Riding a bicycle: Do we need more than a helmet?

Background: To assess pediatric bicycle‐related traumatization in view of types of injuries, incidence and modes of prevention. Methods: Retrospective study of pediatric cases admitted to the pediatric intensive care unit of a university‐affiliated level II trauma hospital in Israel over 12 consecutive years. Results: Forty‐six patients (three girls, 43 boys) with bicycle‐related injuries formed 1% of the total pediatric intensive care unit admissions during the study period. The number of patients with bicycle‐related injuries increased significantly during recent years (1996–2001 vs 2002–07: P= 0.003). Most of the cases presented abdominal injuries (54.4%) followed by head (32.6%) and chest (13%) injuries. The median age of patients with abdominal trauma was significantly lower in comparison to patients with other types of injuries (P= 0.002). Abdominal cases required longer hospitalization compared with other patients (P= 0.003). Falling from a bicycle was the main mechanism of injury in abdominal cases (88%) (P= 0.003). Motor vehicle impacts were the main mechanism of injury in patients with head (60%) and chest (66.6%) trauma. Conclusion: The incidence of severe bicycle‐related injuries requiring intensive care hospitalization is increasing and abdominal trauma forms the main portion of those injuries. We suggest introducing a trunk‐protective measure for young bicyclists. Exact information on the mechanism of the injury is important for evaluating the injured patient more accurately.     

Management of major blunt pediatric renal trauma: Single-center experience

ObjectiveTo review the impact of major pediatric renal trauma and its management on long-term function and morphology of the injured kidney.MethodsThirty-six blunt trauma patients (20 males, 16 females) presented in 2004–2007 (age range 2 days to 14 years; mean 6.2 years). Thirty-seven renal units were included: 13 grade III, 14 grade IV, and 10 grade V injuries. Follow up was for 3–38 (mean 14) months. Patients were managed non-operatively unless vitally unstable. The most common causes of trauma were motor vehicle accidents and falls. Fourteen patients had associated non-renal injuries. Four patients had pre-existing renal problems.ResultsThe surgical intervention group (13 patients, 36%) included 9/10 grade V and 4/14 grade IV renal injuries. Surgical repair of lacerations was performed in seven cases, partial nephrectomy in four cases and nephrectomy in two cases. Follow up showed no significant change in renal function, and none developed hypertension. The non-operative group (24 patients, 63.2%) included all grade III injuries, 10 grade IV injuries, and one grade V injury. There was an excellent outcome for 18/24 patients (75%) with kidney preservation, no complications from urinary extravasation and hematoma resolution. The remaining patients had lower polar infarction (1), renal atrophy (1), persistent subcapsular collection (2), recurrent hematuria requiring angioembolization (1), and there was one death related to central nervous system injury.ConclusionThe outcome of our management of pediatric major renal trauma was favorable overall. Longer follow up is needed with regard to renal function and development of hypertension.     

Pediatric farm-related injuries: a series of 96 hospitalized patients

Ninety-six children were admitted during a 9-year period to a pediatric level 1 trauma center for treatment of farm-related injuries. The age range was from 6 weeks to 17 years (median, 7.5 years; mean, 7.6 years; standard deviation, 4.4). Thirty-nine patients (40.6%) had an animal-related injury, including 36 children (37.5%) who had an injury associated with a horse. Amish children had an increased risk of horse-related injury when compared with non-Amish children (p=0.04; RR=2.09, 95% CI: 1.18相似文献   

A one-year prospective ED cohort of pediatric trauma.

During a 12-month period ending on November 30, 1988, data were collected on 4623 pediatric patients visiting a pediatric emergency department with trauma (excluding burns). Sixty-one percent were male. Common causes of the trauma included suspected child abuse (4%), organized sports (6%), nonorganized sports (4%), pedestrian motor vehicle accidents (MVAs) (3%), bicycle MVAs (2%), and automobile MVAs (3%). However, most of the incidents had none of the identified associated activities surrounding the trauma (60%). Incidents took place at home (41%), on the street (11%), at school (10%), and at a playground or park (10%). Injuries involved the external body (59%), extremity (26%), head or neck (13%), face (4%), chest (1%), and abdomen (2%) and were more common during the summer. Injury severity scores had a mean of 1.8 and were grouped as: less than 3 (80%), 3-6 (19%), and greater than 6 (1.6%). Factors associated with higher trauma severity included MVAs, water-related injuries, sports, streets, schools, parks, playgrounds, skateboards, skates, and alcohol.     

