Multiple Trauma In Children Research Articles

Preclinical care of children with multiple trauma

Severe multiple trauma in children is rare with approximately 380-550cases per year in Germany. In addition to the S3 guideline "Polytrauma", which was published more than a decade ago, the S2Kguideline "Severe multiple trauma care in childhood" was published in 2020. Accidents and especially the resulting traumatic brain injuries still represent the most frequent cause of death in children. While prehospital treatment according to Prehospital Trauma Life Support (PHTLS®) is basically analogous to that in adults which is based on the ABCDE concept (airway, breathing, circulation, disability, exposure), knowledge of age-dependent anatomical-physiological characteristics is essential. For simplification, various tools and dosing aids, such as the pediatric emergency ruler and specific emergency tables, are available. Further treatment after initial preclinical care should take place in an interdisciplinary manner in designated pediatric trauma centers.

MULTIPLE TRAUMA STRUCTURING IN CHILDREN WITH ESTIMATION ACCORDING TO ISS SYSTEM AND CONCENTRATIONS OF S100B PROTEIN MARKERS AND CYSTATIN C

Introduction: to analyze pathological processes in a patient with multiple trauma. Classification and structuring are not taken into account, as they require estimation of condition severity and dynamics of pathological process. It is frequently impossible to do so. In every specific case, it is necessary to structure multiple trauma. The Injury Severity Score (ISS) system is useful in this case, as it consists of a combination, certain quantitative and qualitative estimate which makes it possible to estimate a patient’s condition at early pre-hospital stage and adjust treatment. Purpose: to make a structural analysis of a multiple trauma in children in the state of shock using ISS and concentrations of S100B protein and cystatin C to change the examination tactics and improve treatment outcomes. Materials and methods. 44 patients in shock with multiple trauma were structured and examined. The patients came for treatment from cities of the northern region and the city of Kemerovo. Patients mainly had a predominant severe cranial cerebral injury (SCCI). There were 36 patients including two patients with diffuse axonal injuries and 8 patients with predominant skeletal trauma (ST) and damage of internal organs with the syndrome of intraperitoneal bleeding (SPB). Results: treatment protocols were taken into account alongside with objectively obtained data on multiple trauma structure based on the ISS severity scale. We obtained reliable data on the type of changes in S100B and cystatin C concentrations during the acute period of multiple trauma. Conclusions: multiple trauma structuring in children using the ISS system and S100B protein and cystatin C concentrations enables objective detection of signs characterizing the severity of an acute period among those injured and optimization of the examination scheme along with a treatment program.

Abstract P-499: EFFECTS OF TWO DIFFERENT SEDATION REGIMENS ON SEDATION AND INFLAMMATORY RESPONSE IN CRITICALLY ILL CHILDREN WITH MULTIPLE TRAUMAS

Aims & Objectives: To compare the efficacy and anti-inflammatory effects of dexmedetomidine and midazolam of critical ill children with multiple trauma. Methods A prospective randomized controlled trial was conducted.Critical ill children with multiple trauma admitted to PICU of Anhui Province Children’s Hospital who were randomly generated by computer and divided into dexmedetomidine group and midazolam group. Children of two groups both received sufentanil for analgesia.The goal of sedation was to maintain RASS score of -1 to 0. The level of IL-6, IL-8, IL-10, IL-1β),TNF-α and CRP detected by ELISA at 24, 48, 72 hours after treatment, and the duration of mechanical ventilation, ratio of CRRT, length of stay in the PICU, ratio of sepsis and MOF and mortality were also recorded. Results Compared with midazolam, dexmedetomidine decreased the level of pro-inflammatory cytokines and increased the level of anti-inflammatory cytokines. At 24 hours after treatment, the levels of serum IL-1β, TNF-α significantly decreased and IL-10 significantly increased. At 48 hours after treatment, the levels of serum IL-6, IL-8, IL-1β, TNF-α and CRP significantly decreased and IL-10 significantly increased. At 72 hours after treatment, only the levels of serum IL-8 and CRP significantly decreased. Compared with midazolam, dexmedetomidine could significantly reduce the duration of mechanical ventilation, length of PICU stay, the ratio of sepsis.But there were no significant differences in ratio of CRRT and MOF and mortality between two groups. Conclusions Compared with midazolam, dexmedetomidine had better efficacy in the treatment of severe multiple trauma in children and reduce the level of inflammation.

