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Key Points

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  1. Children follow different patterns of injury than adults.

  2. Commonly used scoring systems have decreased predictive power in injured children because, among other problems, few systems take into account size-based differences in pediatric physiology.

  3. Despite these problems, scoring systems decrease subjective evaluation of trauma, and therefore play a critical role in pediatric trauma research and quality improvement (QI).

  4. Injury prevention is a key component of any trauma system and trauma center. The priorities for prevention initiatives are best decided at the community level based on measured needs.

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Introduction

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In the United States, more children will die from trauma than any other cause—more than from cancer, more than from AIDS, more than from congenital anomalies, more than from all other causes combined. Injury-related death is responsible for nearly 30% of all years of potential life lost. Mortality is but the tip of the injury iceberg. For every injury-related death in the pediatric population, there are 12 children hospitalized for injury, and more than 60 treated for an injury in an emergency department (Table 77-1). Development of trauma systems, optimization of trauma care, and institution of injury prevention measures have not been successful at eliminating this problem. However, such efforts have not been without benefit.

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Table Graphic Jump Location
Table 77-1Annual Pediatric Trauma Volume in the United States
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In the IOM report on pediatric emergency care (including trauma), deficiencies in current practices were highlighted. In addition, the IOM stated that the ideal system would “…ensure that each patient receives the most appropriate care, at the optimal location, with the minimum delay.” That same IOM report recognized the system of hospitals (trauma centers) established to care for injured Americans as a “model of care.” However, while the evidence is clear that trauma systems improve the care of the adult trauma patient, it is less clear that such is the case for the pediatric trauma patient. In this chapter, we describe pediatric trauma systems, epidemiology, injury scoring, and prevention, with special attention on how pediatric injury differs from adult injury.

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Trauma Systems

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Organized trauma systems were developed largely through federal legislation, especially the National Highway Safety Act of 1966 and the Emergency Medical Services Act of 1973. Later, several state trauma systems were established (eg, Maryland, Illinois), and these served as models for other states interested in creating an organized trauma system. The American College of Surgeons, through their Committee on Trauma, published “Optimal Care for the Injured Patient,” a document designed to outline the standards for the organization of trauma centers. Absent from this document was specific language describing the needs of centers caring for injured children. ...

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