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INTRODUCTION

FOCUS POINTS

  1. Trauma is the leading cause of pediatric mortality and these patients are best served at facilities equipped to treat children.

  2. Injuries not in character with the play patterns of children should raise concerns for nonaccidental trauma.

  3. The primary survey for pediatric patients is ABCDE: Airway, Breathing, Circulation, Disability, and Exposure.

  4. It is important to prevent hypothermia in trauma patients to avoid the triad of acidosis, coagulopathy, and death.

  5. Burn patients are in a hypermetabolic state and have altered pharmacodynamics of many drugs, including neuromuscular blockers. They can also become very tolerant to pain medications.

  6. If inhalational injury is suspected in a burn patient, intubation should happen early.

Traumatic injuries are an important public health concern in pediatrics. Accidents are the leading cause of death in children over the age of 1. Unintentional injury was responsible for 17,603 deaths in the United States in patients ages 19 years and under in 2017.1 Twenty-five children in the United States die from injuries every day.2 Accidental injury also places a large cost burden on the health care system, exceeding $20 billion annually in costs.3

TYPES OF INJURY

Falls are the leading cause of nonfatal injuries in children from birth to age 14. Motor vehicle accidents are the leading cause of death for 5- to 19-year-olds. Drowning is the most common cause of death in children ages 1 to 4. Burns are also common causes of mortality from ages 1 to 9. Other types of unintentional injuries common in children are suffocation, poisoning, burns, and sports or recreation injuries.2,4

Non-Accidental Trauma

While many injuries are unintentional, child abuse, or non-accidental trauma, is a wide spread concern. Over 3 million reports of child abuse are filed annually in the United States. However, it is likely under-reported and under-detected. The majority of fatalities from child abuse in the United States are in children under 3 years of age, with the greatest percentage under 1 year of age.5 For the protection of the child, it is important to consider early if the injury pattern is suggestive of intentional injury is suggestive of intentional injury.

Some injuries reflect normal childhood behavior and experiences. Toddlers learning to walk and climb are prone to falling. School-aged children are prone to playground accidents. Normal patterns of injury include shin bruises and forehead bumps for toddlers or forearm and elbow fractures from playground accidents. Patterns of injury that should raise concerns include bruising in areas that aren’t usually bumped when walking or running (eg, thigh bruises), rib fractures, fracture of base or vault of skull, eye contusions, intracranial bleeding, multiple burns, and age younger than 1 year. Fractures of large bones, such as a femur, should also raise concern due to the amount of force needed for the fracture. Ribs are difficult to break due to the ...

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