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Pediatric Polytrauma Management

  • Focus on Pediatric Polytrauma
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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Caring for pediatric trauma patients requires an understanding of the distinct anatomy and pathophysiology of the pediatric population compared to adult trauma patients. Initial evaluation, management, and resuscitation are performed as a multidisciplinary approach including pediatric physicians, trauma surgeons, and pediatric intensive care physicians. Head injury severity is the principle determinant of outcome and mortality in polytraumatized children. Abdominal injuries rarely require surgery in contrast to adults, but need to be detected. Spine and pelvic injuries as well as injuries of the extremities require age-adapted surgical procedures. However, the degree of recovery in polytraumatized children is often remarkable, even after apparently devastating injuries. Maximal care should, therefore, be rendered under the assumption that a complete recovery will be made.

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References

  1. American Academy of Pediatrics Section on Orthopaedics; American Academy of Pediatrics Committee on Pediatric Emergency Medicine; American Academy of Pediatrics Section on Critical Care; American Academy of Pediatrics Section on Surgery; American Academy of Pediatrics Section on Transport Medicine; American Academy of Pediatrics Committee on Pediatric Emergency Medicine; Pediatric Orthopaedic Society of North America, Krug SE, Tuggle DW. Management of pediatric trauma. Pediatrics 2008;121:849–54.

    Article  PubMed  Google Scholar 

  2. Arias E, MacDorman MF, Strobino DM, Guyer B. Annual summary of vital statistics—2002. Pediatrics 2003;112:1215–30.

    Article  PubMed  Google Scholar 

  3. Mazurek A. Pediatric injury patterns. Int Anesthesiol Clin 1994;32:11–25.

    CAS  PubMed  Google Scholar 

  4. Jakob H, Brand J, Marzi I. Multiple trauma in pediatric patients. Unfallchirurg 2009;112:951–8.

    Article  CAS  PubMed  Google Scholar 

  5. Gatzka C, Begemann PG, Wolff A, Zörb J, Rueger JM, Windolf J. Injury pattern and clinical course of children with multiple injuries in comparison to adults, Ab 11-year analysis at a clinic of maximum utilization. Unfallchirurg 2005;108:470–80.

    Article  CAS  PubMed  Google Scholar 

  6. Kay RM, Skaggs DL. Pediatric polytrauma management. J Pediatr Orthop 2006;26:268–77.

    PubMed  Google Scholar 

  7. Sharples PM, Storey A, Aynsley-Green A, Eyre JA. Avoidable factors contributing to death of children with head injury. BMJ 1990;300:87–91.

    Article  CAS  PubMed  Google Scholar 

  8. Laurer H, Wutzler S, Wyen H, Westhoff J, Lehnert M, Lefering R, Marzi I; Sektion NIS der DGU. Quality of prehospital and early clinical care of pediatric trauma patients of school age compared to an adult cohort. A matched-pair analysis of 624 patients from the DGU trauma registry. Unfallchirurg 2009;112:771–7.

    Article  CAS  PubMed  Google Scholar 

  9. Bouillon B, Kanz KG, Lackner CK, Mutschler W, Sturm J. The importance of advanced trauma life support (ATLS) in the emergency room. Unfallchirurg 2004;107:844–50.

    Article  CAS  PubMed  Google Scholar 

  10. Agarwal S, Swanson S, Murphy A, Yaeger K, Sharek P, Halamek LP. Comparing the utility of a standard pediatric resuscitation cart with a pediatric resuscitation cart based on the Broselow tape: a randomized, controlled, crossover trial involving simulated resuscitation scenarios. Pediatrics 2005;116:e326–33.

    Article  PubMed  Google Scholar 

  11. So TY, Farrington E, Absher RK. Evaluation of the accuracy of different methods used to estimate weights in the pediatric population. Pediatrics 2009;123:e1045–51.

    Article  PubMed  Google Scholar 

  12. Nakayama DK, Gardner MJ, Rowe MI. Emergency endotracheal intubation in pediatric trauma. Ann Surg 1990;211:218–23.

    Article  CAS  PubMed  Google Scholar 

  13. American College of Surgeons. Hemorrhagic shock classification. In: Advanced Trauma Life Support for Physicians: Instructor’s Manual. Chicago, 1993.

