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CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1990 Jan 1;142(1):27–34.

Pediatric trauma: differences in pathophysiology, injury patterns and treatment compared with adult trauma.

N Kissoon 1, J Dreyer 1, M Walia 1
PMCID: PMC1451562  PMID: 2403481

Abstract

Although multiple trauma remains the leading cause of death among children, fewer resources and less attention have been directed to treatment of the injured child than to treatment of the injured adult. Insufficient training of medical personnel and hence lack of expertise in the management of injured children are factors contributing to disability and death in such children. Although the principles of resuscitation of injured children are similar to those for adults, appreciation of the differences in cardiorespiratory variables, airway anatomy, response to blood loss, thermoregulation and equipment required is essential for successful initial resuscitation. Cerebral, abdominal and thoracic injuries account for most of the disability and death among injured children. Cerebral damage may be due to secondary injuries to the brain and is potentially preventable. The need to preserve the spleen in children complicates the management of abdominal trauma. Although children usually have large cardiorespiratory reserves, they are likely to need airway control and ventilation with thoracic injuries. The psychologic effect of trauma may pose long-term problems and needs close follow-up.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alpert J. J., Feinbloom R. I. Advances in hospital ambulatory services for children. Pediatr Clin North Am. 1974 May;21(2):263–275. doi: 10.1016/s0031-3955(16)32988-1. [DOI] [PubMed] [Google Scholar]
  2. Berg R. A. Emergency infusion of catecholamines into bone marrow. Am J Dis Child. 1984 Sep;138(9):810–811. doi: 10.1001/archpedi.1984.02140470010003. [DOI] [PubMed] [Google Scholar]
  3. Bivins H. G., Ford S., Bezmalinovic Z., Price H. M., Williams J. L. The effect of axial traction during orotracheal intubation of the trauma victim with an unstable cervical spine. Ann Emerg Med. 1988 Jan;17(1):25–29. doi: 10.1016/s0196-0644(88)80498-0. [DOI] [PubMed] [Google Scholar]
  4. Bruce D. A., Alavi A., Bilaniuk L., Dolinskas C., Obrist W., Uzzell B. Diffuse cerebral swelling following head injuries in children: the syndrome of "malignant brain edema". J Neurosurg. 1981 Feb;54(2):170–178. doi: 10.3171/jns.1981.54.2.0170. [DOI] [PubMed] [Google Scholar]
  5. Bruce D. A., Gennarelli T. A., Langfitt T. W. Resuscitation from coma due to head injury. Crit Care Med. 1978 Jul-Aug;6(4):254–269. doi: 10.1097/00003246-197807000-00006. [DOI] [PubMed] [Google Scholar]
  6. Bruce D. A., Schut L., Bruno L. A., Wood J. H., Sutton L. N. Outcome following severe head injuries in children. J Neurosurg. 1978 May;48(5):679–688. doi: 10.3171/jns.1978.48.5.0679. [DOI] [PubMed] [Google Scholar]
  7. Crone R. K. Acute circulatory failure in children. Pediatr Clin North Am. 1980 Aug;27(3):525–538. doi: 10.1016/s0031-3955(16)33890-1. [DOI] [PubMed] [Google Scholar]
  8. Douglas G. J., Simpson J. S. The conservative management of splenic trauma. J Pediatr Surg. 1971 Oct;6(5):565–570. doi: 10.1016/0022-3468(71)90380-0. [DOI] [PubMed] [Google Scholar]
