Chapter 39 - Trauma in Children

Summary

Trauma is the leading cause of mortality and morbidity in children in developed countries. Traumatic brain injury is responsible for the largest proportion of deaths. Preventable death due to major haemorrhage occurs early in the first 24 hours. Mechanisms vary with age. Blunt injury represents over 80% of cases. Falls and road traffic collisions (RTCs) are the most common mechanisms across all ages, except for non-accidental injury (NAI) in < 1 year olds. There has been a substantial rise in penetrating trauma due to gun and knife crime in the adolescent population. The centralisation of trauma services in the United Kingdom with the creation of regional networks has changed how paediatric trauma is managed. Severely injured children are triaged at scene and taken directly to major trauma centres (MTCs). Outcomes have improved, and there is better standardisation between treating institutions. Initial trauma management involves stabilisation, resuscitation, identification and treatment of life-threatening injuries in the primary survey. Some patients will need damage control surgery to control haemorrhage. This is followed by definitive care and rehabilitation. Anaesthetists are an integral part of the trauma team involved throughout the patient journey. Dedicated anaesthetic roles are airway management and ongoing resuscitation during surgery.