Management of Multiply Injured Pediatric Trauma Patients in the Emergency Department

Points and Pearls Excerpt

• Commonly missed injuries in pediatric trauma patients include fractures, intracranial injuries, intra-abdominal injuries, retained foreign bodies, and peripheral nerve injuries.
• Algorithmic progression through the ABCDEs (see Figure 1) of the primary survey will help identify and address life-threatening injuries.
• In children aged < 12 years, maintain suspicion for SCIWORA (spinal cord injuries without radiographic abnormalities) and document a thorough neurologic examination in high-risk patients.

Most Important References

• ATLS Subcommittee, American College of Surgeons’ Committee on Trauma. Chapter 10: Pediatric Trauma. Advanced Trauma Life Support Student Course Manual. 9th ed: American College of Surgeons; 2013. (Textbook) http://www.myatls.com/#my-atls-textbook
• 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):218-224. (Prospective study; 2188 patients) DOI: http://dx.doi.org/10.1097/TA.0000000000001546
• Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59(3):165-175. (Review) DOI: http://dx.doi.org/10.1016/j.annemergmed.2011.10.002
• Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160-1170. (Prospective cohort; 42,412 patients) DOI: https://doi.org/10.1016/S0140-6736(09)61558-0
• Kochanek PM, Carney N, Adelson PD, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition. Pediatr Crit Care Med. 2012;13 Suppl 1:S1-S82. (Guidelines) DOI: http://dx.doi.org/10.1097/PCC.0b013e31823f435