  14. Ruesseler M, Kirschning T, Breitkreutz R, Marzi I, Walcher F. Prehospital and emergency department ultrasound in blunt abdominal trauma. Eur J Trauma Emerg Surg 2009;35:341–46.

    Article  Google Scholar 

  15. Murphy R, Ghosh A. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. The accuracy of abdominal ultrasound in paediatric trauma. Emerg Med J 2001;18:208–9.

    Article  CAS  PubMed  Google Scholar 

  16. Beierle EA, Chen MK, Whalen TV, Doolin EJ. Free fluid on abdominal computed tomography scan after blunt trauma does not mandate exploratory laparotomy in children. J Pediatr Surg 2000;35:990–2; (discussion 993).

    Article  CAS  PubMed  Google Scholar 

  17. Dowd MD. Effect of emergency department care on outcomes in pediatric trauma: what approaches make a difference in quality of care? J Trauma 2007;63:S136–9.

    Article  PubMed  Google Scholar 

  18. Kanz KG, Körner M, Linsenmaier U, Kay MV, Huber-Wagner SM, Kreimeier U, Pfeifer KJ, Reiser M, Mutschler W. Priority-oriented shock trauma room management with the integration of multiple-view spiral computed tomography. Unfallchirurg 2004;107:937–44.

    Article  PubMed  Google Scholar 

  19. Strohm PC, Uhl M, Hauschild O, Stankovic Z, Reising KJ, Lesniak M, Südkamp NP. What is the value of the whole body spiral CT in the primary radiological imaging of severely injured children? Z Orthop Unfall 2008;146:38–43.

    Article  CAS  PubMed  Google Scholar 

  20. Wesson DE, Spence LJ, Williams JI, Armstrong PF. Injury scoring systems in children. Can J Surg 1987;30:398–400.

    CAS  PubMed  Google Scholar 

  21. Nayduch DA, Moylan J, Rutledge R, Baker CC, Meredith W, Thomason M, Cunningham PG, Oller D, Azizkhan RG, Mason T. Comparison of the ability of adult and pediatric trauma scores to predict pediatric outcome following major trauma. J Trauma 1991;31:452–7; (discussion 457-8).

    Article  CAS  PubMed  Google Scholar 

  22. Ott R, Krämer R, Martus P, Bussenius-Kammerer M, Carbon R, Rupprecht H. Prognostic value of trauma scores in pediatric patients with multiple injuries. J Trauma 2000;49:729–36.

    Article  CAS  PubMed  Google Scholar 

  23. Scavarda D, Gabaudan C, Ughetto F, Lamy F, Imada V, Lena G, Paut O. Initial predictive factors of outcome in severe nonaccidental head trauma in children. Childs Nerv Syst 2010 (in press).

  24. Eichelberger MR, Gotschall CS, Sacco WJ, Bowman LM, Mangubat EA, Lowenstein AD. A comparison of the trauma score, the revised trauma score, and the pediatric trauma score. Ann Emerg Med 1989;18:1053–8.

    Article  CAS  PubMed  Google Scholar 

  25. Ramenofsky ML, Ramenofsky MB, Jurkovich GJ, Threadgill D, Dierking BH, Powell RW. The predictive validity of the Pediatric Trauma Score. J Trauma 1988;28:1038–42.

    Article  CAS  PubMed  Google Scholar 

  26. Letts M, Davidson D, Lapner P. Multiple trauma in children: Predicting outcome and long-term results. Can J Surg 2002;45:126–31.

    PubMed  Google Scholar 

  27. Schalamon J, v Bismarck S, Schober PH, Höllwarth ME. Multiple trauma in pediatric patients. Pediatr Surg Int 2003;19:417–23.

    Article  PubMed  Google Scholar 

  28. van der Sluis CK, Kingma J, Eisma WH, ten Duis HJ. Pediatric polytrauma: short-term and long-term outcomes. J Trauma 1997;43:501–6.

