The Multiply Injured Child

Reference work entry


Trauma is the leading cause of death and disability in children. Fractures are rarely the cause of mortality in multiply injured children but contribute significantly to morbidity. Regardless of the mechanism causing the multiple injuries, the initial medical management focuses on the life-threatening, non-orthopedic injuries to stabilize the child’s condition. Subsequent optimal treatment of orthopedic injuries, in a timely fashion, decreases the burden of musculoskeletal disability.


Traumatic Brain Injury Glasgow Coma Scale Injury Severity Score Pelvic Fracture Pediatric Trauma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Abou-Jaoude WA, Sugarman JM, et al. Indicators of genitourinary tract injury or anomaly in cases of pediatric blunt trauma. J Pediatr Surg. 1996;31(1):86–9; discussion 90.PubMedGoogle Scholar
  2. American Academy of Pediatrics. Diagnostic imaging of child abuse. Pediatrics. 2000;105(6):1345–8.Google Scholar
  3. American Academy of Pediatrics Section on Orthopaedics, American Academy of Pediatrics Committee on Pediatric Emergency Medicine, et al. Management of pediatric trauma. Pediatrics. 2008;121(4):849–54.Google Scholar
  4. Amini R, Lavoie A, et al. Pediatric trauma mortality by type of designated hospital in a mature inclusive trauma system. J Emerg Trauma Shock. 2011;4(1):12–9.PubMedCentralPubMedGoogle Scholar
  5. Andrich DE, O'Malley KJ, et al. The type of urethroplasty for a pelvic fracture urethral distraction defect cannot be predicted preoperatively. J Urol. 2003;170(2 Pt 1):464–7.PubMedGoogle Scholar
  6. Aprahamian C, Cattey RP, et al. Pediatric trauma score. Predictor of hospital resource use? Arch Surg. 1990;125(9):1128–31.PubMedGoogle Scholar
  7. Arias E, MacDorman MF, et al. Annual summary of vital statistics–2002. Pediatrics. 2003;112(6 Pt 1):1215–30.PubMedGoogle Scholar
  8. Armstrong PF. Initial management of the multiply injured child: the ABC’s. Instr Course Lect. 1992;41:347–50.PubMedGoogle Scholar
  9. Aufdermaur M. Spinal injuries in juveniles. Necropsy findings in twelve cases. J Bone Joint Surg Br. 1974;56B(3):513–9.PubMedGoogle Scholar
  10. Azu MC, McCormack JE, et al. Venous thromboembolic events in pediatric trauma patients: is prophylaxis necessary? J Trauma. 2005;59(6):1345–9.PubMedGoogle Scholar
  11. Babyn PS, Gahunia HK, et al. Pulmonary thromboembolism in children. Pediatr Radiol. 2005;35(3):258–74.PubMedGoogle Scholar
  12. Barsness KA, Cha ES, et al. The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children. J Trauma. 2003;54(6):1107–10.PubMedGoogle Scholar
  13. Batislam E, Ates Y, et al. Role of Tile classification in predicting urethral injuries in pediatric pelvic fractures. J Trauma. 1997;42(2):285–7.PubMedGoogle Scholar
  14. Benifla M, Weizman Z. Acute pancreatitis in childhood: analysis of literature data. J Clin Gastroenterol. 2003;37(2):169–72.PubMedGoogle Scholar
  15. Bielski RJ, Bassett GS, et al. Intraosseous infusions: effects on the immature physis–an experimental model in rabbits. J Pediatr Orthop. 1993;13(4):511–5.PubMedGoogle Scholar
  16. Blasier RD, McAtee J, et al. Disruption of the pelvic ring in pediatric patients. Clin Orthop Relat Res. 2000;376:87–95.PubMedGoogle Scholar
  17. Bond SJ, Gotschall CS, et al. Predictors of abdominal injury in children with pelvic fracture. J Trauma. 1991;31(8):1169–73.PubMedGoogle Scholar
  18. Borgman MA, Maegele M, et al. Pediatric trauma BIG score: predicting mortality in children after military and civilian trauma. Pediatrics. 2011;127(4):e892–897.PubMedGoogle Scholar
  19. Borse N, Sleet DA. CDC childhood injury report: patterns of unintentional injuries among 0- to 19-year olds in the United States, 2000–2006. Fam Community Health. 2009;32(2):189.PubMedGoogle Scholar
  20. Bosch PP, Vogt MT, et al. Pediatric spinal cord injury without radiographic abnormality (SCIWORA): the absence of occult instability and lack of indication for bracing. Spine (Phila Pa 1976). 2002;27(24):2788–800.Google Scholar
  21. Brainard BJ, Slauterbeck J, et al. Fracture patterns and mechanisms in pedestrian motor-vehicle trauma: the ipsilateral dyad. J Orthop Trauma. 1992;6(3):279–82.PubMedGoogle Scholar
