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Pediatric Trauma

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Update in Pediatrics

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Abstract

Pediatric traumatic injuries remain a major source of morbidity and mortality worldwide. While primary injury prevention is the best way to reduce the burden of disease, a coordinated and systematic approach is essential in effectively caring for injured patients. The approach to a traumatically injured patient involves rapid assessment and correction of immediate life-threatening injuries. The primary survey assesses for injuries to the airway, breathing and circulation. The secondary survey is an assessment of a patient’s disability, extremities and a head to toe evaluation for any additional injuries. The use of adjunct diagnostic modalities such as labs, X-rays, ultrasounds and CT scans are essential in the initial work-up of a trauma patient. Pediatric patients have unique anatomical and physiologic characteristics that lead to specific injury patterns. Though the majority of pediatric trauma patients have favorable outcomes, there is a narrow margin for error making appropriate interventions essential for providing high quality care.

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References

  • Abe T, Aoki M, Deshpande G, et al. Is whole-body CT associated with reduced in-hospital mortality in children with trauma? A nationwide study. Pediatr Crit Care Med. 2019;20(6):e245–50.

    Article  PubMed  Google Scholar 

  • Ajdari A, Boyle LN, Kannan N, et al. Examining emergency department treatment processes in severe pediatric traumatic brain injury. J Healthc Qual. 2017;39(6):334.

    Article  PubMed  PubMed Central  Google Scholar 

  • Araki T, Yokota H, Morita A. Pediatric traumatic brain injury: Characteristic features, diagnosis, and management. Neurol Med. 2017;57(2):82–93.

    Article  Google Scholar 

  • Baker VO, Cuzzola R, Knox C, et al. Teamwork education improves trauma team performance in undergraduate health professional students. J Educ Eval Health Prof. 2015;12:36.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bankole S, Asuncion A, Ross S, et al. First responder performance in pediatric trauma: A comparison with an adult cohort. Pediatr Crit Care Med. 2011;12(4):e166–70.

    Article  PubMed  Google Scholar 

  • Benedict LA, Paulus JK, Rideout L, Chwals WJ. Are CT scans obtained at referring institutions justified prior to transfer to a pediatric trauma center? J Pediatr Surg. 2014;49(1):184–8.

    Article  PubMed  Google Scholar 

  • Borgialli DA, Mahajan P, Hoyle JD Jr, et al. Performance of the pediatric Glasgow coma scale score in the evaluation of children with blunt head trauma. Acad Emerg Med. 2016;23(8):878–84.

    Article  PubMed  Google Scholar 

  • Brenkert TE, Adams C, Vieira RL, Rempell RG. Peritoneal fluid localization on FAST examination in the pediatric trauma patient. Am J Emerg Med. 2017;35(10):1497–9.

    Article  PubMed  Google Scholar 

  • Bruner DI, Pritchard A, Hubert A, Lipman GS. Pulmonary contusions. Trauma Reports. 2011;12:6.

    Google Scholar 

  • Calder BW, Vogel AM, Zhang J, et al. Focused assessment with sonography for trauma in children after blunt abdominal trauma: A multi-institutional analysis. J Trauma Acute Care Surg. 2017;83(2):218–24.

    Article  PubMed  Google Scholar 

  • Capella J, Smith S, Philp A, et al. Teamwork training improves the clinical care of trauma patients. J Surg Educ. 2010;67(6):439–43.

    Article  PubMed  Google Scholar 

  • Casson C, Jones RE, Gee KM, Beres AL. Does microscopic hematuria after pediatric blunt trauma indicate clinically significant injury? J Surg Res. 2019;241:317–22.

    Article  PubMed  Google Scholar 

  • Cheung R, Shukla M, Akers KG, Farooqi A, Sethuraman U. Bicycle handlebar injuries–a systematic review of pediatric chest and abdominal injuries. Am J Emerg Med. 2022;51:13–21.

    Article  PubMed  Google Scholar 

  • Choi J, Carlos G, Nassar AK, Knowlton LM, Spain DA. The impact of trauma systems on patient outcomes. Curr Probl Surg. 2021;58(1):100849.

    Article  PubMed  Google Scholar 

  • Clough RA, Khan M. Initial CABC: Advances that have led to increased survival in military casualties. Trauma. 2019;21(4):247–51.

    Article  Google Scholar 

  • Cooper A, Barlow B, DiScala C, String D. Mortality and truncal injury: The pediatric perspective. J Pediatr Surg. 1994;29(1):33–8.