Pediatric blunt carotid injury: a review of the National Pediatric Trauma Registry.

Blunt carotid injury (BCI) is an uncommon yet potentially devastating entity which has received little attention in the pediatric literature. In an attempt to better characterize pediatric BCI, a review of the National Pediatric Trauma Registry was performed. Records were obtained from all children diagnosed with internal or common carotid injury associated with blunt trauma. The incidence of BCI was 0.03% (15 of 57,659 blunt trauma patients). Variables examined included: age, gender, mechanism of injury, associated injuries, various injury severity scores, and outcome. Various injuries were associated with an increase in BCI incidence including chest trauma (4-fold), combined head and chest trauma (6-fold), basilar skull fractures (4-fold), intracranial hemorrhage (6-fold), and clavicle fractures (8-fold). Thirty-three percent of the patients diagnosed with BCI suffered neurological complications directly attributable to their carotid injuries. Current practices regarding screening, diagnosis, and treatment are reviewed.     

The Hawaii EMS-C project data: I. Reducing pediatric emergency morbidity and mortality; II. Statewide pediatric emergency registry to monitor morbidity and morality.

During a 12-month period ending on 11/30/88, data were collected on 16,010 pediatric patients who visited a pediatric emergency department (ED). These ED patients prospectively fell into one of the target areas for further study, including wheezing (15%), trauma (excluding burns; 29%), burns (1%), water-related injuries (1%), ingestions and toxic substance exposures (2%), child abuse (3%), handicapping conditions (5%), preventable incidents (33%), and ambulance arrivals (7%). Handicapped patients were more likely to require an ambulance. Younger patients, males, and patients with handicaps, wheezing, and Medicaid insurance were more likely to visit the ED on multiple occasions. Primary care physicians could be identified in 77% of the cohort. Large-scale interventions to reduce preventable pediatric morbidity and mortality have suffered from difficulties in documenting their effect in a population-based sample. A statewide pediatric emergency encounter registry is proposed.     

Pediatric trauma management in a rural Wisconsin trauma center

OBJECTIVE: To determine the results of pediatric trauma care managed with a cooperative effort by general surgeons and pediatric intensivists in comparison to national standards. DESIGN: Retrospective chart review. SETTING: Referral level II trauma center in rural Wisconsin. PATIENTS: All pediatric trauma patients age 16 and younger admitted to the hospital from 1990 to 1993. METHODS: Demographics, mechanisms of injury, revised trauma score (RTS), injury severity score (ISS), surgical procedures, need for intensive care, and outcome were examined. All patients were primarily managed by the trauma surgery service. Those patients requiring intensive care were managed jointly by the trauma surgery service and pediatric intensivists. Outcome was predicted by TRISS analysis; patients identified as "unexpected deaths" underwent critical clinical review to determine potential for survival. RESULTS: There were 531 pediatric trauma admissions. The mean age was 9.0 +/- 6.2 (SEM) years and two thirds of the patients were boys. Over half of all injuries were from falls, recreational activities, and motor vehicle crashes. There were few penetrating injuries. The mean RTS was 7.58 +/- 0.05, and the majority of patients had an ISS below 10. Sixty-two percent of patients required surgical procedures, most of which were orthopedic. Fourteen percent of patients were admitted to the pediatric intensive care unit. There were 13 deaths for a mortality rate of 2.4%. TRISS analysis identified six deaths as unexpected. Four drownings were not included in TRISS analysis, and there were no unexpected survivors. Of the six unexpected deaths, there were no significant management errors identified on careful review. CONCLUSIONS: Cooperation between general surgeons and pediatric intensivists can result in excellent pediatric trauma care in a rural level II trauma center.     