  22. Brandao LR, Labarque V, et al. Pulmonary embolism in children. Semin Thromb Hemost. 2011;37(7):772–85.PubMedGoogle Scholar
  23. Brazelton T, Gozain A. Classification of trauma in children. In Basow D, editor. Waltham: UpToDate; 2012.Google Scholar
  24. Brown JK, Jing Y, et al. Patterns of severe injury in pediatric car crash victims: crash injury research engineering network database. J Pediatr Surg. 2006;41(2):362–7.PubMedGoogle Scholar
  25. Buckley SL, Gotschall C, et al. The relationships of skeletal injuries with trauma score, injury severity score, length of hospital stay, hospital charges, and mortality in children admitted to a regional pediatric trauma center. J Pediatr Orthop. 1994;14(4):449–53.PubMedGoogle Scholar
  26. Buess E, Illi OE, et al. Ruptured spleen in children–15-year evolution in therapeutic concepts. Eur J Pediatr Surg. 1992;2(3):157–61.PubMedGoogle Scholar
  27. Burt CW, Fingerhut LA. Injury visits to hospital emergency departments: United States, 1992–95. Vital Health Stat. 1998;13(131):1–76.Google Scholar
  28. Campbell DJ, Sprouse 2nd LR, et al. Injuries in pediatric patients with seatbelt contusions. Am Surg. 2003;69(12):1095–9.PubMedGoogle Scholar
  29. Canarelli JP, Boboyono JM, et al. Management of abdominal contusion in polytraumatized children. Int Surg. 1991;76(2):119–21.PubMedGoogle Scholar
  30. Caniano DA, Ruth B, et al. Wound management with vacuum-assisted closure: experience in 51 pediatric patients. J Pediatr Surg. 2005;40(1):128–32.PubMedGoogle Scholar
  31. Centers for Disease Control and Prevention. Vital signs: Unintentional injury deaths among persons aged 0–19 years – United States, 2000–2009. MMWR Morb Mortal Wkly Rep. 2012;61:270–6.Google Scholar
  32. Champion HR, Sacco WJ, et al. A revision of the trauma score. J Trauma. 1989;29(5):623–9.PubMedGoogle Scholar
  33. Chan L, Reilly KM, et al. Odds of critical injuries in unrestrained pediatric victims of motor vehicle collision. Pediatr Emerg Care. 2006;22(9):626–9.PubMedGoogle Scholar
  34. Cloutier DR, Baird TB, et al. Pediatric splenic injuries with a contrast blush: successful nonoperative management without angiography and embolization. J Pediatr Surg. 2004;39(6):969–71.PubMedGoogle Scholar
  35. Coburn MC, Pfeifer J, et al. Nonoperative management of splenic and hepatic trauma in the multiply injured pediatric and adolescent patient. Arch Surg. 1995;130(3):332–8.PubMedGoogle Scholar
  36. Cochran A, Mann NC, et al. Resource utilization and its management in splenic trauma. Am J Surg. 2004;187(6):713–9.PubMedGoogle Scholar
  37. Coley BD, Mutabagani KH, et al. Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma. J Trauma. 2000;48(5):902–6.PubMedGoogle Scholar
  38. Colombani PM, Buck JR, et al. One-year experience in a regional pediatric trauma center. J Pediatr Surg. 1985;20(1):8–13.PubMedGoogle Scholar
  39. Copeland CE, Bosse MJ, et al. Effect of trauma and pelvic fracture on female genitourinary, sexual, and reproductive function. J Orthop Trauma. 1997;11(2):73–81.PubMedGoogle Scholar
  40. Cowley R. The resuscitation and stabilization of major multiple trauma patients in a trauma center environment. Clin Med. 1976;83:16–22.Google Scholar
  41. Cramer KE. The pediatric polytrauma patient. Clin Orthop Relat Res. 1995;318:125–35.PubMedGoogle Scholar
  42. Cyr C, Michon B, et al. Venous thromboembolism after severe injury in children. Acta Haematol. 2006;115(3–4):198–200.PubMedGoogle Scholar
  43. Danseco ER, Miller TR, et al. Incidence and costs of 1987–1994 childhood injuries: demographic breakdowns. Pediatrics. 2000;105(2):E27.PubMedGoogle Scholar
  44. Davis DH, Localio AR, et al. Trends in operative management of pediatric splenic injury in a regional trauma system. Pediatrics. 2005;115(1):89–94.PubMedGoogle Scholar
  45. Demetriades D, Karaiskakis M, et al. Pelvic fractures in pediatric and adult trauma patients: are they different injuries? J Trauma. 2003;54(6):1146–51; discussion 1151.PubMedGoogle Scholar
  46. Densmore JC, Lim HJ, et al. Outcomes and delivery of care in pediatric injury. J Pediatr Surg. 2006;41(1):92–8; discussion 92–98.PubMedGoogle Scholar