Effects of different sedation regimens on sedation and inflammatory response in critically ill children with multiple trauma

To compare the sedation and anti-inflammatory effects of dexmedetomidine and midazolam on critical ill children with multiple trauma. A prospective randomized controlled trial was conducted. Sixty-five critical ill children with multiple trauma admitted to pediatric intensive care unit (PICU) of Anhui Province Children's Hospital from January 2014 to September 2016 were enrolled, who were randomly divided into dexmedetomidine group (33 cases) and midazolam group (32 cases). Children of both groups received sufentanil for analgesia. Children in dexmedetomidine group firstly received 1.0 μg/kg intravenous bolus of dexmedetomidine for 10 minutes, then continuous infusion of 0.2-0.7 μg×kg-1×h-1, while in midazolam group children received 1-5 μg×kg-1×min-1 of midazolam in continuous infusion. The goal of sedation was to maintain a Richmond agitation-sedation scale (RASS) score of -1 to 0. The level of serum interleukin (IL-6, IL-8, IL-10, IL-1β), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) were detected by enzyme linked immunosorbent assay (ELISA) at 24, 48, 72 hours after treatment, and the duration of mechanical ventilation, ratio of continuous renal replacement therapy (CRRT), length of stay in the PICU, ratio of sepsis and multiple organ failure (MOF) and mortality were also recorded. Compared with midazolam, dexmedetomidine decreased the level of pro-inflammatory cytokines and increased the level of anti-inflammatory cytokines. At 24 hours after treatment, the levels of serum IL-1β, TNF-α significantly decreased and IL-10 significantly increased [IL-1β (ng/L): 6.48±2.89 vs. 8.07±3.14, TNF-α (μg/L): 11.25±5.21 vs. 15.44±5.97, IL-10 (ng/L): 12.10±5.35 vs. 9.58±4.71, all P < 0.05]. At 48 hours after treatment, the levels of serum IL-6, IL-8, IL-1β, TNF-α and CRP significantly decreased and IL-10 significantly increased [IL-6 (ng/L): 209.67±80.49 vs. 336.31±123.94, IL-8 (ng/L): 229.09±80.81 vs. 298.28±90.25, IL-1β (ng/L): 7.31±3.02 vs. 8.74±3.17, TNF-α (μg/L): 12.52±4.79 vs. 16.58±5.98, CRP (g/L): 47.82±24.92 vs. 72.35±31.71, IL-10 (ng/L): 12.90±5.42 vs. 10.01±4.79, all P < 0.05]. At 72 hours after treatment, the levels of serum IL-8 and CRP significantly decreased [IL-8 (ng/L): 234.64±96.24 vs. 290.28±103.97, CRP (g/L): 53.24±29.12 vs. 86.58±38.30, both P < 0.05]. Compared with midazolam, dexmedetomidine could significantly reduce the duration of mechanical ventilation (days: 4.7±1.3 vs. 6.6±2.1), length of PICU stay (days: 9.5±2.7 vs. 12.3±3.9, both P < 0.05), and the ratio of sepsis (33.3% vs. 53.1%, P < 0.05). But there were no significant differences in ratio of CRRT (18.2% vs. 18.8%), MOF (9.1% vs. 18.8%) and mortality (6.1% vs. 12.5%) between two groups (all P > 0.05). Compared with midazolam, dexmedetomidine had better efficacy in the treatment of severe multiple trauma in children and reduce the level of inflammation.

