Clinical evaluation of the child: injury to the chest and abdomen

Abstract

In the paediatric age group (under 18 years) injury continues to be the dominant cause of mortality, being more common than all other causes combined. Disability resulting from injury represents a major expenditure in financial and emotional terms. The child’s anatomy and physiology are such that directly applying the principles of adult trauma care to the child can result in a less than optimal outcome and can add to long-term and/or permanent disability. Chest and abdominal injuries are the second and third most common causes of death, respectively, in childhood and when combined represent the second leading cause of death in this age group due to injury. There are six life-threatening injuries seen in paediatric injuries: airway obstruction, tension pneumothorax, massive haemothorax, open pneumothorax, flail chest and cardiac tamponade. There are six other potentially life-threatening injuries: simple pneumothorax, pulmonary contusion, tracheobronchial disruption, blunt cardiac injury, aortic disruption and haemothorax. These entities are discussed in terms of identification and treatment. Abdominal injuries are generally well recognized by trauma surgeons. The difference in the paediatric age group involves the diagnosis of intra-abdominal injuries. The principle of diagnosis is that the injured organ should be specifically identified, not just left at the impression that something is bleeding, perforated or otherwise disrupted. The main diagnostic modality is the spiral or helical computerized tomography scan. This is an appropriate diagnostic method in all but the most severely injured and haemodynamically abnormal children. Care in initial assessment and management and in specific diagnosis has great potential to decrease the mortality in a country’s youngest citizens.