Minor Injuries and Major Trauma in Paediatrics: Natalie May

Natalie May gives you the break down of paediatric trauma.

Paediatric trauma is relatively rare but terrifying. However, there are many ways we can think about paediatric trauma to make these challenging situations easier to face.

Children are inherently portable. This means that they often turn up at peripheral, non-paediatric centres that are not major trauma centres.

This highlights the importance of all physicians knowing how to deal with these cases.

Anatomy and physiology of children is different to adults. Their ability to compensate is remarkable. This means the index of suspicion of serious injury should be higher.

For instance, their ribs are a lot more pliable than those of adults, meaning hollow viscous organ injuries are more common following trauma.

Similarly, their vital signs can be more confounding. Tachycardia could simply mean fear or pain.

On the other hand, it could indicate a major internal bleed. This leads to children being under and over triaged at a high rate.

Teenagers also present challenges. Does the surly, teenage girl with limited verbal responses have a serious head injury..? Or is she being a stereotypical teenage girl?

The mechanism of children trauma differs from that of adults.

Polytrauma is rare in children without adult involvement, such as a motor vehicle accident. However, as children develop through adolescence, the mechanisms of injury begin to resemble those of adults.

Quad bike accidents, stabbings and even shootings become more common. Isolated thoracic injuries become the second most common cause of trauma in adolescents 16 years and older.

Toddlers by comparison get isolated limb injuries more commonly. They are mobile, curious and have no sense of danger. Their height to the ground is less, making head trauma less common, and less serious.

Under one’s however are more often carried by adults and lack protective reflexes making skull fractures more common. Polytrauma in this age group should also raise suspicion of non-accidental injury. External factors often need to be involved for more serious polytrauma.

Natalie suggests being suspicious of horse-riding children!

Once a child is in your department, the assessment differs slightly to that of an adult. Specifically, scanning protocols are different with less use of pan scanning and more focussed scanning. CT for heads and penetrating chest trauma and abdomen, and plain films for C-spine, limbs, pelvis, and blunt trauma to the chest.

Natalie concludes by discussing the differences in management of injuries, comparing children and adult interventions. She also discusses the outcomes of children with major trauma and the vast implications on the child, the family and society.

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