  9. Eichelberger M. R., Randolph J. G. Thoracic trauma in children. Surg Clin North Am. 1981 Oct;61(5):1181–1197. doi: 10.1016/s0039-6109(16)42540-5. [DOI] [PubMed] [Google Scholar]
  10. Eichelberger M. R., Stossel-Pratsch G., Mangubat E. A. A pediatric emergencies training program for emergency medical services. Pediatr Emerg Care. 1985 Dec;1(4):177–179. doi: 10.1097/00006565-198512000-00001. [DOI] [PubMed] [Google Scholar]
  11. Ein S. H., Shandling B., Simpson J. S., Stephens C. A. Nonoperative management of traumatized spleen in children: how and why. J Pediatr Surg. 1978 Apr;13(2):117–119. doi: 10.1016/s0022-3468(78)80001-3. [DOI] [PubMed] [Google Scholar]
  12. Fesmire F. M., Luten R. C. The pediatric cervical spine: developmental anatomy and clinical aspects. J Emerg Med. 1989 Mar-Apr;7(2):133–142. doi: 10.1016/0736-4679(89)90258-8. [DOI] [PubMed] [Google Scholar]
  13. Haller J. A., Jr, Donahoo J. S. Traumatic asphyxia in children: pathophysiology and management. J Trauma. 1971 Jun;11(6):453–457. doi: 10.1097/00005373-197106000-00001. [DOI] [PubMed] [Google Scholar]
  14. Haller J. A., Jr Pediatric trauma. The No. 1 killer of children. JAMA. 1983 Jan 7;249(1):47–47. doi: 10.1001/jama.249.1.47. [DOI] [PubMed] [Google Scholar]
  15. Henrys P., Lyne E. D., Lifton C., Salciccioli G. Clinical review of cervical spine injuries in children. Clin Orthop Relat Res. 1977 Nov-Dec;(129):172–176. doi: 10.1097/00003086-197711000-00020. [DOI] [PubMed] [Google Scholar]
  16. Holbrook P. R. Prehospital care of critically ill children. Crit Care Med. 1980 Oct;8(10):537–540. doi: 10.1097/00003246-198010000-00002. [DOI] [PubMed] [Google Scholar]
  17. Hood J. M., Smyth B. T. Nonpenetrating intraabdominal injuries in children. J Pediatr Surg. 1974 Feb;9(1):69–77. doi: 10.1016/0022-3468(74)90011-6. [DOI] [PubMed] [Google Scholar]
  18. Iserson K. V., Criss E. A. Pediatric venous cutdowns: utility in emergency situations. Pediatr Emerg Care. 1986 Dec;2(4):231–234. doi: 10.1097/00006565-198612000-00006. [DOI] [PubMed] [Google Scholar]
  19. Izant R. J., Jr, Hubay C. A. The annual injury of 15,000,000 children: a limited study of childhood accidental injury and death. J Trauma. 1966 Jan;6(1):65–74. doi: 10.1097/00005373-196601000-00008. [DOI] [PubMed] [Google Scholar]
  20. Jaffe D. M., Binns H., Radkowski M. A., Barthel M. J., Engelhard H. H., 3rd Developing a clinical algorithm for early management of cervical spine injury in child trauma victims. Ann Emerg Med. 1987 Mar;16(3):270–276. doi: 10.1016/s0196-0644(87)80171-3. [DOI] [PubMed] [Google Scholar]
  21. Kane N. M., Cronan J. J., Dorfman G. S., DeLuca F. Pediatric abdominal trauma: evaluation by computed tomography. Pediatrics. 1988 Jul;82(1):11–15. [PubMed] [Google Scholar]
  22. Kraus J. F., Fife D., Conroy C. Pediatric brain injuries: the nature, clinical course, and early outcomes in a defined United States' population. Pediatrics. 1987 Apr;79(4):501–507. [PubMed] [Google Scholar]
  23. Levy J. L., Jr, Linder L. H. Major abdominal trauma in children. Am J Surg. 1970 Jul;120(1):55–58. doi: 10.1016/s0002-9610(70)80144-1. [DOI] [PubMed] [Google Scholar]
  24. Marsh M. L., Marshall L. F., Shapiro H. M. Neurosurgical intensive care. Anesthesiology. 1977 Aug;47(2):149–163. doi: 10.1097/00000542-197708000-00006. [DOI] [PubMed] [Google Scholar]