儿童颈椎外伤的诊断及治疗

目的 探讨儿童颈椎外伤的临床特点、诊断、治疗方法及难点和要点.方法 回顾性分析我院1995年1月至2005年12月期间治疗的儿童颈椎外伤病例的临床资料,同时检索分析国内外关于儿童颈椎外伤的文献.结果 11例患儿纳入本研究,其中男8例,女3例;平均年龄(12.1±4.0)岁;受伤机制包括坠落伤(3例),运动伤(3例),车祸伤(2例),直接暴力伤(2例),因娱乐致伤(1例).受伤部位分布为C1-34例,C4-77例.4例合并神经系统症状,其中1例为无骨折脱位型脊髓损伤.4例接受手术治疗,7例行保守治疗.结论 儿童颈椎外伤相对少见,其在临床表现、影像学检查及治疗方法上均存在与年龄相关的特点.熟悉这些特点对儿童颈椎外伤患儿的诊断及治疗至关重要.     

Emergency medical care and severe home accidents in children. Study of 630 cases over 5 years. Their significance in traumatic accidents

Among calls put through to the Mobile Emergency Unit of a Paris urban area district for a pediatric problem over a five-year period (n = 630), 19% were for a household injury (with or without physical injury) and 22% (n = 712) were for a physical injury outside the home. Thus, injuries were the reason for over 40% of pediatric calls and half these injuries occurred in the child's home. Household injuries were serious, with a prehospital mortality rate of nearly 5% and intensive care treatment in one-third of cases. Fifty-five per cent (60% in boys) of household injuries occurred in preschool-age children. Half these injuries (burns excluded) were physical injuries (66% in boys). Forty per cent of household injuries (n = 251) were caused by a fall, from over one meter in half the cases. Most of these injuries occurred around mealtimes (3/4 of cases). As compared with out-of-home childhood injuries, prehospital mortality rate was significantly higher (p less than 0.001) and single injuries significantly more prevalent (p less than 0,001) in household physical injuries. Prevalences of lesions of the face, head and neck, chest, abdomen, and pelvis were comparable for out-of-home and at-home physical injuries; conversely, lesions of the upper limbs were more common in household injuries (p less than 0,01), whereas lesions of the lower limbs were more prevalent in out-of-home trauma. Lastly, household physical injuries occurred mainly in children under five, whereas out-of-home childhood injuries were more common after five years of age (p less than 0,001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Blunt abdominal trauma in children: epidemiology, management, and management problems in a developing country

Trauma is the leading cause of death in children in developed countries. In tropical Africa, it is only beginning to assume importance as infections and malnutrition are controlled. In developed countries, the availability of advanced imaging modalities has now reduced the necessity for laparotomy to less than 10% following blunt abdominal trauma (BAT) in children. This report reviews the epidemiology, management, and unnecessary laparotomies for pediatric BAT in a developing country in a retrospective review of 57 children aged 15 years or less at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria over 12 years. The average age was 9 years and the male-female ratio 3.8:1. Seventy-four percent (74%) of abdominal injuries in children were due to blunt trauma. The commonest causes of injury were road traffic accidents (RTA) (57%), 88% in pedestrians and 59% in children aged 5–9 years. Falls were the cause of trauma in 36%, 60% of them aged 10–15 years. Other causes of injury were sports in 5% and animals in 2%. Diagnosis was clinical, supported by diagnostic peritoneal lavage or paracentesis. Two patients had ultrasonography, and none had computed tomography. Fifty-three patients had a laparotomy, 2 died before surgery, 1 was managed nonoperatively, and in 1 surgery was declined. There were 34 splenic injuries, 20 treated by splenic preservation, splenectomy in 13, and non-operative in 1. Fourteen gastrointestinal injuries were treated in 12 patients. Of 9 hepatic injuries, 4 were minor and were left untreated, 3 were repaired, 1 was packed to arrest hemorhage, and a lacerated accesory liver was excised. Four injuries to the urinary tract (bladder contusion 2, bladder rupture 1, ruptured hydronephrotic kidney 1) were treated accordingly. There were 4 retroperitoneal hematomas associated with other intra-abdominal injuries and 2 pancreatic contusions. One lacerated gallbladder was treated by cholecystectomy and a ruptured left hemidiaphragm was repaired transperitoneally. In retrospect, 27 (51%) patients could have been managed by observation (splenic injury 20, liver injury 5, bladder contusion 2) using advanced imaging modalities. One patient developed an intra-abdominal abscess following splenorrhaphy. The average hospital stay was 17 days. Mortality was 8 (14.5%) from gastric perforation (3), liver injury (2), splenic injury (1), and 2 patients died before surgery. BAT in this population results predominantly from RTA in pedestrians. Laparotomy may be avoided in 51% of cases if advanced imaging modalities are readily available. Accepted: 28 October 1999     