  47. Dereeper E, Ciardelli R, et al. Fatal outcome after polytrauma: multiple organ failure or cerebral damage? Resuscitation. 1998;36(1):15–8.PubMedGoogle Scholar
  48. Dormans JP. Evaluation of children with suspected cervical spine injury. J Bone Joint Surg Am. 2002;84-A(1):124–32.PubMedGoogle Scholar
  49. Eichelberger MR, Gotschall CS, et al. A comparison of the trauma score, the revised trauma score, and the pediatric trauma score. Ann Emerg Med. 1989;18(10):1053–8.PubMedGoogle Scholar
  50. Eppich WJ, Zonfrillo MR. Emergency department evaluation and management of blunt abdominal trauma in children. Curr Opin Pediatr. 2007;19(3):265–9.PubMedGoogle Scholar
  51. Evans DL, Bethem D. Cervical spine injuries in children. J Pediatr Orthop. 1989;9(5):563–8.PubMedGoogle Scholar
  52. Farris MK, Chowdhry VK, et al. Osteosarcoma following single fraction radiation prophylaxis for heterotopic ossification. Radiat Oncol. 2012;7:140.PubMedCentralPubMedGoogle Scholar
  53. Frank JB, Lim CK, et al. The efficacy of magnetic resonance imaging in pediatric cervical spine clearance. Spine (Phila Pa 1976). 2002;27(11):1176–9.Google Scholar
  54. Galano GJ, Vitale MA, et al. The most frequent traumatic orthopaedic injuries from a national pediatric inpatient population. J Pediatr Orthop. 2005;25(1):39–44.PubMedGoogle Scholar
  55. Garcia VF, Gotschall CS, et al. Rib fractures in children: a marker of severe trauma. J Trauma. 1990;30(6):695–700.PubMedGoogle Scholar
  56. Garvin KL, McCarthy RE, et al. Pediatric pelvic ring fractures. J Pediatr Orthop. 1990;10(5):577–82.PubMedGoogle Scholar
  57. Gill A. In: Basow D, editor. Prevention of bicycle injuries in children. Waltham: UpToDate; 2012.Google Scholar
  58. Greenberg MI. Falls from heights. JACEP. 1978;7(8):300–1.PubMedGoogle Scholar
  59. Greenspan AI, MacKenzie EJ. Functional outcome after pediatric head injury. Pediatrics. 1994;94(4 Pt 1):425–32.PubMedGoogle Scholar
  60. Guillamondegui OD, Mahboubi S, et al. The utility of the pelvic radiograph in the assessment of pediatric pelvic fractures. J Trauma. 2003;55(2):236–9; discussion 239–240.PubMedGoogle Scholar
  61. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58(4):453–8.PubMedGoogle Scholar
  62. Gustilo RB, Mendoza RM, et al. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24(8):742–6.PubMedGoogle Scholar
  63. Guy J, Haley K, et al. Use of intraosseous infusion in the pediatric trauma patient. J Pediatr Surg. 1993;28(2):158–61.PubMedGoogle Scholar
  64. Hall JR, Reyes HM, et al. The outcome for children with blunt trauma is best at a pediatric trauma center. J Pediatr Surg. 1996;31(1):72–6; discussion 76–77.PubMedGoogle Scholar
  65. Hannan EL, Farrell LS, et al. Predicting inpatient mortality for pediatric trauma patients with blunt injuries: a better alternative. J Pediatr Surg. 2000;35(2):155–9.PubMedGoogle Scholar
  66. Hanten G, Dennis M, et al. Childhood head injury and metacognitive processes in language and memory. Dev Neuropsychol. 2004;25(1–2):85–106.PubMedGoogle Scholar
  67. Harlan SR, Nixon GW, et al. Follow-up skeletal surveys for nonaccidental trauma: can a more limited survey be performed? Pediatr Radiol. 2009;39(9):962–8.PubMedGoogle Scholar
  68. Harper NS, Eddleman S, et al. The utility of follow-up skeletal surveys in child abuse. Pediatrics. 2013;131(3):e672–8.PubMedGoogle Scholar
  69. Hauser CJ, Adams Jr CA, et al. Surgical Infection Society guideline: prophylactic antibiotic use in open fractures: an evidence-based guideline. Surg Infect (Larchmt). 2006;7(4):379–405.Google Scholar
  70. Herzenberg JE, Hensinger RN, et al. Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous. J Bone Joint Surg Am. 1989;71(1):15–22.PubMedGoogle Scholar
  71. Hoffmann R, Nerlich M, et al. Blunt abdominal trauma in cases of multiple trauma evaluated by ultrasonography: a prospective analysis of 291 patients. J Trauma. 1992;32(4):452–8.PubMedGoogle Scholar
  72. Holmes JF, Brant WE, et al. Emergency department ultrasonography in the evaluation of hypotensive and normotensive children with blunt abdominal trauma. J Pediatr Surg. 2001;36(7):968–73.PubMedGoogle Scholar