  25. Mayer T., Matlak M. E., Johnson D. G., Walker M. L. The modified injury severity scale in pediatric multiple trauma patients. J Pediatr Surg. 1980 Dec;15(6):719–726. doi: 10.1016/s0022-3468(80)80271-5. [DOI] [PubMed] [Google Scholar]
  26. Merten D. F., Osborne D. R. Craniocerebral trauma in the child abuse syndrome. Pediatr Ann. 1983 Dec;12(12):882–887. doi: 10.3928/0090-4481-19831201-06. [DOI] [PubMed] [Google Scholar]
  27. Merten D. F., Radkowski M. A., Leonidas J. C. The abused child: a radiological reappraisal. Radiology. 1983 Feb;146(2):377–381. doi: 10.1148/radiology.146.2.6849085. [DOI] [PubMed] [Google Scholar]
  28. OLIVER T. K., Jr TEMPERATURE REGULATION AND HEAT PRODUCTION IN THE NEWBORN. Pediatr Clin North Am. 1965 Aug;12:765–779. doi: 10.1016/s0031-3955(16)31744-8. [DOI] [PubMed] [Google Scholar]
  29. Orlowski J. P. Cardiopulmonary resuscitation in children. Pediatr Clin North Am. 1980 Aug;27(3):495–512. doi: 10.1016/s0031-3955(16)33888-3. [DOI] [PubMed] [Google Scholar]
  30. Pang D., Wilberger J. E., Jr Spinal cord injury without radiographic abnormalities in children. J Neurosurg. 1982 Jul;57(1):114–129. doi: 10.3171/jns.1982.57.1.0114. [DOI] [PubMed] [Google Scholar]
  31. Ramenofsky M. L., Morse T. S. Standards of care for the critically injured pediatric patient. J Trauma. 1982 Nov;22(11):921–933. doi: 10.1097/00005373-198211000-00007. [DOI] [PubMed] [Google Scholar]
  32. Rosenberg N. Pediatric cardiac arrest. Emerg Med Clin North Am. 1983 Dec;1(3):609–617. [PubMed] [Google Scholar]
  33. Seidel J. S., Hornbein M., Yoshiyama K., Kuznets D., Finklestein J. Z., St Geme J. W., Jr Emergency medical services and the pediatric patient: are the needs being met? Pediatrics. 1984 Jun;73(6):769–772. [PubMed] [Google Scholar]
  34. Showers J., Apolo J., Thomas J., Beavers S. Fatal child abuse: a two-decade review. Pediatr Emerg Care. 1985 Jun;1(2):66–70. [PubMed] [Google Scholar]
  35. Smith R. J., Keseg D. P., Manley L. K., Standeford T. Intraosseous infusions by prehospital personnel in critically ill pediatric patients. Ann Emerg Med. 1988 May;17(5):491–495. doi: 10.1016/s0196-0644(88)80245-2. [DOI] [PubMed] [Google Scholar]
  36. Smyth B. T. Chest trauma in children. J Pediatr Surg. 1979 Feb;14(1):41–47. doi: 10.1016/s0022-3468(79)80574-6. [DOI] [PubMed] [Google Scholar]
  37. Spivey W. H. Intraosseous infusions. J Pediatr. 1987 Nov;111(5):639–643. doi: 10.1016/s0022-3476(87)80236-6. [DOI] [PubMed] [Google Scholar]
  38. Spivey W. H., Lathers C. M., Malone D. R., Unger H. D., Bhat S., McNamara R. N., Schoffstall J., Tumer N. Comparison of intraosseous, central, and peripheral routes of sodium bicarbonate administration during CPR in pigs. Ann Emerg Med. 1985 Dec;14(12):1135–1140. doi: 10.1016/s0196-0644(85)81015-5. [DOI] [PubMed] [Google Scholar]
  39. Teasdale G., Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81–84. doi: 10.1016/s0140-6736(74)91639-0. [DOI] [PubMed] [Google Scholar]
  40. West K. W., Grosfeld J. L. Postsplenectomy sepsis: historical background and current concepts. World J Surg. 1985 Jun;9(3):477–483. doi: 10.1007/BF01655284. [DOI] [PubMed] [Google Scholar]
  41. Young B., Rapp R. P., Norton J. A., Haack D., Tibbs P. A., Bean J. R. Early prediction of outcome in head-injured patients. J Neurosurg. 1981 Mar;54(3):300–303. doi: 10.3171/jns.1981.54.3.0300. [DOI] [PubMed] [Google Scholar]

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