Three-wheel and four-wheel all-terrain vehicle injuries in children

In January 1988, sales of new three-wheel all-terrain vehicles (ATVs) were banned in the United States because of the high incidence of injury associated with their use, especially by children. Four-wheel ATVs remain on the market. A retrospective review of all ATV injuries seen in a level I pediatric trauma center was conducted to compare the nature and severity of injuries in three-wheel vehicles with those associated with four-wheelers. A total of 36 ATV injuries were seen from April 1986 to August 1988. All patients were less than 16 years of age; 72% were less than or equal to 12 years of age. Of the patients, 56% were boys; 44% were girls. Although 56% of incidents involved three-wheelers, a larger number of more serious injuries, defined as the presence of indicators of injury severity (eg, death, Injury Severity Score greater than or equal to 10, intensive care unit admission, or need for surgery), involved four-wheel vehicles. A total of 15 injuries occurred in 1987; 12 injuries, including the first death involving an ATV at the pediatric trauma center, occurred in the 7 months since the sales ban. Immature judgment and/or motor skills were the most common factors contributing to injury. Existing information regarding injuries involving three-wheel ATVs is supported by our data, according to which it is suggested that four-wheel vehicles may be dangerous in the hands of immature or unskilled operators less than 16 years of age. Injury prevention efforts should be directed at prohibiting any ATV use by persons less than 16 years of age.     

Paediatric utilization of a general emergency department in a developing country

AIM: Knowledge of the spectrum and frequencies of pediatric emergencies presenting to an emergency department (ED) of individual developing countries is vital in optimizing the quality of care delivered locally. METHODS: A prospective 6 wk review of all pediatric (< 18 y) attendees to an urban ED was done, with patient age, presenting complaints, diagnoses, time of arrival and disposition recorded. RESULTS: Complete data were available on 1172 patients, with an age range of 4 d to 18 y (mean +/- SD 6.9 +/- 5.6 y); 43% were aged < or = 4 y. The main presenting complaints were injuries (26.9%), fever (24%) and breathing difficulties (16.6%). The most common diagnosis was minor trauma (24.2%), with soft-tissue injuries predominating (80.6%). The other diagnoses were asthma (12.6%), upper respiratory infections (12.1%), other infections (12.1%) and gastroenteritis (11.8%). Equal proportions of patients were seen throughout the day. 25% of patients were admitted. Young age (< 1 y); presence of past medical history, general practitioner referrals, diagnosis of bronchiolitis and pneumonia were significantly associated with risk of admission. CONCLUSION: A wide spectrum of paediatric illnesses was seen in the ED, with an overrepresentation of young children. This supports the decision to have either a separate pediatric ED or paediatric residents on the staff. The training curricula should emphasize the management of pediatric trauma, infections and asthma. Alternatively, developing guidelines for the five most common presenting complaints would account for 82% of all attendees and could be directed towards all staff on the ED.     