  73. Holmes JF, Gladman A, et al. Performance of abdominal ultrasonography in pediatric blunt trauma patients: a meta-analysis. J Pediatr Surg. 2007;42(9):1588–94.PubMedGoogle Scholar
  74. Holt GE, Mencio GA. Pelvic C-clamp in a pediatric patient. J Orthop Trauma. 2003;17(7):525–7.PubMedGoogle Scholar
  75. Investigators F, Petrisor B, et al. Fluid lavage of open wounds (FLOW): a multicenter, blinded, factorial pilot trial comparing alternative irrigating solutions and pressures in patients with open fractures. J Trauma. 2011;71(3):596–606.Google Scholar
  76. Jakob H, Lustenberger T, Schneidmueller D, Sander AL, Walcher F, Marzi I. Pediatric polytrauma management. Eur J Trauma Emerg Surg. 2010;36(4):325–38.Google Scholar
  77. Jawadi AH, Letts M. Injuries associated with fracture of the femur secondary to motor vehicle accidents in children. Am J Orthop (Belle Mead NJ). 2003;32(9):459–62; discussion 462.Google Scholar
  78. Karunakar MA, Goulet JA, et al. Operative treatment of unstable pediatric pelvis and acetabular fractures. J Pediatr Orthop. 2005;25(1):34–8.PubMedGoogle Scholar
  79. Keret D, Harcke HT, et al. Heterotopic ossification in central nervous system-injured patients following closed nailing of femoral fractures. Clin Orthop Relat Res. 1990;256:254–9.PubMedGoogle Scholar
  80. Kim KA, Wang MY, et al. Analysis of pediatric head injury from falls. Neurosurg Focus. 2000;8(1):e3.PubMedGoogle Scholar
  81. King J, Diefendorf D, et al. Analysis of 429 fractures in 189 battered children. J Pediatr Orthop. 1988;8(5):585–9.PubMedGoogle Scholar
  82. Kluger G, Kochs A, et al. Heterotopic ossification in childhood and adolescence. J Child Neurol. 2000;15(6):406–13.PubMedGoogle Scholar
  83. Knudson MM, Shagoury C, et al. Can adult trauma surgeons care for injured children? J Trauma. 1992;32(6):729–37; discussion 737–729.PubMedGoogle Scholar
  84. Kocher MS, Kasser JR. Orthopaedic aspects of child abuse. J Am Acad Orthop Surg. 2000;8(1):10–20.PubMedGoogle Scholar
  85. Kreder HJ, Armstrong P. A review of open tibia fractures in children. J Pediatr Orthop. 1995;15(4):482–8.PubMedGoogle Scholar
  86. Kumaresan S, Sances Jr A, et al. Biomechanical analysis of padding in child seats and head injury. Biomed Sci Instrum. 2002;38:453–8.PubMedGoogle Scholar
  87. Lallier M, Bouchard S, et al. Falls from heights among children: a retrospective review. J Pediatr Surg. 1999;34(7):1060–3.PubMedGoogle Scholar
  88. Lane WG, Dubowitz H. What factors affect the identification and reporting of child abuse-related fractures? Clin Orthop Relat Res. 2007;461:219–25.PubMedGoogle Scholar
  89. Larson JT, Dietrich AM, et al. Effective use of the air ambulance for pediatric trauma. J Trauma. 2004;56(1):89–93.PubMedGoogle Scholar
  90. Lauber S, Schulte TL, et al. Acute compartment syndrome following intramedullary pulse lavage and debridement for osteomyelitis of the tibia. Arch Orthop Trauma Surg. 2005;125(8):564–6.PubMedGoogle Scholar
  91. Lavelle WF, Uhl R, et al. Management of open fractures in pediatric patients: current teaching in Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs. J Pediatr Orthop B. 2008;17(1):1–6.PubMedGoogle Scholar
  92. Lee LK, Fleisher G. In: Basow D, editor. Trauma management: approach to the unstable child. Waltham: UpToDate; 2012.Google Scholar
  93. Leinwand MJ, Atkinson CC, et al. Application of the APSA evidence-based guidelines for isolated liver or spleen injuries: a single institution experience. J Pediatr Surg. 2004;39(3):487–90; discussion 487–490.PubMedGoogle Scholar
  94. Letts M, Davidson D, et al. Multiple trauma in children: predicting outcome and long-term results. Can J Surg. 2002;45(2):126–31.PubMedCentralPubMedGoogle Scholar
  95. Levy JA, Bachur RG. Bedside ultrasound in the pediatric emergency department. Curr Opin Pediatr. 2008;20(3):235–42.PubMedGoogle Scholar
  96. Levy ML, Granville RC, et al. Deep venous thrombosis in children and adolescents. J Neurosurg. 2004;101(1 Suppl):32–7.PubMedGoogle Scholar
  97. Limbird TJ, Ruderman RJ. Fat embolism in children. Clin Orthop Relat Res. 1978;136:267–9.PubMedGoogle Scholar
  98. Loder RT. Pediatric polytrauma: orthopaedic care and hospital course. J Orthop Trauma. 1987;1(1):48–54.PubMedGoogle Scholar