    Article  PubMed  Google Scholar 

  29. Sookplung P, Vavilala MS. What is new in pediatric traumatic brain injury? Curr Opin Anaesthesiol 2009;22:572–8.

    Article  PubMed  Google Scholar 

  30. Ruchholtz S, Nast-Kolb D. Craniocerebral trauma. Chirurg 2002;73:194–207; (quiz 208-9).

    Article  CAS  PubMed  Google Scholar 

  31. Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, Klug G, Wallace D, Henning R, Tibballs J. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 2001;17:154–62.

    Article  CAS  PubMed  Google Scholar 

  32. Bliss D, Silen M. Pediatric thoracic trauma. Crit Care Med 2002;30:S409–15.

    Article  PubMed  Google Scholar 

  33. Till H. Das thoraxtrauma im kindesalter. In: Rueger JM, Schlickewei W, Engert J, Sommerfeldt DW, eds. Das Kindliche Polytrauma. Darmstadt: Steinkopff; 2004:75–81.

    Google Scholar 

  34. Ceran S, Sunam GS, Aribas OK, Gormus N, Solak H. Chest trauma in children. Eur J Cardiothorac Surg 2002;21:57–9.

    Article  PubMed  Google Scholar 

  35. Dereeper E, Ciardelli R, Vincent JL. Fatal outcome after polytrauma: Multiple organ failure or cerebral damage? Resuscitation 1998;36:15–8.

    Article  CAS  PubMed  Google Scholar 

  36. Landau A, van As AB, Numanoglu A, Millar AJ, Rode H. Liver injuries in children: the role of selective non-operative management. Injury 2006;37:66–71.

    Article  CAS  PubMed  Google Scholar 

  37. Peitzman AB, Ford HR, Harbrecht BG, Potoka DA, Townsend RN. Injury to the spleen. Curr Probl Surg 2001;38:932–1008.

    Article  CAS  PubMed  Google Scholar 

  38. Tinkoff G, Esposito TJ, Reed J, Kilgo P, Fildes J, Pasquale M, Meredith JW. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg 2008;207:646–55.

    Article  PubMed  Google Scholar 

  39. Gaines BA, Ford HR. Abdominal and pelvic trauma in children. Crit Care Med 2002;30:S416–23.

    Article  PubMed  Google Scholar 

  40. Meier DE, Coln CD, Hicks BA, Guzzetta PC. Early operation in children with pancreas transection. J Pediatr Surg 2001;36:341–4.

    Article  CAS  PubMed  Google Scholar 

  41. Schlickewei W, Keck T. Pelvic and acetabular fractures in childhood. Injury 2005;36:A57–63.

    Article  PubMed  Google Scholar 

  42. Smith WR, Oakley M, Morgan SJ. Pediatric pelvic fractures. J Pediatr Orthop 2004;24:130–5.

    PubMed  Google Scholar 

  43. Demetriades D, Karaiskakis M, Velmahos GC, Alo K, Murray J, Chan L. Pelvic fractures in pediatric and adult trauma patients: are they different injuries? J Trauma 2003;54:1146–51; (discussion 1151).

    Article  PubMed  Google Scholar 

  44. Thannheimer A, Buehren V. Becken. In: Marzi I, ed. Kindertraumatologie. Darmstadt: Steinkopff; 2006:249–68.

    Chapter  Google Scholar 

  45. Holt GE, Mencio GA. Pelvic C-clamp in a pediatric patient. J Orthop Trauma 2003;17:525–7.

    Article  PubMed  Google Scholar 

  46. Spiguel L, Glynn L, Liu D, Statter M. Pediatric pelvic fractures: a marker for injury severity. Am Surg 2006;72:481–4.

    PubMed  Google Scholar 

  47. Leonard M, Sproule J, McCormack D. Paediatric spinal trauma and associated injuries. Injury 2007;38:188–93.

    Article  CAS  PubMed  Google Scholar 

  48. Gore PA, Chang S, Theodore N. Cervical spine injuries in children: attention to radiographic differences and stability compared to those in the adult patient. Semin Pediatr Neurol 2009;16:42–58.