School accidents in Austria

The aim of this study was to obtain information about the mechanisms and types of injuries in school in Austria. Children between 0 and 18 years of age presenting with injuries at the trauma outpatient in the Department of Pediatric Surgery in Graz and six participating hospitals in Austria were evaluated over a 2-year prospective survey. A total of 28,983 pediatric trauma cases were registered. Personal data, site of the accident, circumstances and mechanisms of accident and the related diagnosis were evaluated. At the Department of Pediatric Surgery in Graz 21,582 questionnaires were completed, out of which 2,148 children had school accidents (10%). The remaining 7,401 questionnaires from peripheral hospitals included 890 school accidents (12%). The male/female ratio was 3:2. In general, sport injuries were a predominant cause of severe trauma (42% severe injuries), compared with other activities in and outside of the school building (26% severe injuries). Injuries during ball-sports contributed to 44% of severe injuries. The upper extremity was most frequently injured (34%), followed by lower extremity (32%), head and neck area (26%) and injuries to thorax and abdomen (8%). Half of all school related injuries occur in children between 10 and 13 years of age. There are typical gender related mechanisms of accident: Boys get frequently injured during soccer, violence, and collisions in and outside of the school building and during craft work. Girls have the highest risk of injuries at ball sports other than soccer.     

儿童创伤临床特点及死亡危险因素分析

目的 分析儿童创伤的临床特点及死亡危险因素,为探索预防措施及降低病死率提供参考.方法 回顾性分析2014年4月至2016年3月我院急诊科收治的7 936例创伤患儿的临床特点,利用Logistic回归分析对可能引起创伤患儿死亡的危险因素进行分析.结果 创伤患儿男性多于女性(1.73∶1),外地患儿(5535例)多于本地患儿(2401例)(χ2=14.314,P＜0.05).婴儿期(2024例)和幼儿期(3097例)病例数最多.四肢[41.9%(3324/7936)]和皮肤创伤[38.5%(3058324/7936)]最多见.儿童创伤原因因年龄段不同而有所差异,坠落、跌倒、交通事故是引起儿童创伤的常见原因.存活组1933例、死亡组5例的儿童创伤评分分别为8.53±2.17、3.17±1.29,普通住院组1852例、ICU组86例的儿童创伤评分分别为9.72±1.25、5.23±1.84.休克失代偿、机械通气、Glasgow评分≤7分、儿童创伤评分＜8分是引起创伤儿童死亡的危险因素.结论 家长应提高安全意识、加强对儿童的看护、遵守交通规则以降低儿童创伤发生率.临床医生应对休克失代偿、机械通气、Glasgow评分、儿童创伤评分等因素予以足够重视,尽早识别危重患儿,提高抢救成功率.     

Trauma in pediatric urology

In pediatric trauma, the kidney is the most commonly injured organ of the urinary tract. Renal trauma occurs in 10% to 20% of all pediatric blunt abdominal trauma cases. The vast majority of renal injuries can be treated conservatively. However, cases associated with hemodynamic instability require operative interventions. Injuries to the ureter, bladder or urethra are almost exclusively encountered in polytraumatized children. The aim of this article is to give an overview on traumatic injuries to the pediatric urinary system.     

Motor vehicle injuries in childhood: a hospital-based study in Saudi Arabia

Motor vehicles are a major cause of injury-related deaths in children and may also result in temporary or permanent disability. A retrospective analysis of the medical charts of children aged 12 years and younger, who were involved in motor vehicle injuries during a 10-year period, was undertaken. All children who were admitted and treated at King Fahad National Guard Hospital, Riyadh from January 1994 to December 2003 were included in this study. Data analyzed included age, gender, and mechanism of injury, type of injury, management and outcome. Motor vehicle injuries accounted for approximately 42% of all pediatric traumas. There were 664 children, 469 (71%) male and 195 (29%) female and a male: female ratio 2.4:1.Four hundred and seventy two children were injured as pedestrians (71%), 177 as auto passengers (27%), 11 as bicyclists (1.5%), and 4 as motorcyclists (0.5%). Five hundred and sixty two injured children (85%) were between the ages of 1 and 8 years. The most common injuries were to the head and extremities. Thirty-four children (5.1%) died from their injuries, 30 from head trauma. Thirty-five children (5.3%) were discharged home with neurological impairment from head trauma. In this study, the risk factors associated with high volume of motor vehicle injuries in children include, male, 1–8 years, and pedestrian. Head trauma is the most common cause of morbidity and mortality. This study suggests that nationwide programs should target the use of seatbelts and helmets, and dangerous driving practices.     