    Article  CAS  PubMed  Google Scholar 

  • Cornelius B, Cummings Q, Assercq M, Rizzo E, Gennuso S, Cornelius A. Current practices in tranexamic acid administration for pediatric trauma patients in the United States. J Trauma Nursing. 2021;28(1):21–5.

    Article  Google Scholar 

  • Crompton EM, Lubomirova I, Cotlarciuc I, Han TS, Sharma SD, Sharma P. Meta-analysis of therapeutic hypothermia for traumatic brain injury in adult and pediatric patients. Crit Care Med. 2017;45(4):575–83.

    Article  PubMed  Google Scholar 

  • Docimo S, Diggs L, Crankshaw L, Lee Y, Vinces F. No evidence supporting the routine use of digital rectal examinations in trauma patients. Indian J Surg. 2015;77(4):265–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Easter JS, Bakes K, Dhaliwal J, Miller M, Caruso E, Haukoos JS. Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: A prospective cohort study. Ann Emerg Med. 2014;64(2):145–52. e5

    Article  PubMed  PubMed Central  Google Scholar 

  • Eslami MH, Saadeddin ZM, Rybin DV, et al. Trends and outcomes of pediatric vascular injuries in the United States: An analysis of the national trauma data bank. Ann Vasc Surg. 2019;56:52–61.

    Article  PubMed  Google Scholar 

  • Evangelista ME, Gaffley M, Neff LP. Massive transfusion protocols for pediatric patients: Current perspectives. J Blood Med. 2020;11:163.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Filanovsky Y, Miller P, Kao J. Myth: Ketamine should not be used as an induction agent for intubation in patients with head injury. CJEM. 2010;12(2):154–7.

    Article  PubMed  Google Scholar 

  • Gates RL, Price M, Cameron DB, et al. Non-operative management of solid organ injuries in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. J Pediatr Surg. 2019;54(8):1519–26.

    Article  PubMed  Google Scholar 

  • Gilley M, Beno S. Damage control resuscitation in pediatric trauma. Curr Opin Pediatr. 2018;30(3):338–43.

    Article  PubMed  Google Scholar 

  • Golden J, Isani M, Bowling J, et al. Limiting chest computed tomography in the evaluation of pediatric thoracic trauma. J Trauma Acute Care Surg. 2016;81(2):271–7.

    Article  PubMed  Google Scholar 

  • Goldstick JE, Cunningham RM, Carter PM. Current causes of death in children and adolescents in the United States. N Engl J Med. 2022;386(20):1955–6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Haasz M, Simone LA, Wales PW, et al. Which pediatric blunt trauma patients do not require pelvic imaging? J Trauma Acute Care Surg. 2015;79(5):828–32.

    Article  PubMed  Google Scholar 

  • Hale AT, Alvarado A, Bey AK, et al. X-ray vs. CT in identifying significant C-spine injuries in the pediatric population. Childs Nerv Syst. 2017;33(11):1977–83.

    Article  PubMed  Google Scholar 

  • Hoffmann F, Schmalhofer M, Lehner M, Zimatschek S, Grote V, Reiter K. Comparison of the AVPU scale and the pediatric GCS in prehospital setting. Prehosp Emerg Care. 2016;20(4):493–8.

    Article  PubMed  Google Scholar 

  • Horst J, Leonard JC, Vogel A, Jacobs R, Spinella PC. A survey of US and Canadian hospitals’ paediatric massive transfusion protocol policies. Transfus Med. 2016;26(1):49–56.

    Article  CAS  PubMed  Google Scholar 

  • Hsieh T, Kuo P, Hsu S, Chien P, Hsieh H, Hsieh C. Effect of hypothermia in the emergency department on the outcome of trauma patients: A cross-sectional analysis. Int J Environ Res Public Health. 2018;15(8):1769.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hwu RS, Spinella PC, Keller MS, Baker D, Wallendorf M, Leonard JC. The effect of massive transfusion protocol implementation on pediatric trauma care. Transfusion. 2016;56(11):2712–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jakobsen RB, Gran SF, Grimsmo B, et al. Examining participant perceptions of an interprofessional simulation-based trauma team training for medical and nursing students. J Interprof Care. 2018;32(1):80–8.

    Article  PubMed  Google Scholar 

  • Johnson DJ, Johnson CC, Goobie SM, et al. High-dose versus low-dose tranexamic acid to reduce transfusion requirements in pediatric scoliosis surgery. J Pediatr Orthop. 2017;37(8):e552–7.