The significance of physiotherapy in the treatment of children with multiple traumatic injuries

AbstractRapid development of civilization, observed in the contemporary world, makes human life easier, but at the same time, it brings a lot of dangers and threats. Constant ‘race against the clock’, moving from one place to another, stress and fatigue result in a growing number of traffic accidents which claim the lives and health of adults as well as children. Most of the injuries are multiple traumatic injuries that affect two or more bodily organs or systems and cause damage to at least two body areas. They constitute exceptionally difficult, interdisciplinary therapeutic problem which is the most frequent cause of death and development of a disease in children over 3 years old.The aim of this research study was to conduct a retrospective analysis of physiotherapeutic procedures applied in the course of treatment of multiple trauma in children hospitalized in the Voivodship Medical Centre in Opole (Wojewódzkie Centum Medyczne).It was carried out in the group of 9 children aged 5-17 in the years of 2011-2013. As multiorgan injuries in children affect a developing body, they require a professional, interdisciplinary, therapeutic proceeding. The analysis of the ways of treatment shows that after securing basic vital functions of the children and the stabilization of their health, physiotherapy takes its turn. Its main role is to restore child’s physical ability, which was disordered due to the injury, as much as it is possible. According to the analysis of clinical and therapeutic progress in all 9 patients suffering from multi-organ injuries, an attempt has been undertaken to set the scheme of physiotherapeutic proceeding in such cases. Preparing the scheme, all basic rules of physiotherapeutic proceeding have been taken into consideration, namely, introducing therapeutic activities as soon as possible taking into account patient’s condition and the extent of damage/injury.The analysis proved that physiotherapy in multiple trauma is a complicated process that involves many techniques, methods and procedures. Moreover, every physiotherapeutic treatment ought to be adjusted individually to the patient depending on their condition and dysfunctions. Skilful management of the rehabilitation process significantly accelerates patient’s recovery to the extent of proper physical function, and limits the degree of disability after multipletrauma.

Pediatric multiple trauma

Multiple trauma in children is rare so that even large trauma centers will only treat a small number of cases. Nevertheless, accidents are the most common cause of death in childhood whereby the causes are mostly traffic accidents and falls. Head trauma is the most common form of injury and the degree of severity is mostly decisive for the prognosis. Knowledge on possible causes of injury and injury patterns as well as consideration of anatomical and physiological characteristics are of great importance for treatment. The differences compared to adults are greater the younger the child is. Decompression and stopping bleeding are the main priorities before surgical fracture stabilization. The treatment of a severely injured child should be carried out by an interdisciplinary team in an approved trauma center with expertise in pediatrics. An inadequate primary assessment involves a high risk of early mortality. On the other hand children have a better prognosis than adults with comparable injuries.

Multiple trauma in children: critical care overview.

Multiple trauma is more than the sum of the injuries. Management not only of the physiologic injury but also of the pathophysiologic responses, along with integration of the child's emotional and developmental needs and the child's family, forms the basis of trauma care. Multiple trauma in children also elicits profound psychological responses from the healthcare providers involved with these children. This overview will address the pathophysiology of multiple trauma in children and the general principles of trauma management by an integrated trauma team. Trauma is a systemic disease. Multiple trauma stimulates the release of multiple inflammatory mediators. A lethal triad of hypothermia, acidosis, and coagulopathy is the direct result of trauma and secondary injury from the systemic response to trauma. Controlling and responding to the secondary pathophysiologic sequelae of trauma is the cornerstone of trauma management in the multiply injured, critically ill child. Damage control surgery is a new, rational approach to the child with multiple trauma. The selection of children for damage control surgery depends on the severity of injury. Major abdominal vascular injuries and multiple visceral injuries are best considered for this approach. The effective management of childhood multiple trauma requires a combined team approach, consideration of the child and family, an organized trauma system, and an effective quality assurance and improvement mechanism.

Evaluating the prognosis of multiple, severely traumatized children in the intensive care unit.

To assess the Pediatric Risk of Mortality (PRISM) score and to identify other prognosis factors in severe, multiple trauma in children. Retrospective study over a 9-year period. A Pediatric Intensive Care Unit (PICU) in a University Hospital. One hundred and thirty-three traumatized children, 8.6 years (8 months-16 years), were reviewed. None. Pediatric Trauma Score (PTS), Injury Severity Score (ISS), New ISS (NISS), Glasgow Coma Scale (GCS) score, and PRISM were calculated. The areas under the Receiver Operating Characteristic (ROC Az) curves, were compared. Univariate and multivariate analyses were performed. The mortality rate was 25.6%. PRISM performed well for discrimination between survivors and non-survivors. Az PRISM 0.9387 (0.029) was not different from Az GCS score 0.9451 (0.027) (P=0.568), but was significantly different from Az ISS 0.756 (0.052) (P<0.001), Az NISS 0.7606 (0.051) (P<0.001), and Az PTS 0.8244 (0.047) (P=0.016). Death was significantly associated with head trauma (P=0.014), PRISM >35, PTS <5, GCS <7, and ISS or NISS >32 (P<0.00001). PRISM >35 (P=0.001) and GCS <7 (P=0.003) were independent risk factors of death. PRISM is a reliable tool for evaluating the prognosis of multiple, severely traumatized children. Its relative simplicity and the fact that it is extremely widespread as a general prognosis score in PICUs represent other arguments for its use. Due to the leading influence of head trauma on mortality, GCS, a score even simpler than PRISM, showed identical accuracy regarding survival prediction.

