Pediatric trauma is the leading cause of death of children, as well as the leading cause of permanent disability in this population. It has often been said that children are not merely small adults, and this is never more accurate than in pediatric trauma.1 Although the principles of trauma care are the same for children as with adults, the differences in care required to optimally treat the injured child require special knowledge, careful management, and attention to the unique physiology and psychology of the growing child or adolescent. With this in mind, it is important to view pediatric trauma as a similar but separate entity from adult trauma. It was Haller of Johns Hopkins University who stressed the importance of regional trauma systems for pediatric patients. His system for safe care included two-way communication, dependable transportation, emergency medical technicians trained in the care of newborns, infants, and children, a designated pediatric intensive care unit (ICU), and rehabilitation.2 His work has helped shape and improve our pediatric trauma care significantly.
Although medical science has made vast strides in the surgical care of the neonate and child, injury remains the leading cause of childhood death in patients under 14 years of age.3 As developing countries become more sophisticated, injury becomes the leading cause of death in children.4 Of interest, there was a 45.3% reduction in the mortality rates from unintentional injury in children in the United States from 1979 to 1996.5 This reduction is crucial if one accepts that the treatment of injuries sustained in the year 2000 will ultimately cost $406 billion—$80.2 billion in medical costs and $326 billion in productivity losses.6 Of that total, injuries among children aged 0–14 account for $51 billion.6 Using the Centers for Disease Control and Prevention Web-Based Injury Statistics Query and Reporting System (WISQARS), a death and injury report for any age group and any type of injury can be obtained.
Children have different patterns and causes of injury depending on age, further emphasizing the need for regional pediatric trauma centers. The defined age range constituting a pediatric age group, however, varies between institutions. The mechanisms of injury and mortality in children have remained remarkably consistent. In children over 1 year and under 14 years of age, motor vehicle crashes cause 44.2% of all pediatric trauma deaths (2000–2005). A detailed review of mortality statistics reveals the home as an area of continuing concern.7 Other areas of concern include falls, bicycle-related injuries, and injuries associated with crashes of all-terrain vehicles.8
Childhood injuries most commonly occur as energy is transferred abruptly by rapid acceleration, deceleration, or a combination of both. The body of a child is very elastic and energy can be transferred creating internal injuries without significant external signs. Due to the relative close proximity of vital organs when compared with adults, children can have multiple injuries from a single exchange of energy. Penetrating trauma ...