    Article  PubMed  Google Scholar 

  • Kornelsen E, Kuppermann N, Nishijima D, et al. Effectiveness and safety of tranexamic acid in pediatric trauma: A systematic review and meta-analysis. Am J Emerg Med. 2022;55:103–10.

    Article  PubMed  Google Scholar 

  • Kulvatunyou N, Erickson L, Vijayasekaran A, et al. Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. Br J Surg. 2014;101(2):17–22.

    Article  CAS  PubMed  Google Scholar 

  • Kulvatunyou N, Bauman ZM, Edine SBZ, et al. The small (14 Fr) percutaneous catheter (P-CAT) versus large (28–32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. J Trauma Acute Care Surg. 2021;91(5):809–13.

    Article  CAS  PubMed  Google Scholar 

  • Kyu HH, Pinho C, Wagner JA, et al. Global and national burden of diseases and injuries among children and adolescents between 1990 and 2013: Findings from the global burden of disease 2013 study. JAMA Pediatr. 2016;170(3):267–87.

    Article  PubMed  Google Scholar 

  • Lapierre A, Bouferguene S, Gauvin-Lepage J, Lavoie P, Arbour C. Effectiveness of interprofessional manikin-based simulation training on teamwork among real teams during trauma resuscitation in adult emergency departments: A systematic review. Simul Healthc. 2020;15(6):409–21.

    Article  PubMed  Google Scholar 

  • Lee YT, Feng XYJ, Lin Y, Chiang LW. Pediatric trauma team activation: Are we making the right call? Eur J Pediatr Surg. 2014;24(01):46.

    Article  PubMed  Google Scholar 

  • Lee SH, Frey M, Kerrey BT, Zhang Y, Byczkowski T, Geis GL. A video-based, case-control study of factors associated with intraosseous catheterization during pediatric resuscitation. Ann Emerg Med. 2020;75(6):755–61.

    Article  PubMed  Google Scholar 

  • Liang T, Roseman E, Gao M, Sinert R. The utility of the focused assessment with sonography in trauma examination in pediatric blunt abdominal trauma: A systematic review and meta-analysis. Pediatr Emerg Care. 2021;37(2):108–18.

    Article  PubMed  Google Scholar 

  • Linnaus ME, Notrica DM, Langlais CS, et al. Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC study. J Pediatr Surg. 2017;52(2):340–4.

    Article  PubMed  Google Scholar 

  • Lott C, Truhlář A, Alfonzo A, et al. European resuscitation council guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021;161:152–219.

    Article  PubMed  Google Scholar 

  • van Maarseveen OE, Huijsmans RL, Leenen LP, Ham WH. Variation of in-hospital trauma team staffing: New resuscitation, new team. BMC Emerg Med. 2022;22(1):1–6.

    Google Scholar 

  • Mandt MJ, Hayes K, Severyn F, Adelgais K. Appropriate needle length for emergent pediatric needle thoracostomy utilizing computed tomography. Prehosp Emerg Care. 2019;23(5):663–71.

    Article  PubMed  Google Scholar 

  • Mehrotra S, Misir A. Special traumatized populations: Accidental hypothermia in children. Curr Pediatr Rev. 2018;14(1):28–33.

    Article  PubMed  Google Scholar 

  • Meltzer JA, Stone ME, Reddy SH, Silver EJ. Association of whole-body computed tomography with mortality risk in children with blunt trauma. JAMA Pediatr. 2018;172(6):542–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Miller D, Crandall C, Washington C III, McLaughlin S. Improving teamwork and communication in trauma care through in situ simulations. Acad Emerg Med. 2012;19(5):608–12.

    Article  PubMed  Google Scholar 

  • Mohammad A, Branicki F, Abu-Zidan FM. Educational and clinical impact of advanced trauma life support (ATLS) courses: A systematic review. World J Surg. 2014;38(2):322–9.

    Article  PubMed  Google Scholar 

  • Myatra SN, Doctor JR. Use of videolaryngoscopy as a teaching tool for novices performing tracheal intubation results in greater first pass success in neonates and infants. Indian J Anaesth. 2019;63(10):781.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nabaweesi R, Ramakrishnaiah RH, Aitken ME, et al. Injured children receive twice the radiation dose at nonpediatric trauma centers compared with pediatric trauma centers. J Am Coll Radiol. 2018;15(1):58–64.

    Article  PubMed  Google Scholar 

  • Netherton S, Milenkovic V, Taylor M, Davis PJ. Diagnostic accuracy of eFAST in the trauma patient: A systematic review and meta-analysis. CJEM. 2019;21(6):727–38.

