Pediatric trauma
Encyclopedia
Pediatric trauma refers to a traumatic
injury that happens to an infant
, child
or adolescent
.
and physiological
differences between children and adults. For example, the internal organs are closer in proximity to each other in children than in adults; this places children at higher risk of traumatic injury.
An important part of managing trauma in children is weight estimation. A number of methods to estimate weight exist, including the Broselow tape, Leffler formula, and Theron formula. Of these three methods, the Broselow tape is the most accurate for weight estimation in children ≤25 kg, while the Theron formula performs better with patients weighing >40 kg.
Due to basic geometry
, a child's weight to surface area ratio is lower than an adult's, children more readily lose their body heat through radiation and have a higher risk of becoming hypothermic
. Smaller body size in children often makes them more prone to poly traumatic injury.
and a modified version of the Glasgow Coma Scale
. More complex classification systems, such as the Revised Trauma Score
, APACHE II
, and SAPS II
add physiologic data to the equation in an attempt to more precisely define the severity, which can be useful in triaging casualties as well as in determining medical management and predicting prognosis.
Though useful, all of these measures have significant limitations when applied to pediatric patients. For this reason, health care providers often employ classification systems that have been modified or even specifically developed for use in the pediatric population. For example, the Pediatric Glasgow Coma Scale is a modification of the Glasgow Coma Scale that is useful in patients who have not yet developed language skills.
Emphasizing the importance of body weight and airway diameter, the Pediatric Trauma Score (PTS) was developed to specifically reflect the vulnerability of children to traumatic injury. The minimal score is -6 and the maximum score is +12. There is a linear relationship between the decrease in PTS and the mortality risk (i.e. the lower the PTS, the higher the mortality risk). Mortality is estimated at 9% with a PTS > 8, and at 100% with a PTS ≤ 0.
In most cases the severity of a pediatric trauma injury is determined by the pediatric trauma score despite the fact that some research has shown there is no benefit between it and the revised trauma scale.
—greater than all other causes combined. It also is the leading cause of permanent paralysis for children. In the US approximately 16,000,000 children go to a hospital emergency room due to some kind of injury every year. Male children are more frequently injured then female children by a ratio of two to one. One of the most common causes of penetrating injury in children is because of writing utensils and other common household objects as many are readily available to children in the course of their day.
Trauma (medicine)
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
injury that happens to an infant
Infant
A newborn or baby is the very young offspring of a human or other mammal. A newborn is an infant who is within hours, days, or up to a few weeks from birth. In medical contexts, newborn or neonate refers to an infant in the first 28 days after birth...
, child
Child
Biologically, a child is generally a human between the stages of birth and puberty. Some vernacular definitions of a child include the fetus, as being an unborn child. The legal definition of "child" generally refers to a minor, otherwise known as a person younger than the age of majority...
or adolescent
Adolescence
Adolescence is a transitional stage of physical and mental human development generally occurring between puberty and legal adulthood , but largely characterized as beginning and ending with the teenage stage...
.
Anatomic and physiologic differences in children
There are significant anatomicalHuman anatomy
Human anatomy is primarily the scientific study of the morphology of the human body. Anatomy is subdivided into gross anatomy and microscopic anatomy. Gross anatomy is the study of anatomical structures that can be seen by the naked eye...
and physiological
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
differences between children and adults. For example, the internal organs are closer in proximity to each other in children than in adults; this places children at higher risk of traumatic injury.
An important part of managing trauma in children is weight estimation. A number of methods to estimate weight exist, including the Broselow tape, Leffler formula, and Theron formula. Of these three methods, the Broselow tape is the most accurate for weight estimation in children ≤25 kg, while the Theron formula performs better with patients weighing >40 kg.
Due to basic geometry
Geometry
Geometry arose as the field of knowledge dealing with spatial relationships. Geometry was one of the two fields of pre-modern mathematics, the other being the study of numbers ....
