General Pediatric Trauma Principles and Triage

Questions and Answers

Case: Your healthcare unit is sent to a farm to see a child who has fallen through a hay hole. You find a 7-year-old boy lying on the grass near a barn. His mother tells you that she saw him fall from the second floor of the barn through the hay hole down about 12 feet. Initial assessment shows that the boy is responding only to painful stimuli. Breathing is superficial with audible snoring. The skin is pale, with mild cyanosis. Respiratory rate is 12 breaths per minute; heart rate is 130 beats per minute. The skin is cold, radial pulse is weak, and capillary refill is >3 seconds. Pupils are equally dilated and are reactive to light. Air influx cannot be detected through auscultation in the right hemithorax and is diminished in the left. Oxygen saturation is 82%. He has broken teeth and a swollen nose, with moderate hemorrhage. The abdomen is stiff on palpation. The right leg is swollen, with evident deformity to the femur.

1 How often do blunt injuries occur in the pediatric population compared to penetrating injuries?

While the prevalence of blunt pediatric injuries varies by geography and region, blunt injury accounts for approximately 90% of all pediatric traumas. When blunt force is applied to a child’s small body, multisystem trauma occurs frequently, although the majority of injuries are mild to moderate in severity.

2 What are the typical patterns of injury in pediatric patients?

Falls account for the majority of all pediatric injuries, the majority of which are not fatal. Most common causes of death from injuries are motor vehicle associated, whether the child is an occupant, pedestrian, or cyclist. The nonfatal injury patterns for different mechanisms are listed here:

1.
Pedestrian struck
- a.
  Low speed: lower extremity fractures
- b.
  High speed: multiple trauma, head and neck injuries, lower extremity fractures
2.
Automobile occupant
- a.
  Unrestrained: multiple trauma, head and neck injuries, scalp and facial lacerations
- b.
  Restrained: chest and abdominal injuries, lower spine fractures
3.
Fall from height
- a.
  Low: upper extremity fractures
- b.
  Medium: head and neck injuries, upper and lower extremity fractures
- c.
  High: multiple trauma head and neck injuries, upper and lower extremity fractures
4.
Fall from a bicycle
- a.
  Without helmet: head and neck injuries, scalp and facial lacerations, upper extremity fractures
- b.
  With helmet: upper extremity fractures
- c.
  Striking handlebar: internal abdominal injuries

Other causes of death in descending incidence are:

1.
Drowning
2.
House fires
3.
Homicides
- a.
  Infants—most commonly due to maltreatment
- b.
  Children and adolescents—most commonly by firearm injuries
4.
Falls

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