    Article  PubMed  Google Scholar 

  • Noland DK, Apelt N, Greenwell C, et al. Massive transfusion in pediatric trauma: An ATOMAC perspective. J Pediatr Surg. 2019;54(2):345–9.

    Article  PubMed  Google Scholar 

  • Osler TM, Vane DW, Tepas JJ, Rogers FB, Shackford SR, Badger GJ. Do pediatric trauma centers have better survival rates than adult trauma centers? An examination of the national pediatric trauma registry. J Trauma Acute Care Surg. 2001;50(1):96–101.

    Article  CAS  Google Scholar 

  • Overmann KM, Robinson BR, Eckman MH. Cervical spine evaluation in pediatric trauma: A cost-effectiveness analysis. Am J Emerg Med. 2020;38(11):2347–55.

    Article  PubMed  Google Scholar 

  • Ozcan A, Ahn T, Akay B, Menoch M. Imaging for pediatric blunt abdominal trauma with different prediction rules: Is the outcome the same? Pediatr Emerg Care. 2022;38(2):e654–8.

    Article  PubMed  Google Scholar 

  • Ozcanoglu HD, Ozalp S, Kahraman IA, et al. The effects of different doses of tranexamic acid infusions on the postoperative outcomes of pediatric cardiovascular surgery. Med Bull Haseki. 2022;60(4):366–73.

    Article  Google Scholar 

  • Pandit V, Michailidou M, Rhee P, et al. The use of whole body computed tomography scans in pediatric trauma patients: Are there differences among adults and pediatric centers? J Pediatr Surg. 2016;51(4):649–53.

    Article  PubMed  Google Scholar 

  • Peclet MH, Newman KD, Eichelberger MR, Gotschall CS, Garcia VF, Bowman LM. Thoracic trauma in children: An indicator of increased mortality. J Pediatr Surg. 1990;25(9):961–6.

    Article  CAS  PubMed  Google Scholar 

  • Polites SF, Nygaard RM, Reddy PN, et al. Multicenter study of crystalloid boluses and transfusion in pediatric trauma—When to go to blood? J Trauma Acute Care Surg. 2018;85(1):108–12.

    Article  PubMed  Google Scholar 

  • Polites SF, Moody S, Williams RF, et al. Timing and volume of crystalloid and blood products in pediatric trauma: An Eastern Association for the Surgery of Trauma multicenter prospective observational study. J Trauma Acute Care Surg. 2020;89(1):36–42.

    Article  PubMed  Google Scholar 

  • Puckett Y, Bonacorsi L, Caley M, et al. Imaging before transfer to designated pediatric trauma centers exposes children to excess radiation. J Trauma Acute Care Surg. 2016;81(2):229–35.

    Article  PubMed  Google Scholar 

  • Qazi K, Wright MS, Kippes C. Stable pediatric blunt trauma patients: Is trauma team activation always necessary? J Trauma Acute Care Surg. 1998;45(3):562–4.

    Article  CAS  Google Scholar 

  • Quinn N, Palmer CS, Bernard S, Noonan M, Teague WJ. Thoracostomy in children with severe trauma: An overview of the paediatric experience in Victoria, Australia. Emerg Med Australas. 2020;32(1):117–26.

    Article  PubMed  Google Scholar 

  • Riera A, Hayward H, Silva CT, Chen L. Reevaluation of FAST sensitivity in pediatric blunt abdominal trauma patients: Should we redefine the qualitative threshold for significant hemoperitoneum? Pediatr Emerg Care. 2021;37(12):e1012–9.

    Article  PubMed  Google Scholar 

  • Rotondo MF, Nathens AB, Neal M, et al. NTDB/TQIP staff NTDB pediatric report. Chicago: American College of Surgeons; 2016.

    Google Scholar 

  • Ruggero JM, Martin MJ. Difficult decisions in trauma: Is ABC the right mantra? In: Wilson K, Rogers SO, editors. Difficult decisions in trauma surgery. Springer; 2022. p. 3–11.

    Chapter  Google Scholar 

  • Sabzghabaei A, Shojaee M, Safari S, Hatamabadi HR, Shirvani R. The accuracy of urinalysis in predicting intra-abdominal injury following blunt traumas. Emergency. 2016;4(1):11.

    PubMed  PubMed Central  Google Scholar 

  • Santos D, Carron P, Yersin B, Pasquier M. EZ-IO® intraosseous device implementation in a pre-hospital emergency service: A prospective study and review of the literature. Resuscitation. 2013;84(4):440–5.