  99. Loder RT, Gullahorn LJ, et al. Factors predictive of immobilization complications in pediatric polytrauma. J Orthop Trauma. 2001;15(5):338–41.PubMedGoogle Scholar
  100. Loder RT, O’Donnell PW, et al. Epidemiology and mechanisms of femur fractures in children. J Pediatr Orthop. 2006;26(5):561–6.PubMedGoogle Scholar
  101. MacKenzie EJ, Rivara FP, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366–78.PubMedGoogle Scholar
  102. Maio RF, Portnoy J, et al. Injury type, injury severity, and repeat occurrence of alcohol-related trauma in adolescents. Alcohol Clin Exp Res. 1994;18(2):261–4.PubMedGoogle Scholar
  103. Maksoud Jr JG, Moront ML, et al. Resuscitation of the injured child. Semin Pediatr Surg. 1995;4(2):93–9.PubMedGoogle Scholar
  104. Mandelstam SA, Cook D, et al. Complementary use of radiological skeletal survey and bone scintigraphy in detection of bony injuries in suspected child abuse. Arch Dis Child. 2003;88(5):387–90; discussion 387–390.PubMedCentralPubMedGoogle Scholar
  105. Michaud LJ, Rivara FP, et al. Predictors of survival and severity of disability after severe brain injury in children. Neurosurgery. 1992;31(2):254–64.PubMedGoogle Scholar
  106. Mital MA, Garber JE, et al. Ectopic bone formation in children and adolescents with head injuries: its management. J Pediatr Orthop. 1987;7(1):83–90.PubMedGoogle Scholar
  107. Mooney JF. The use of “damage control orthopedics” techniques in children with segmental open femur fractures. J Pediatr Orthop B. 2012;21(5):400–3.PubMedGoogle Scholar
  108. Mooney 3rd JF, Argenta LC, et al. Treatment of soft tissue defects in pediatric patients using the V.A.C. system. Clin Orthop Relat Res. 2000;376:26–31.PubMedGoogle Scholar
  109. Mourad WF, Packianathan S, Shourbaji RA. Radiation-induced sarcoma following radiation prophylaxis of heterotopic ossification. Practical Radiation Oncol. 2012;2:151–4.Google Scholar
  110. Musemeche CA, Fischer RP, et al. Selective management of pediatric pelvic fractures: a conservative approach. J Pediatr Surg. 1987;22(6):538–40.PubMedGoogle Scholar
  111. Mutabagani KH, Coley BD, et al. Preliminary experience with focused abdominal sonography for trauma (FAST) in children: is it useful? J Pediatr Surg. 1999;34(1):48–52; discussion 52–44.PubMedGoogle Scholar
  112. Nakayama DK, Copes WS, et al. Differences in trauma care among pediatric and nonpediatric trauma centers. J Pediatr Surg. 1992;27(4):427–31.PubMedGoogle Scholar
  113. Odetola FO, Miller WC, et al. 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(1):74–7.PubMedGoogle Scholar
  114. Onuora VC, Patil MG, et al. Missed urological injuries in children with polytrauma. Injury. 1993;24(9):619–21.PubMedGoogle Scholar
  115. Ott R, Kramer R, et al. Prognostic value of trauma scores in pediatric patients with multiple injuries. J Trauma. 2000;49(4):729–36.PubMedGoogle Scholar
  116. Owens BD, White DW, et al. Comparison of irrigation solutions and devices in a contaminated musculoskeletal wound survival model. J Bone Joint Surg Am. 2009;91(1):92–8.PubMedGoogle Scholar
  117. Pape HC, Hildebrand F, et al. Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery. J Trauma. 2002;53(3):452–61; discussion 461–452.PubMedGoogle Scholar
  118. Peclet MH, Newman KD, et al. Thoracic trauma in children: an indicator of increased mortality. J Pediatr Surg. 1990;25(9):961–5; discussion 965–966.PubMedGoogle Scholar
  119. Pitone ML, Attia MW. Patterns of injury associated with routine childhood falls. Pediatr Emerg Care. 2006;22(7):470–4.PubMedGoogle Scholar
  120. Podesta ML, Jordan GH. Pelvic fracture urethral injuries in girls. J Urol. 2001;165(5):1660–5.PubMedGoogle Scholar
  121. Pollack MM, Patel KM, et al. PRISM III: an updated pediatric risk of mortality score. Crit Care Med. 1996;24(5):743–52.PubMedGoogle Scholar
  122. Potoka DA, Schall LC, et al. Impact of pediatric trauma centers on mortality in a statewide system. J Trauma. 2000;49(2):237–45.PubMedGoogle Scholar
  123. Potoka DA, Schall LC, et al. Development of a novel age-specific pediatric trauma score. J Pediatr Surg. 2001;36(1):106–12.PubMedGoogle Scholar