    Article  PubMed  Google Scholar 

  49. Bulas DI, Fitz CR, Johnson DL. Traumatic atlanto-occipital dislocation in children. Radiology 1993;188:155–8.

    CAS  PubMed  Google Scholar 

  50. Rose S, Marzi I. Wirbelsäule. In: Marzi I, ed. Kindertraumatologie. Darmstadt: Steinkopff; 2006:397–430.

    Chapter  Google Scholar 

  51. Blauth M, Schmidt U. Wirbelsäulenverletzungen bei Kindern. In: Tscherne H, ed. Unfallchirurgie—Wirbelsaeule. Berlin: Springer; 1998:383–99.

    Google Scholar 

  52. Blauth M, Schmidt U, Lange U. Injuries of the cervical spine in children. Unfallchirurg 1998;101:590–612.

    Article  CAS  PubMed  Google Scholar 

  53. Vialle LR, Vialle E. Pediatric spine injuries. Injury 2005;36:B104–12.

    Article  PubMed  Google Scholar 

  54. Platzer P, Jaindl M, Thalhammer G, Dittrich S, Kutscha-Lissberg F, Vecsei V, Gaebler C. Cervical spine injuries in pediatric patients. J Trauma 2007;62:389–96; (discussion 394-6).

    Article  PubMed  Google Scholar 

  55. Jakob H, Marzi I. Das polytrauma im kindesalter. In: Oestern HJ, ed. Das Polytrauma. Präklinisches und Klinisches Management. München: Elsevier; 2008:321–43.

    Google Scholar 

  56. Keel M, Trentz O. Pathophysiology of polytrauma. Injury 2005;36:691–709.

    Article  PubMed  Google Scholar 

  57. Odetola FO, Miller WC, Davis MM, Bratton SL. The relationship between the location of pediatric intensive care unit facilities and child death from trauma: a county-level ecologic study. J Pediatr 2005;147:74–7.

    Article  PubMed  Google Scholar 

  58. Hahn YS, Fuchs S, Flannery AM, Barthel MJ, McLone DG. Factors influencing posttraumatic seizures in children. Neurosurgery 1988;22:864–7.

    Article  CAS  PubMed  Google Scholar 

  59. Raimondi AJ, Hirschauer J. Head injury in the infant and toddler. Coma scoring and outcome scale. Childs Brain 1984;11:12–35.

    CAS  PubMed  Google Scholar 

  60. Fritz H, Bauer R. Prehospital immediate care of severe traumatic brain injury in children. Notfall Rettungsmedizin 2002;5:335–40.

    Article  Google Scholar 

  61. Jöhr M. Schädelhirntrauma. In: Jöhr M, ed. Kinderanästhesie. Lübeck: Fischer; 1998:207–12.

    Google Scholar 

  62. Frank J, Marzi I, Mutschler W. Shock room management of polytrauma. Zentralbl Chir 1996;121:943–9.

    CAS  PubMed  Google Scholar 

  63. Helm M, Kulla M, Lampl L. Advanced Trauma Life Support. A training concept also for Europe. Anaesthesist 2007;56:1142–6.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe University Medical School, Frankfurt/Main, Germany

    Heike Jakob, Thomas Lustenberger, Dorien Schneidmüller, Anna L. Sander, Felix Walcher &  Ingo Marzi

  2. Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe University Medical School, Theodor-Stern-kai 7, 60590, Frankfurt/Main, Germany

    Ingo Marzi

Authors
  1. Heike Jakob
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  2. Thomas Lustenberger
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  3. Dorien Schneidmüller
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  4. Anna L. Sander
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  6. Ingo Marzi
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Correspondence to Ingo Marzi.

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Jakob, H., Lustenberger, T., Schneidmüller, D. et al. Pediatric Polytrauma Management. Eur J Trauma 36, 325–338 (2010). https://doi.org/10.1007/s00068-010-1125-3

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  • DOI: https://doi.org/10.1007/s00068-010-1125-3

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