, a child's weight to surface area ratio is lower than an adult's, children more readily lose their body heat through radiation and have a higher risk of becoming hypothermic
Hypothermia
Hypothermia is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as . Body temperature is usually maintained near a constant level of through biologic homeostasis or thermoregulation...
. Smaller body size in children often makes them more prone to poly traumatic injury.
Pediatric Trauma Score
Several classification systems have been developed that use some combination of subjective and objective data in an effort to quantify the severity of trauma. Examples include the Injury Severity ScoreInjury Severity Score
The Injury Severity Score is an established medical score to assess trauma severity. It correlates with mortality, morbidity and hospitalization time after trauma...
and a modified version of the Glasgow Coma Scale
Glasgow Coma Scale
Glasgow Coma Scale or GCS is a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment...
. More complex classification systems, such as the Revised Trauma Score
Revised Trauma Score
The Revised Trauma Score is a tool for on-site triage for Multiple Casualty Incidents. Its superior efficiency is due to both speed and objectivity. It is designed to provide a comprehensive assessment for medical professionals of any field....
, APACHE II
APACHE II
APACHE II is a severity-of-disease classification system , one of several ICU scoring systems...
, and SAPS II
SAPS II
SAPS II is a severity of disease classification system . Its name stands for "Simplified Acute Physiology Score", and is one of several ICU scoring systems.-Application:...
add physiologic data to the equation in an attempt to more precisely define the severity, which can be useful in triaging casualties as well as in determining medical management and predicting prognosis.
Though useful, all of these measures have significant limitations when applied to pediatric patients. For this reason, health care providers often employ classification systems that have been modified or even specifically developed for use in the pediatric population. For example, the Pediatric Glasgow Coma Scale is a modification of the Glasgow Coma Scale that is useful in patients who have not yet developed language skills.
Emphasizing the importance of body weight and airway diameter, the Pediatric Trauma Score (PTS) was developed to specifically reflect the vulnerability of children to traumatic injury. The minimal score is -6 and the maximum score is +12. There is a linear relationship between the decrease in PTS and the mortality risk (i.e. the lower the PTS, the higher the mortality risk). Mortality is estimated at 9% with a PTS > 8, and at 100% with a PTS ≤ 0.
In most cases the severity of a pediatric trauma injury is determined by the pediatric trauma score despite the fact that some research has shown there is no benefit between it and the revised trauma scale.
Epidemiology in the United States
Pediatric trauma accounted for 59.5% of all mortality for children under 18 in 2004. Injury is the leading cause of death in this age group in the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
—greater than all other causes combined. It also is the leading cause of permanent paralysis for children. In the US approximately 16,000,000 children go to a hospital emergency room due to some kind of injury every year. Male children are more frequently injured then female children by a ratio of two to one. One of the most common causes of penetrating injury in children is because of writing utensils and other common household objects as many are readily available to children in the course of their day.
See also
- Blunt traumaBlunt traumaIn medical terminology, blunt trauma, blunt injury, non-penetrating trauma or blunt force trauma refers to a type of physical trauma caused to a body part, either by impact, injury or physical attack; the latter usually being referred to as blunt force trauma...
- Blast injuryBlast injuryA blast injury is a complex type of physical trauma resulting from direct or indirect exposure to an explosion. Blast injuries occur with the detonation of high-order explosives as well as the deflagration of low order explosives...
- Geriatric traumaGeriatric traumaGeriatric trauma refers to a traumatic injury that occurs to an elderly person. The three prevailing causes of traumatic death in the elderly are falls , traffic collisions and burns....
- Penetrating traumaPenetrating traumaPenetrating trauma is an injury that occurs when an object pierces the skin and enters a tissue of the body, creating an open wound. In blunt, or non-penetrating trauma, there may be an impact, but the skin is not necessarily broken. The penetrating object may remain in the tissues, come back out...
- Pediatric Advanced Life SupportPediatric Advanced Life SupportPediatric Advanced Life Support is a 2 day American Heart Association training program. The goal of the course is to aid the pediatric healthcare provider in developing the knowledge and skills necessary to efficiently and effectively manage critically ill infants and children, resulting in...