  124. Pressley JC, Trieu L, et al. National injury-related hospitalizations in children: public versus private expenditures across preventable injury mechanisms. J Trauma. 2007;63(3 Suppl):S10–19.PubMedGoogle Scholar
  125. Rees MJ, Aickin R, et al. The screening pelvic radiograph in pediatric trauma. Pediatr Radiol. 2001;31(7):497–500.PubMedGoogle Scholar
  126. Reff RB. The use of external fixation devices in the management of severe lower-extremity trauma and pelvic injuries in children. Clin Orthop Relat Res. 1984;188:21–33.PubMedGoogle Scholar
  127. Richardson MC, Hollman AS, et al. Comparison of computed tomography and ultrasonographic imaging in the assessment of blunt abdominal trauma in children. Br J Surg. 1997;84(8):1144–6.PubMedGoogle Scholar
  128. Roaten JB, Partrick DA, et al. Nonaccidental trauma is a major cause of morbidity and mortality among patients at a regional level 1 pediatric trauma center. J Pediatr Surg. 2006;41(12):2013–5.PubMedGoogle Scholar
  129. Robinson CM. Current concepts of respiratory insufficiency syndromes after fracture. J Bone Joint Surg Br. 2001;83(6):781–91.PubMedGoogle Scholar
  130. Roche BG, Bugmann P, et al. Blunt injuries to liver, spleen, kidney and pancreas in pediatric patients. Eur J Pediatr Surg. 1992;2(3):154–6.PubMedGoogle Scholar
  131. Rohrer MJ, Cutler BS, et al. A prospective study of the incidence of deep venous thrombosis in hospitalized children. J Vasc Surg. 1996;24(1):46–9; discussion 50.PubMedGoogle Scholar
  132. Rourke KF, McCammon KA, et al. Open reconstruction of pediatric and adolescent urethral strictures: long-term follow up. J Urol. 2003;169(5):1818–21; discussion 1821.PubMedGoogle Scholar
  133. Rozycki GS, Maull KI. Injuries sustained by falls. Arch Emerg Med. 1991;8(4):245–52.PubMedCentralPubMedGoogle Scholar
  134. Sabharwal S, Zhao C, et al. Pediatric orthopaedic patients presenting to a university emergency department after visiting another emergency department: demographics and health insurance status. J Pediatr Orthop. 2007;27(6):690–4.PubMedGoogle Scholar
  135. Saladino R, Lund D, et al. The spectrum of liver and spleen injuries in children: failure of the pediatric trauma score and clinical signs to predict isolated injuries. Ann Emerg Med. 1991;20(6):636–40.PubMedGoogle Scholar
  136. Sanchez JL, Lucas J, et al. Outcome of adolescent trauma admitted to an adult surgical intensive care unit versus a pediatric intensive care unit. J Trauma. 2001;51(3):478–80.PubMedGoogle Scholar
  137. Sanchez B, Waxman K, et al. Cervical spine clearance in blunt trauma: evaluation of a computed tomography-based protocol. J Trauma. 2005;59(1):179–83.PubMedGoogle Scholar
  138. Sandoval JA, Sheehan MP, et al. Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: an increasing population at risk. J Vasc Surg. 2008;47(4):837–43.PubMedGoogle Scholar
  139. Scalea TM, Boswell SA, et al. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma. 2000;48(4):613–21; discussion 621–613.PubMedGoogle Scholar
  140. Schafermeyer R. Pediatric trauma. Emerg Med Clin North Am. 1993;11(1):187–205.PubMedGoogle Scholar
  141. Schalamon J, Bismarck S, et al. Multiple trauma in pediatric patients. Pediatr Surg Int. 2003;19(6):417–23.PubMedGoogle Scholar
  142. Schall LC, Potoka DA, et al. A new method for estimating probability of survival in pediatric patients using revised TRISS methodology based on age-adjusted weights. J Trauma. 2002;52(2):235–41.PubMedGoogle Scholar
  143. Schluter PJ, Nathens A, et al. Trauma and Injury Severity Score (TRISS) coefficients 2009 revision. J Trauma. 2010;68(4):761–70.PubMedGoogle Scholar
  144. Schulman J, Sacks J, et al. State level estimates of the incidence and economic burden of head injuries stemming from non-universal use of bicycle helmets. Inj Prev. 2002;8(1):47–52.PubMedCentralPubMedGoogle Scholar
  145. Sharma OP, Oswanski MF, et al. Pediatric blunt trauma: a retrospective analysis in a level I trauma center. Am Surg. 2006;72(6):538–43.PubMedGoogle Scholar
  146. Silber JS, Flynn JM, et al. Analysis of the cause, classification, and associated injuries of 166 consecutive pediatric pelvic fractures. J Pediatr Orthop. 2001;21(4):446–50.PubMedGoogle Scholar
