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Trauma is the leading cause of death and disability in children
>1 year of age.1 Because children have different
anatomy and physiology compared with adults, the management of injuries
in children differs in some respects. Many injuries can be managed initially
in a general hospital ED, but care of the most seriously injured
children requires prompt triage and transportation to a designated
pediatric trauma center.
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In 2005, unintentional injuries accounted for 36% of
all deaths in children 1 to 14 years of age and led all other causes
of death.1 This percentage was a decline from 45% of
all deaths in 1980. For children <1 year of age, unintentional
injury accounts for 3.8% of fatalities.2 Traumatic brain
injury from unintentional trauma remains the primary cause of death
among children.3 Motor vehicle crashes are the
leading cause of death among children >1 year of age, accounting
for 18% of all deaths and 44% of all deaths due
to trauma.2 Motor vehicle crashes are also the most
frequent cause of nonfatal injury, followed by pedestrian injuries. Motor
vehicle fatalities among children <16 years of age have fallen
an average of 5% per year for boys and 3.5% per
year for girls.4 Alcohol use by a driver is a factor
in about 2% of crashes leading to a fatal injury to a child.5 Falls
account for only 1.6% of deaths, but are the most frequent cause
of nonfatal injuries in children <10 years of age.2 Falls
are also the most common cause of injury in infants presenting to
the ED.6 Unintentional suffocation is the most
frequent cause of death due to injury in infants.2 In
2005 the death rate for boys 10 to 14 years of age was nearly twice
the rate for girls.2
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Homicides have increased 50% between 1980 and 2005 and
now account for about 6% of deaths in children from 1 to
14 years of age.1 Homicide is the second leading
cause of death due to injury in infants, and infants are 10 times
more likely to die from homicide than are children 5 to 9 years
of age.2
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Because most morbidity and mortality in pediatric trauma is due
to traumatic brain injury, prehospital interventions should focus
on airway and respiratory management, recognition of shock, spinal
immobilization, and rapid transport to an appropriate facility based
upon the predicted severity of injury. Prehospital care providers
must be skilled in recognition and prevention of hypoxia and shock,
because these are significant factors in causing secondary cerebral
injury. Although establishment of IV access may be the prehospital
ALS intervention that is most often performed, the beneficial effects
of this intervention remain in doubt for the majority of pediatric
trauma patients. Although airway management is crucial to prevent
hypoxia, prehospital endotracheal intubation requires specialized
skills and training, and it is not associated with better outcomes
in children than is bag-valve mask ventilation.7 Most
prehospital care providers have significant inexperience in pediatric
endotracheal intubation. Shortening the time interval between injury
and definitive care remains a priority; minimizing on-scene time
is an important issue in ...