4. Pediatric Trauma Assessment

Objectives
  • Recognize the distinctive features of global management of the child with trauma.
  • Assess children with trauma according to specific priorities.
  • Name the most common traumatic injuries among children.

Global Management of the child with Trauma

The management of pediatric trauma requires a systematic approach. The ABCDE strategy is a widely accepted strategy for initial evaluation, stabilization, and immediate treatment if necessary, and it must then be followed by a secondary evaluation. This process usually takes place before a detailed personal history or complete physical examination data are available.

Three peaks of trauma mortality rates can be identified. The first peak corresponds to deaths within the first seconds or minutes after the traumatic event, due to serious injury to the brain, spinal cord, heart, or aortic or large vessels. Few patients are able to survive these injuries, even with immediate assistance.

The second peak in mortality rates occurs from minutes to hours after the trauma. These patients have better survival chances if they are treated during the first hours after the incident (golden hours) or, ideally, during the first hour. The injuries associated with this peak include epidural or subdural hematoma, hemothorax or tension pneumothorax, lesions with significant bleeding, such as intra-abdominal injuries (spleen laceration or rupture), and complex pelvic fractures.

Case 2

You are called to a sports field where a 6-year-old girl has been struck with a hockey stick. The girl has a large hematoma in the forehead and is crying. She has not lost consciousness, but she is not making eye contact with her teacher or with you. She looks confused, her blood pressure is normal, and the ABCDE assessment shows normal vital signs with no other apparent injuries. During the initial evaluation the girl exhibits progressive drowsiness and it is difficult to wake her.

  • What is the major threat to this patient's life?
  • What interventions are needed?

The third peak in trauma mortality rate occurs from days to weeks after the traumatic event and is due to multiorgan failure or sepsis.

The Advanced Trauma Life Support (ATLS) course was designed in the United States to provide health personnel with a tool for a systematic approach to the management of injured patients. In this course, emphasis is placed on management during the first critical hour. The same guidelines are used in a disaster situation that requires management of large numbers of victims. The goal with each patient is to identify and manage the most life-threatening condition using the ABCDE approach. This approach can be used with both adults and children, as long as pediatric-specific features are taken into consideration.