  147. Silva SR, Bosch P. Intramuscular air as a complication of pulse-lavage irrigation. A case report. J Bone Joint Surg Am. 2009;91(12):2937–40.PubMedGoogle Scholar
  148. Sindelar HA, Barnett NP, et al. Adolescent alcohol use and injury. A summary and critical review of the literature. Minerva Pediatr. 2004;56(3):291–309.PubMedGoogle Scholar
  149. Sivit CJ, Taylor GA, et al. Safety-belt injuries in children with lap-belt ecchymosis: CT findings in 61 patients. AJR Am J Roentgenol. 1991;157(1):111–4.PubMedGoogle Scholar
  150. Skaggs DL, Kautz SM, et al. Effect of delay of surgical treatment on rate of infection in open fractures in children. J Pediatr Orthop. 2000;20(1):19–22.PubMedGoogle Scholar
  151. Skaggs DL, Friend L, et al. The effect of surgical delay on acute infection following 554 open fractures in children. J Bone Joint Surg Am. 2005;87(1):8–12.PubMedGoogle Scholar
  152. Slater A, Shann F, et al. PIM2: a revised version of the paediatric index of mortality. Intensive Care Med. 2003;29(2):278–85.PubMedGoogle Scholar
  153. Smith Jr JS, Martin LF, et al. Do trauma centers improve outcome over non-trauma centers: the evaluation of regional trauma care using discharge abstract data and patient management categories. J Trauma. 1990;30(12):1533–8.PubMedGoogle Scholar
  154. Smith WR, Oakley M, et al. Pediatric pelvic fractures. J Pediatr Orthop. 2004;24(1):130–5.PubMedGoogle Scholar
  155. Soundappan SV, Holland AJ, et al. Transfer of pediatric trauma patients to a tertiary pediatric trauma centre: appropriateness and timeliness. J Trauma. 2007;62(5):1229–33.PubMedGoogle Scholar
  156. Spiguel L, Glynn L, et al. Pediatric pelvic fractures: a marker for injury severity. Am Surg. 2006;72(6):481–4.PubMedGoogle Scholar
  157. Stafford PW, Blinman TA, et al. Practical points in evaluation and resuscitation of the injured child. Surg Clin North Am. 2002;82(2):273–301.PubMedGoogle Scholar
  158. Stylianos S, Egorova N, et al. Variation in treatment of pediatric spleen injury at trauma centers versus nontrauma centers: a call for dissemination of American Pediatric Surgical Association benchmarks and guidelines. J Am Coll Surg. 2006;202(2):247–51.PubMedGoogle Scholar
  159. Sullivan T, Haider A, et al. Prediction of mortality in pediatric trauma patients: new injury severity score outperforms injury severity score in the severely injured. J Trauma. 2003;55(6):1083–7; discussion 1087–1088.PubMedGoogle Scholar
  160. Suthers SE, Albrecht R, et al. Surgeon-directed ultrasound for trauma is a predictor of intra-abdominal injury in children. Am Surg. 2004;70(2):164–7; discussion 167–168.PubMedGoogle Scholar
  161. Swift EE, Taylor HG, et al. Sibling relationships and behavior after pediatric traumatic brain injury. J Dev Behav Pediatr. 2003;24(1):24–31.PubMedGoogle Scholar
  162. Taeger G, Ruchholtz S, et al. Damage control orthopedics in patients with multiple injuries is effective, time saving, and safe. J Trauma. 2005;59(2):409–16; discussion 417.PubMedGoogle Scholar
  163. Tataria M, Nance ML, et al. Pediatric blunt abdominal injury: age is irrelevant and delayed operation is not detrimental. J Trauma. 2007;63(3):608–14.PubMedGoogle Scholar
  164. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81–4.PubMedGoogle Scholar
  165. Tepas 3rd JJ, Ramenofsky ML, et al. The pediatric trauma score as a predictor of injury severity: an objective assessment. J Trauma. 1988;28(4):425–9.PubMedGoogle Scholar
  166. Thompson EC, Perkowski P, et al. Morbidity and mortality of children following motor vehicle crashes. Arch Surg. 2003;138(2):142–5.PubMedGoogle Scholar
  167. Tolo VT. External skeletal fixation in children's fractures. J Pediatr Orthop. 1983;3(4):435–42.PubMedGoogle Scholar
  168. Tolo VT. Orthopaedic treatment of fractures of the long bones and pelvis in children who have multiple injuries. Instr Course Lect. 2000;49:415–23.PubMedGoogle Scholar
  169. Torode I, Zieg D. Pelvic fractures in children. J Pediatr Orthop. 1985;5(1):76–84.PubMedGoogle Scholar
  170. Trowbridge MJ, Sege RD, et al. Intentional injury management and prevention in pediatric practice: results from 1998 and 2003 American Academy of Pediatrics Periodic Surveys. Pediatrics. 2005;116(4):996–1000.PubMedGoogle Scholar
