatric trauma care
- Emergency medicine
- Public health
Context:
- Trauma accounts for 50% of deaths in children aged 1-15.
- Significant sequelae and handicaps pose a major public health challenge.
- Pediatric trauma presents unique challenges due to anatomical and physiological differences.
Purpose:
- To outline the specific considerations and management strategies for pediatric trauma.
- To highlight the importance of a multidisciplinary team approach.
- To detail the two-step management protocol: emergency assessment/resuscitation and secondary evaluation with imaging.
Summary:
- Head injuries are common, with cerebral edema more frequent than mass lesions in children.
- New monitoring techniques like transcranial Doppler and jugular vein oxygen saturation aid in preventing secondary brain injury.
- Spinal cord injuries without radiological abnormality (SC/WORA) are noted, alongside conservative management for abdominal injuries and favorable outcomes for pulmonary contusions.
Impact:
- Improved understanding of pediatric trauma management can reduce mortality and long-term disability.
- Early recognition and intervention, particularly for head and spinal cord injuries, are crucial.
- Emphasis on preventing secondary ischemic brain injury and considering child abuse is vital for better patient outcomes.
Abstract:
Trauma are responsible for approximately 50% of the deaths of the pediatric population between 1-15 years of age. This high mortality rate, associated with frequent sequelae, leading sometimes to severe handicaps, is a major problem of public health in the developed countries. Pediatric trauma have some particularities, due to anatomical and physiological differences, and to specific injury mechanisms. Management of a patient with severe trauma is best performed by trained physicians, working in a multidisciplinary team with a two steps approach: 1) emergency rapid clinical assessment and resuscitation. 2) a secondary complete clinical evaluation associated with medical imaging, mainly based on CT scan. Head injuries are frequent and represent the main prognosis factor, mass lesions being less frequent and cerebral oedema more frequent in children, than in adult; brain swelling appears to be less frequent than initially reported. Management of head trauma has evolved in recent years, and is now largely directed towards the prevention of secondary ischemic brain injury: new monitoring devices are proposed to pursue that goal: transcranial doppler and continuous jugular vein oxygen saturation monitoring. Spinal cord injuries are rare but may be severe: cervical and spinal cord injuries without radiological abnormality (SC/WORA) appear to be more frequent than in adult. Most often, abdominal plain viscera injuries are treated with a conservative non operative approach. Among chest injuries, pulmonary contusion is the most frequent, with a favorable outcome in most cases within 3-4 days. Child abuse must be suspected in any case where there is no clear injury mechanism or when there is a discrepancy between the severity of the injury and the alleged mechanism.