Paediatric trauma evaluation and management are critical components of paediatric emergency medicine, aiming to provide timely and effective care to children who have suffered traumatic injuries. With unique anatomical and physiological considerations, paediatric trauma requires specialised attention and expertise. In this field, medical professionals must adeptly assess and manage injuries, considering developmental stage, growth potential, and emotional needs. By employing evidence-based practices and interdisciplinary collaboration, healthcare providers strive to optimise outcomes and minimise long-term sequelae for paediatric trauma patients.

Key Components of Paediatric Trauma Evaluation & Management

Assessment and Triage: The paediatric trauma evaluation begins with a thorough assessment and triage process. Healthcare providers must quickly assess the severity of injuries, prioritise care based on the child's condition, and initiate appropriate interventions.
Anatomical and Physiological Differences: Children have unique anatomical and physiological differences compared to adults, which must be considered during trauma evaluation and management. These differences include smaller airways, higher metabolic rates, and greater susceptibility to hypovolemic shock.
Age-Specific Considerations: Paediatric trauma care must be tailored to the child's age and developmental stage. Infants, toddlers, school-aged children, and adolescents may present with different injury patterns and require varying approaches to evaluation and management.
Injury Patterns and Mechanisms: Understanding common injury patterns and mechanisms in paediatric trauma is crucial for accurate assessment and management. Falls, motor vehicle collisions, bicycle accidents, and sports-related injuries are among the leading causes of paediatric trauma.
Advanced Diagnostic Imaging: Advanced diagnostic imaging modalities, such as computed tomography (CT) scans and magnetic resonance imaging (MRI), play a vital role in assessing paediatric trauma injuries. However, radiation exposure must be minimised, especially in young patients.
Multidisciplinary Approach: Paediatric trauma care involves a multidisciplinary team comprising emergency physicians, trauma surgeons, paediatric specialists, nurses, respiratory therapists and social workers. Collaborative decision-making ensures comprehensive and holistic care for the injured child.
Pain Management: Effective pain management is essential in paediatric trauma care to alleviate distress and facilitate recovery. Pharmacological and non-pharmacological interventions tailored to the child's age and condition are employed to manage pain effectively.
Emotional and Psychological Support: Paediatric trauma can have profound emotional and psychological effects on both the child and their family. Providing compassionate support, counselling, and resources for coping and resilience is integral to holistic trauma care.
Prevention and Education: Paediatric trauma prevention initiatives, including education on injury prevention, proper car seat use, bicycle safety, and sports injury prevention, are essential components of paediatric trauma care. Empowering caregivers and communities with knowledge and resources can help reduce the incidence of paediatric trauma.
Rehabilitation and Follow-Up Care: Rehabilitation and long-term follow-up care are critical aspects of paediatric trauma management, especially for children with complex injuries or disabilities. Physical therapy, occupational therapy, and psychological support contribute to optimal recovery and quality of life.

By addressing these components comprehensively, healthcare providers can deliver high-quality paediatric trauma evaluation and management, ensuring the best possible outcomes for injured children.

Common Paediatric Trumas & Management

Paediatric traumas encompass many injuries that can occur in children, each requiring specific evaluation and management strategies. Here are different types of paediatric traumas and how to manage them:

Head Trauma

Evaluation: Assess for altered mental status, vomiting, headache, seizures, or signs of skull fracture.
Management: Stabilise the cervical spine if trauma is suspected. Perform a neurological examination, including a Glasgow Coma Scale (GCS) assessment. Consider imaging studies such as a head CT scan to evaluate for intracranial injuries. Monitor closely for signs of increased intracranial pressure (ICP) and provide supportive care.

Abdominal Trauma

Evaluation: Assess for abdominal pain, distention, tenderness, and signs of internal bleeding (e.g., hypovolemic shock).
Management: Perform a focused abdominal examination and FAST exam to evaluate for intra-abdominal injuries. Consider imaging studies such as abdominal ultrasound or CT scan. If necessary, provide appropriate fluid resuscitation and consult a paediatric surgeon for further management.

Orthopaedic Trauma

Evaluation: Assess for deformity, swelling, tenderness, and limited range of motion in the affected limb or joint.
Management: Stabilise the injured limb or joint and immobilise it with splints or casts. Perform neurovascular assessments to monitor for signs of compartment syndrome or vascular compromise. Consult an orthopaedic surgeon for further evaluation and management, including reduction, fixation, or surgical intervention.

Thoracic Trauma

Evaluation: Assess for respiratory distress, chest pain, diminished breath sounds, and signs of pneumothorax or hemothorax.
Management: Stabilise the chest if trauma is suspected. Perform a chest X-ray to evaluate for rib fractures, pneumothorax, or pulmonary contusions. Provide oxygen supplementation and pain management as needed. Consider insertion of a chest tube for the management of pneumothorax or hemothorax.

Burn Injuries

Evaluation: Assess the extent and depth of the burn injury, including total body surface area (TBSA) affected and involvement of critical areas (face, hands, feet, genitalia).
Management: Cool the burn with running water or sterile dressings. Provide pain management and fluid resuscitation based on the extent of the burn. Dress the burn wound appropriately and consider referral to a burn centre for specialised care and management.

Traumatic Brain Injury (TBI)

Evaluation: Assess for altered mental status, loss of consciousness, focal neurological deficits, and signs of increased ICP.
Management: Stabilise the cervical spine if trauma is suspected. Perform a neurological examination and obtain imaging studies such as a head CT scan. Implement measures to reduce ICP, including head elevation, sedation, and osmotic therapy. Consider consultation with a neurosurgeon for further management, including surgical intervention.

Conclusion

In managing paediatric traumas, it's crucial to follow established protocols, consider the child's age and developmental stage, and involve multidisciplinary teams for optimal care. Early recognition, prompt intervention, and appropriate referral are essential to achieving favourable outcomes for injured children.

Frequently Asked Questions

Q1. How should a child with suspected head trauma be evaluated?
A1. A child with suspected head trauma should undergo a thorough neurological examination, including assessment of mental status, pupillary responses, and motor function. Imaging studies such as a head CT scan may be indicated to evaluate for intracranial injuries.

Q2. What are the key signs of abdominal trauma in children?
A2. Key signs of abdominal trauma in children include abdominal pain, distention, tenderness, and signs of internal bleeding (e.g., hypovolemic shock). A focused abdominal examination and FAST exam are essential for evaluation.

Q3. How should orthopaedic trauma in children be managed?
A3. Orthopaedic trauma in children should be managed by stabilising the injured limb or joint and immobilising it with splints or casts as needed. Neurovascular assessments should be performed, and consultation with an orthopaedic surgeon may be required for further management.

Q4. What steps are involved in managing a child with thoracic trauma?
A4. Managing a child with thoracic trauma involves stabilising the chest if trauma is suspected, performing a chest X-ray to evaluate for rib fractures or pneumothorax, and providing oxygen supplementation and pain management as needed. Chest tube insertion may be necessary for pneumothorax or hemothorax.

Q5. How should burn injuries in children be initially treated?
A5. Burn injuries in children should be initially treated by cooling the burn with running water or sterile dressings, providing pain management and fluid resuscitation based on the extent of the burn, and dressing the burn wound appropriately. Referral to a burn centre for specialised care may be necessary, depending on the severity of the burn.

References:

https://www.orthobullets.com/pediatrics/4124/pediatric-trauma-evaluation-and-management
https://www.uptodate.com/contents/trauma-management-approach-to-the-unstable-child