Abstract
Severe trauma is the most common cause of mortality in children and is associated with a high socioeconomic burden. The most frequently injured organs in children are the head and thorax, followed by the extremities and by abdominal injuries. The efficient and early assessment and management of these injuries is essential to improve patients' outcome. Physical examination as well as imaging techniques like ultrasound, X-ray and computer tomography are crucial for a valid early diagnosis. Furthermore, laboratory analyses constitute additional helpful tools for the detection and monitoring of pediatric injuries. Specific inflammatory markers correlate with post-traumatic complications, including the development of multiple organ failure. Other laboratory parameters, including lactate concentration, coagulation parameters and markers of organ injury, represent further clinical tools to identify trauma-induced disorders. In this review, we outline and evaluate specific biomarkers for inflammation, acid-base balance, blood coagulation and organ damage following pediatric polytrauma. The early use of relevant laboratory markers may assist decision making on imaging tools, thus contributing to minimize radiation-induced long-term consequences, while improving the outcome of children with multiple trauma.
Highlights
Multiple trauma is the leading cause of mortality in both adolescents and pediatric patients [1, 2]
In this study 25 adults and 24 children were enrolled who survived a flame burn covering more than 20% of total body surface area and cytokine levels were measured within the first week after trauma [44]
This study investigated a cohort of 45 children with the clinical diagnosis of TBI (GCS 3-15) compared to 40 healthy patients [125]
Summary
Multiple trauma is the leading cause of mortality in both adolescents and pediatric patients [1, 2]. In most of the recently published studies ( in Germany and other high income countries) road traffic accidents are the leading cause of injuries in children, followed by falls from heights [3,4,5,6]. Motor vehicle crashes account for 78% of severe injuries in children compared to at least 63% in adults [3]. The ISS is calculated based on the Abbreviated Injury Scale (AIS) and considers the three most severely injured body regions [9]. With regard to the ISS definition, “multiple trauma” is defined as an ISS ≥16. This definition is validated for pediatric polytrauma [4, 10]
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