Pediatric ocular trauma: Characteristics and outcomes among a French cohort (2007–2016)

Pediatric ocular trauma is a major cause of acquired monocular blindness. Post-traumatic visual impairment can lead to significant handicap. In France, recent data on the epidemiology of pediatric ocular trauma are lacking.AimTo describe the characteristics of a pediatric cohort with ocular trauma and to analyse patient outcomes.Material and methodsThis was a retrospective observational study of pediatric ocular trauma (age < 15 years) presenting to pediatric and ophthalmology emergency units of our tertiary university hospital between January 1, 2007 and December 31, 2016. Data were collected on: age, sex, time and circumstances of trauma, injury type and location, trauma mechanism, other associated injuries, hospitalisation rate and length of stay, treatment, and sequelae (visual impairment). Ocular traumas were classified according to the Birmingham Eye Trauma Terminology (BETT) system and the Ocular Trauma Score (OTS).ResultsA total of 337 children were included (247 males). The global mean age was 8.4 ± 4.1 years (range 6 months to 14.9 years). The trauma occurred at home (51%) or in a public area (21%). Blunt objects (22%) and direct trauma (17%) were the main mechanisms. According to the BETT, 23% of ocular traumas were open-globe traumas (OGT): penetrating (n = 39), perforating (n = 12), with intraocular foreign body (n = 24). Among closed-globe injuries (CGT), hyphema was the most frequent lesion (22%). Associated injuries were recorded in 32 patients. In all, 63% of patients had an OTS of 5 (good visual prognosis) while 39 children (12%) had an OTS of ≤ 3. In 47 patients, there was an initial surgery; 62% of children were hospitalised. By the end of the ophthalmic follow-up, 32 patients (9.5%) had sequelae. Children aged between 2 and 5 years had the greatest proportion of sequelae (15%). Compared with female patients, male patients were older (P = 0.0007) and were more frequently injured by projectiles (P = 0.036). Compared with CGT, OGT were more frequent among younger children (P = 0.0015). Ocular injuries secondary to a projectile and spring-summer accidents were associated more frequently with a poor visual prognosis (OTS ≤ 3; P = 0.036, OR = 2.5 [1.1–5.8] and P < 0.0001, OR = 5.8 [3.2–10.7] respectively).CommentsThe annual admission for pediatric ocular trauma was stable during the study period (200 cases per 100,000 annual trauma admissions in the first period [2007–2011] and 195 cases per 100,000 during the most recent period [2012–2016]). Projectiles such as Airsoft gun bullets and paintball are still the cause of severe injuries while reports on ocular injuries secondary to blaster or Nerf guns use are starting to be published.ConclusionThe great majority of ocular traumas could be prevented, especially by wearing protective goggles during at-risk activities. French legislation should be stricter about the sale of any Airsoft gun to children under 18 years old. Parents must repeat educational warnings to their children handling sharp objects. The social and psychological burden of relative visual impairment is of importance: One in ten children will have a permanent visual defect.     

Traumatic pelvic fractures in children and adolescents

Although traumatic pelvic fractures in children are relatively rare, these injuries are identified in about 5% of children admitted to level 1 trauma centers after blunt trauma.1, 2, 3, 4 Such injuries differ from adult pelvic fractures in important ways and require distinct strategies for management. While the associated mortality rate for children with pelvic fractures is much lower than that for adults, the patient may require urgent surgical intervention for associated life-threatening injuries such as head trauma and abdominal injury. Unstable pelvic ring fractures should be acutely managed using an initial approach similar to that used in adult orthopedic traumatology. Although very few pediatric pelvic fractures will ultimately need surgical treatment, patients with these injuries must be followed over time to confirm proper healing, ensure normal pelvic growth, and address any potential complications. The trauma team suspecting a pelvic fracture in a child must understand the implication of such a finding, identify fracture patterns that increase suspicion of associated injuries, and involve pediatric or adult orthopedic specialists as appropriate during the management of the patient.