  171. Truitt AK, Sorrells DL, et al. Pulmonary embolism: which pediatric trauma patients are at risk? J Pediatr Surg. 2005;40(1):124–7.PubMedGoogle Scholar
  172. Tso EL, Beaver BL, et al. Abdominal injuries in restrained pediatric passengers. J Pediatr Surg. 1993;28(7):915–9.PubMedGoogle Scholar
  173. Tuttle MS, Smith WR, et al. Safety and efficacy of damage control external fixation versus early definitive stabilization for femoral shaft fractures in the multiple-injured patient. J Trauma. 2009;67(3):602–5.PubMedGoogle Scholar
  174. United States Administration for Children, Youth, and Families, Child Welfare Information Gateway (U.S.). Child maltreatment 2011. Washington, DC: U.S. Dept. of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, Child Welfare Information Gateway; 2011.Google Scholar
  175. United States National Highway Traffic Safety Administration. Booster seat effectiveness estimates based on CDS and state data. Washington, DC: U.S. Dept. of Transportation, National Highway Traffic Safety Administration; 2010a.Google Scholar
  176. United States National Highway Traffic Safety Administration. Children injured in motor vehicle traffic crashes. Washington, DC: U.S. Dept. of Transportation, National Highway Traffic Safety Administration; 2010b.Google Scholar
  177. United States National Highway Traffic Safety Administration. Traffic safety facts 2009. Washington, DC: U.S. Dept. of Transportation, National Highway Traffic Safety Administration; 2009.Google Scholar
  178. Uranus S, Pfeifer J. Nonoperative treatment of blunt splenic injury. World J Surg. 2001;25(11):1405–7.PubMedGoogle Scholar
  179. Vaca F, Anderson CL, et al. Child safety seat knowledge among parents utilizing emergency services in a level I trauma center in Southern California. Pediatrics. 2002;110(5):e61.PubMedGoogle Scholar
  180. van der Sluis CK, Kingma J, et al. Pediatric polytrauma: short-term and long-term outcomes. J Trauma. 1997;43(3):501–6.PubMedGoogle Scholar
  181. Vazquez WD, Garcia VF. Pediatric pelvic fractures combined with an additional skeletal injury is an indicator of significant injury. Surg Gynecol Obstet. 1993;177(5):468–72.PubMedGoogle Scholar
  182. Vitale MG, Kessler MW, et al. Pelvic fractures in children: an exploration of practice patterns and patient outcomes. J Pediatr Orthop. 2005;25(5):581–7.PubMedGoogle Scholar
  183. Waddell JP, Drucker WR. Occult injuries in pedestrian accidents. J Trauma. 1971;11(10):844–52.PubMedGoogle Scholar
  184. Wang MY, Kim KA, et al. Injuries from falls in the pediatric population: an analysis of 729 cases. J Pediatr Surg. 2001;36(10):1528–34.PubMedGoogle Scholar
  185. Wetzel RC, Burns RC. Multiple trauma in children: critical care overview. Crit Care Med. 2002;30(11 Suppl):S468–477.PubMedGoogle Scholar
  186. Williams RL, Connolly PT. In children undergoing chest radiography what is the specificity of rib fractures for non-accidental injury? Arch Dis Child. 2004;89(5):490–2.PubMedCentralPubMedGoogle Scholar
  187. Wyen H, Heike J, Wutzler S, Lefering R, Laurer H, Marzi I, Lehnert M. Prehospital and early clinical care of infants, children, and teenagers compared to an adult cohort: analysis of 2691 children in comparison to 21435 adult patients from the trauma registry of DGU in a 15-year period. Eur J Trauma Emerg Surg. 2010;36(4):300–7.Google Scholar
  188. Yian EH, Gullahorn LJ, et al. Scoring of pediatric orthopaedic polytrauma: correlations of different injury scoring systems and prognosis for hospital course. J Pediatr Orthop. 2000;20(2):203–9.PubMedGoogle Scholar
  189. Young B, Rapp RP, et al. Early prediction of outcome in head-injured patients. J Neurosurg. 1981;54(3):300–3.PubMedGoogle Scholar
  190. Zhao XG, Zhao GF, et al. Research progress in mechanism of traumatic brain injury affecting speed of fracture healing. Chin J Traumatol. 2007;10(6):376–80.PubMedGoogle Scholar
  191. Zuckerbraun BS, Morrison K, et al. Effect of age on cervical spine injuries in children after motor vehicle collisions: effectiveness of restraint devices. J Pediatr Surg. 2004;39(3):483–6.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Orthopedic SurgeryThe University of NebraskaOmahaUSA

Personalised recommendations