Pediatric Traumatic Injury Research Articles

Current concepts in the acute management of severe pediatric head trauma

Head injuries are a substantial problem in children. These injuries can be the result of intentional or unintentional trauma. Traumatic brain injury can range from focal lacerations and contusions to diffuse axonal injury with intracranial hypertension. Brain injury can he either primary or secondary in nature. Primary brain injury occurs at the time of injury and, although preventable, is not treatable. Secondary injury occurs from insults that occur after the injury event such as hypotension, hypoxia, and/or intracranial hypertension. The outcome of children with traurmatic brain injury can be improved by preventing or minimizing these secondary injuries. For emergency medicine physicians, the cornerstones of management are early recognition and treatment of these secondary injuries. This article reviews current principles in the management of pediatric traumatic braid injury.

The relationship of caregiver coping to family outcomes during the initial year following pediatric traumatic injury.

This study identified coping strategies associated with caregiver outcomes following pediatric injury and examined injury type as a moderator of coping efficacy. Families of 103 children with traumatic brain injury (TBI) and 71 children with orthopedic injuries were followed prospectively during the initial year postinjury. The groups had comparable preinjury characteristics and hospitalization experiences but differed on neurological insult. In hierarchical regression analyses, acceptance was associated with lower burden and denial was associated with greater distress in both groups. Active coping resulted in higher distress following TBI but not orthopedic injuries. Conversely, the use of humor was related to diminishing distress following TBI but unrelated to distress following orthopedic injuries. Results are discussed in terms of the implications for intervention following TBI.

The relationship of caregiver coping to family outcomes during the initial year following pediatric traumatic injury.

The relationship of caregiver coping to family outcomes during the initial year following pediatric traumatic injury.

Children at play: the death and injury pattern in New South Wales, Australia, July 1990-June 1994.

To describe and to understand the pattern of play-related deaths and injury (excluding organized sports) among children in New South Wales (NSW), Australia. This study utilized a state-wide prospective surveillance data collection of paediatric traumatic deaths and injuries at the Royal Alexandra Hospital for Children. Deaths and injury cases were selected from the NSW Trauma Death Registry and Childsafe NSW database. Information including basic demographics, the surrounding circumstances of death and injury incidents, and the required treatment was collected. There were 30 play-related deaths and 92 drownings over the 4-year period. The male to female ratio was about 2:1. Excluding drowning, which has been reported elsewhere, and sports, the leading causes of play-related deaths were burns (eight) and asphyxiation (eight). An average of 6444 presentations to the emergency departments per year were recorded with sex ratio and age distribution pattern similar to the deaths. The home was the most common place (55.5%) of play-related injury, specifically the living and sleeping area. Falls, both under and above 1 metre, were the most common causes of injury (50.9%). The leading mechanism was cuts and lacerations (21.2%). Nearly one-third (32.7%) of all injuries were to the head, with face, cheek, forehead and scalp as the most common injured body part. Significant associations between place of injury, injured body parts and age were observed. Play-related injury is common among children, and in some cases causes severe injury and death. To tackle the problem of play-related deaths and injuries, a holistic approach is suggested. This includes the provision of a safe environment, supervision by parents, education of children and detailed data collection.

Missed Injuries in Pediatric Trauma

Missed injuries in trauma continue to be a nemesis to the trauma surgeon. Missed injuries in adult trauma patients range in frequency from 9 to 28 per cent, with some being life threatening or permanently disabling. We report the incidence of missed injuries in pediatric trauma to be 20 per cent, in our retrospective review of 107 severe pediatric trauma patients. These missed injuries, however, were neither life threatening nor permanently disabling. We also found that mechanism of injury and patient age affected the incidence of missed injuries in our population.

Parent and Child Perspectives on the Long-Term Difficulties of Pediatric Traumatic Injuries,

s: Abstracts of Papers Presented at the Seventeenth Annual Meeting of the Society for Developmental and Behavioral Pediatrics: SEPTEMBER 26-27,1999: Seattle, Washington: PDF Only

Delayed diagnosis of injury in pediatric trauma: Furnival RA, Woodward GA, Schunk JE. Pediatrics. 1996;98:58–62

Delayed diagnosis of injury in pediatric trauma: Furnival RA, Woodward GA, Schunk JE. Pediatrics. 1996;98:58–62

Delayed diagnosis of injury in pediatric trauma: Furnival RA, Woodward GA, Schunk JE. Pediatrics 98:56, 1996

Delayed diagnosis of injury in pediatric trauma: Furnival RA, Woodward GA, Schunk JE. Pediatrics 98:56, 1996

Delayed Diagnosis of Injury in Pediatric Trauma

To define the frequency and nature of delayed diagnosis of injury (DDI) in pediatric trauma. Retrospective review. Tertiary pediatric trauma center. Medical records of 1175 pediatric trauma admissions from July 1, 1989, through June 30, 1992, were reviewed. Fifty (4.3%) patients had 53 DDI. Fractures accounted for 38 DDI, most commonly of the extremities (total, 16). The delay until injury diagnosis ranged from 1 to 55 (median, 3) days. Patients with DDI had lower scores on the Glasgow Coma Scale, higher injury severity scores, and longer pediatric intensive care unit and hospital stays than patients without DDI. Patients with DDI more frequently required medical transport, emergent intubation, admission to the pediatric intensive care unit, and surgery. The DDI altered treatment for 68% of patients; 10 required surgery, including second operations for 6 children. DDI represents a failure of pediatric trauma care at all levels. The severely injured child is at the greatest risk of DDI. All pediatric patients with trauma warrant ongoing evaluation to identify initially unrecognized injuries.