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KEY POINTS

KEY POINTS

  • Injuries are the leading cause of death in the United States for persons age 1 to 19 years and the fifth leading cause of death for newborns and infants age less than 1 year.

  • The Broselow emergency tape or Pediatric Advanced Weight Prediction in the Emergency Room (PAWPER) provide estimated weight of a child using length-based estimation without (Broselow) or with (PAWPER) adjustment for body habitus.

  • The Shock Index, Pediatric Age-Adjusted (SIPA) identifies injured children with high injury severity, need for blood transfusion within the first 24 hours, and increased in-hospital mortality.

  • Criteria to activate a massive transfusion protocol in injured children may include 20 mL/kg of packed red blood cells in the first hour or anticipated blood loss greater than one-half blood volume in 12 hours or greater than one blood volume in 24 hours.

  • The motor component of the Glasgow Coma Scale (GCS) alone identifies a child with a serious traumatic brain injury.

  • In general, the presence of free fluid on a focused assessment with sonography for trauma (FAST) examination is an indication for computed tomography imaging in a stable injured child.

  • Spinal cord injury without radiologic abnormality is particularly hazardous because children may only present with transient neurologic findings, but then go on to develop neurologic deficits hours to days after the initial injury.

  • Children with two or more rib fractures are more likely to require a thoracostomy tube, thoracotomy, thoracoscopy, and/or laparotomy.

  • For a child with an injury to a solid organ in the abdomen, the success of nonoperative management approaches 95%.

  • Suspicion of child abuse should be raised if there is a discrepancy between the history and the extent of injury, if there are explanations that do not fit, or if the amount of time between the incident and presentation for medical attention is significant.

INTRODUCTION

Early in the last century, little distinction was made in the care of children from adults. William E. Ladd, a general surgeon, observed this firsthand as he cared for severely burned children in the Halifax disaster of 1917. “Dr. Ladd was distressed by the quality of surgical care offered to these small patients and was determined to improve it.”1 He and Dr. Robert E. Gross in the mid-20th century pioneered a new field of surgery specific to children, illuminating features of children that merited special attention. They and others recognized that although the care of children shared some similarities to that of the adult, there were distinctly different anatomic and physiologic characteristics and surgical conditions in children that made them unique. In 1962, the first pediatric trauma unit opened at the Kings County Hospital Center in Brooklyn. Yet, the lack of dedicated care and clinical protocols persisted in the United States until the early 1970s. The first designated pediatric shock trauma unit in the United States opened at the Johns Hopkins Children’s Center and became incorporated into the statewide University ...

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