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Emergency Medicine

Paediatric trauma

The basics

The paediatric trauma is very different to that encountered in adult practice. Most paediatric trauma is blunt injury with patterns sustained that are unique to children. Trauma is the leading cause of death of children aged 1-14 in the developed world. The majority of this is road trauma; motor vehicle accidents, pedestrians and cyclists, with falls in younger children being very common.

Body habitus and blunt mechanism makes multisystem injury common in children, resulting in some specific injury patterns, as can be seen below:

Table of injury patterns

Mechanism	Injury Pattern
MVA	Restrained: chest/abdominal injury, lumbar spine Unrestrained: multiple, head and neck, facial
Pedestrian	Low speed: leg # High speed: multiple, head and neck, leg #
Bicycle	No helmet: head and neck, facial, arm # Helmet: arm #
Fall	Low: arm # Medium: head and neck, arm and leg # High: multiple

Up to 90% of paediatric trauma involves the head; however, it is important to remember that the mechanism of injury determines the amount of energy absorbed upon impact. The nature of injury is often determined through the anatomic features of children, which are different to adults:

• Small body mass, with a greater force applied per unit body area
• Head proportionately larger to body
• Compliant skeleton, meaning force is transmitted to soft tissue
• Energy is transmitted to the body with less fat, less connective tissue and close organs
• High surface area to volume ratio, increasing thermal loss
• At risk of road trauma because of inquisitive, unpredictable behaviour
• Harder to see as pedestrians because of size
• Adolescents make poor risk assessments and have a feeling of invincibility
• Extra stress from separation anxiety.

So why is a primary survey important to master?

The primary survey provides a systematic way of assessing a patient using a system that prioritises potential life threatening problems in the trauma patient: 'ABCDE'.

During this process, one should identify and treat imminently life threatening injuries before progressing to the next level of primary survey assessment: for example:

• hypoxia
• tension pneumothorax
• shock
• cardiac tamponade or herniation

From Advanced Trauma Life Support 8th Edition:

• Injury mortality surpasses deaths from all other childhood illnesses combined.
• Anatomy, physiology and mechanisms produce distinct patterns of injury.
• Mechanisms of injury are related both to age and stage of development.
• Neurologic and respiratory derangements far exceed haemodynamic derangements.

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