    Article  PubMed  Google Scholar 

  • Shi F, Xiao Y, Xiong W, Zhou Q, Huang X. Cuffed versus uncuffed endotracheal tubes in children: A meta-analysis. J Anesth. 2016;30(1):3–11.

    Article  PubMed  Google Scholar 

  • Shin JI, Lee NJ, Cho SK. Pediatric cervical spine and spinal cord injury: A national database study. Spine. 2016;41(4):283–92.

    Article  PubMed  Google Scholar 

  • Shroyer MC, Griffin RL, Mortellaro VE, Russell RT. Massive transfusion in pediatric trauma: Analysis of the national trauma databank. J Surg Res. 2017;208:166–72.

    Article  PubMed  Google Scholar 

  • Slaar A, Fockens MM, Wang J, et al. Triage tools for detecting cervical spine injury in pediatric trauma patients. Cochrane Database Syst Rev. 2017;12:CD011686.

    PubMed  Google Scholar 

  • Steinemann S, Berg B, Skinner A, et al. In situ, multidisciplinary, simulation-based teamwork training improves early trauma care. J Surg Educ. 2011;68(6):472–7.

    Article  PubMed  Google Scholar 

  • Stephens CQ, Boulos MC, Connelly CR, Gee A, Jafri M, Krishnaswami S. Limiting thoracic CT: A rule for use during initial pediatric trauma evaluation. J Pediatr Surg. 2017;52(12):2031–7.

    Article  PubMed  Google Scholar 

  • Stringel G, Xu ML, Lopez J. Minimally invasive surgery in pediatric trauma: One institution’s 20-year experience. JSLS. 2016;20(1):e2015.00111.

    Article  PubMed  PubMed Central  Google Scholar 

  • Swendiman RA, Goldshore MA, Blinman TA, Nance ML. Laparoscopic management of pediatric abdominal trauma: A national trauma data bank experience. J Laparoendosc Adv Surg Tech A. 2019;29(8):1052–9.

    Article  PubMed  Google Scholar 

  • Teague WJ, Amarakone KV, Quinn N. Rule of 4’s: Safe and effective pleural decompression and chest drain insertion in severely injured children. Emerg Med Australas. 2019;31(4):683–7.

    Article  PubMed  Google Scholar 

  • Tepas JJ III, Mollitt DL, Talbert JL, Bryant M. The pediatric trauma score as a predictor of injury severity in the injured child. J Pediatr Surg. 1987;22(1):14–8.

    Article  PubMed  Google Scholar 

  • Tharakan SJ, Kim AG, Collins JL, Nance ML, Blinman TA. Laparoscopy in pediatric abdominal trauma: A 13-year experience. Eur J Pediatr Surg. 2016;26(05):443–8.

    PubMed  Google Scholar 

  • Thyagarajan S, Edmonds NJ. Hemorrhagic shock in pediatric trauma. J Pediatr Crit Care. 2017;4(1):30.

    Article  Google Scholar 

  • Topjian AA, Raymond TT, Atkins D, et al. Part 4: Pediatric basic and advanced life support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16 Suppl 2):S469–523.

    PubMed  Google Scholar 

  • Vardon F, Mrozek S, Geeraerts T, Fourcade O. Accidental hypothermia in severe trauma. Anaesth Crit Care Pain Med. 2016;35(5):355–61.

    Article  PubMed  Google Scholar 

  • Verhoeff K, Saybel R, Fawcett V, Tsang B, Mathura P, Widder S. A quality-improvement approach to effective trauma team activation. Can J Surg. 2019;62(5):305.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wang P, Li N, Gu Y, et al. Comparison of severe trauma care effect before and after advanced trauma life support training. Chin J Traumatol. 2010;13(06):341–4.

    PubMed  Google Scholar 

  • Zagory JA, Wieck MM, Lerner BE, Moody S, Falcone RA, Burke RV. Evaluation of highest level pediatric trauma activation criteria. Pediatr Emerg Care. 2018;34(11):787–90.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. General & Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada

    Joshua K. Ramjist

  2. Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, ON, Canada

    Suzanne Beno & Daniel Rosenfield

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  1. Joshua K. Ramjist
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  2. Suzanne Beno
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Correspondence to Joshua K. Ramjist .

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  1. Pediatrician, Kidcrew Pediatric Medical Clinic, Toronto, ON, Canada

    Shalea Beckwith

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Ramjist, J.K., Beno, S., Rosenfield, D. (2023). Pediatric Trauma. In: Beckwith, S. (eds) Update in Pediatrics. Springer, Cham. https://doi.org/10.1007/978-3-031-41542-5_13

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