Pediatric_Trauma_-_Pathophysiology__Diagnosis_and_Treatment.pdf

Pediatric

Trauma

Pediatric

Pathophysiology, Diagnosis, and Treatment

edited by

DAVID E. WESSON

Baylor College of Medicine

Houston, Texas, U.S.A.

Associate Editors

ARTHUR COOPER

Columbia University College of Physicians and Surgeons

New York, New York, U.S.A.

L. R. TRES SCHERER III

Kiwanis–Riley Regional Pediatric Trauma Center

Indianapolis, Indiana, U.S.A.

STEVEN STYLIANOS

Columbia University College of Physicians and Surgeons

Morgan Stanley Children’s Hospital of New York-Presbyterian

New York, New York, U.S.A.

DAVID W. TUGGLE

University of Oklahoma College of Medicine

Oklahoma City, Oklahoma, U.S.A.

Trauma

Published in 2006 by

Taylor & Francis Group

270 Madison Avenue

New York, NY 10016

No claim to original U.S. Government works

Printed in the United States of America on acid-free paper

10987654321

International Standard Book Number-10: 0-8247-4117-X (Hardcover)

International Standard Book Number-13: 978-0-8247-4117-4 (Hardcover)

This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with

permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish

reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials

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Preface

Injuries cause more than half of all deaths among children in the United States. The

spectrum of causes varies with age, but blunt forces cause the overwhelming majority

of injuries. Children are not just small adults. They differ in many ways from adults.

Many of the differences in behavior, risk exposure, anatomy, and physiology have a

direct bearing on trauma care. In recent years, this reality has been widely accepted in

the ﬁeld. The Committee on Trauma of the American College of Surgeons has speci-

ﬁcally addressed the needs of injured children in its resources document and in the

curriculum of its Advanced Trauma Life Support course. The Committee on

Trauma recommends at least six hours of pediatric trauma–related continuing med-

ical education for all surgeons providing pediatric trauma care, and many states have

established speciﬁc requirements for hospitals receiving injured children. Across the

United States, children’s hospitals, pediatric surgeons, and pediatric emergency

physicians have focused on the needs of injured children and established pediatric-

speciﬁc benchmarks in the management of solid organ injuries, neurotrauma, fractures,

and numerous other types of trauma.

But there is a problem. There are just not enough children’s hospitals or pedi-

atric trauma specialists to meet the needs of all injured children in the United States.

Much, if not most, pediatric trauma care is provided in general hospitals by non-

pediatric specialists. This book is intended for all physicians and surgeons who treat

children with life- and limb-threatening injuries. The primary target audience in-

cludes general surgeons, trauma surgeons, and emergency physicians experienced

in trauma care who want to expand their knowledge of pediatric trauma. The con-

tent relates primarily to direct patient care, excluding such topics as prevention,

organ procurement, and medical legal and legislative issues. The emphasis is on inju-

ries caused by blunt and penetrating mechanical forces to the exclusion of burns and

scald injuries and drowning.

The book is divided into four sections. The ﬁrst deals with trauma systems for

children, including epidemiology and preparations for pediatric trauma care. Section

two covers general principles of resuscitation and supportive care relevant to all

pediatric trauma patients. Section three covers the management of speciﬁc injuries.

Section four deals with rehabilitation and long-term outcomes and how to effectively

communicate with families, particularly when the outcome is not good.

I would like to thank Geoff Greenwood and Taylor & Francis for encouraging

and supporting us in this project. I would also like to thank the authors, who were

selected because of their expertise, for their efforts, and my administrative assistant

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