Multiple trauma in children patterns of injury--treatment strategy--outcome.

In 1994 more than 50,000 children under 15 years were involved in a road accident in Germany. About one third of them received major injuries and 431 children died. These data obviously show the importance of multiple trauma in children in a developed country. Between 1985 and 1990, 64 multi-traumatized children were evaluated after receiving treatment at the Aachen University Hospital. It was possible to evaluate 66% of the patients at the follow-up examination after 1 and 5 years. The results have been measured with the ALOS (Aachen long-term outcome score) and the GOS (Glasgow outcome score) in relation to the degree of trauma. OWN RESULTS: 12.5% died mainly from the effects of a cerebral injury. 25% developed different complications. Again the effects of craniocerebral trauma determined the long-term outcome. All other injuries can be managed by aggressive treatment without major consequences. In multi-traumatized children, craniocerebral trauma is the key injury regarding both lethality and long-term outcome. Therefore, prevention is of primary importance. Aggressive treatment of thoracic and abdominal trauma can usually help to cure completely these injuries. Especially osteosynthetic procedures, exerting little strain and performed as appropriate for children, have made injuries of the limbs less critical.

Comparison of multiple trauma in children and adults

Multiple injuries in children are responsible for a great part of childhood mortality. Remaining handicaps after injuries have a social and economic significance. In this study, the characteristics of polytrauma in childhood are evaluated by comparison with severely injured adults. The two groups of multiple trauma patients (117 children between 3 and 15 years of age and 1159 adults between 16 and 59) were equal in the overall severity of all injuries. Children were mainly hurt as pedestrians, whereas adults had an accident more often as car passengers. The most frequently injured region were in both groups fractures of the extremities. The greatest injury severity represented head injuries in each group. Complications were seen more often in adult patients. Multiple organ failure and isolated liver failure were exclusively seen in the adult group, pneumonia and lung failure occurred significantly more often. The duration of artificial ventilation and the duration of hospital stay were prolonged in the adult group. In summary, children with multiple injuries have a lower mortality rate than adults. The main cause of death are cerebral injuries. Remaining handicaps in surviving children are most often caused by fractures of the lower extremities.

The significance of multiple trauma in children.

Accident-related injuries, mainly traffic-connected, are the most serious threat to health and most-frequent cause of death in the pediatric age group. Usually these are multi-system injuries. While the total number of accidents has decreased over the last 20 years, traffic accidents have become more serious. Conventional prognostic scores are not applicable in children with multiple injuries because of their essential pathophysiologic differences with adults. The Pediatric Trauma Score closes this gap. It is simple to use and provides high reliability.

Pulmonary problems following multiple trauma in children.

Acute respiratory failure (ARF = hypoxemia and/or hypercapnia) is a frequent finding in the polytraumatized patient. Multiple injury is often accompanied by injury of the central nervous system, and the presence or absence of ARF may play a key role for survival and late morbidity. This paper reviews the incidence of pulmonary problems after severe head injury and the possible dysfunctions of the respiratory apparatus following single or multiple trauma. Diagnostic work-up in ARF includes consideration of the mechanisms of injury, clinical examination, determinations of arterial blood gases and chest radiographs which are all essential for the choice of an effective treatment. This frequently includes supportive treatment by continuous positive pressure ventilation.

Multiple trauma in children. Initial management, key to improved survival.

Multiple trauma in children. Initial management, key to improved survival.