Evaluation and Management of Pediatric Patients With Penetrating Trauma to the Torso

Points and Pearls Excerpt

• Children with penetrating trauma to the torso require careful evaluation of the chest, abdomen, pelvis, and genital structures for system-specific injuries that may contribute to rapid decompensation and influence the order of emergent resuscitation.
• Knowing the weight of the child (or at least having an initial estimate) is critical. Obtain an estimate of the patient’s weight by asking the parent(s) for an estimation of their child’s weight or by using length-based formulas that include general body habitus.
• Children can bleed 50% of their blood volume into their chest, and may not show signs of decreased blood pressure until the loss of up to 30% of their blood volume.
• Estimations for total-body blood volume are as follows: infants, 80 mL/kg; children aged 1 to 3 years, 75 mL/kg; children aged > 3 years, 70 mL/kg.

Most Important References

• Brand M, Grieve A. Prophylactic antibiotics for penetrating abdominal trauma. Cochrane Database Syst Rev. 2013(11):CD007370. (Literature review)
• Como JJ, Bokhari F, Chiu WC, et al. Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma. 2010;68(3):721-733. (Practice management guideline)
• Quinn AC, Sinert R. What is the utility of the focused assessment with sonography in trauma (FAST) exam in penetrating torso trauma? Injury. 2011;42(5):482-487. (Literature review)
• CRASH-2 trial collaborators, Shakur H, Roberts I, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23-32. (Randomized controlled trial; 20,211 adults) 
• Pearson EG, Clifton MS. The role of minimally invasive surgery in pediatric trauma.. Surg Clin North Am. 2017;97(1):75- 84. (Review)