الفهرس 
Introduction & RationaleOnly 14 pages are availabe for public view
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Abstract
Every year more than 5 million people die from non-intentional traumatic injuries, homicide and suicide, representing 9% of global deaths. Additionally, 20 to 50 million people suffer non-fatal injuries, many of them resulting in disability. Most of these injuries and deaths occur in children and adolescents below the age of 19, and virtually trauma is the leading cause of death in people less than 40 years.
Trauma can cause rhabdomyolysis through direct muscular injury due to crush or blunt injuries (e.g., road traffic accidents, falls, natural disasters, child abuse) as well as by electrical or thermal burns. Early complications from rhabdomyolysis including acute kidney injury (AKI), compartment syndrome and severe electrolyte disturbances, causing cardiac arrhythmias can present within few hours.
Acute kidney injury is the most significant complication following crush injury. The mechanisms involved in kidney injury include blockage of the renal tubules with myoglobin, damage from free oxygen radicals, and myoglobin-induced vasoconstriction of renal arterioles, as well as secondary injury associated with volume depletion and renal ischemia. AKI is reported in 42% to 50% of children admitted for rhabdomyolysis.
As traumatic rhabdomyolysis can occur with no or with nonspecific symptoms, diagnosis requires high index of suspicion. To make it worse, acute kidney injury can develop even when levels of creatine phosphokinase
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are normal. Based on these facts, we assume that traumatic rhabdomyolysis is common in pediatric trauma and that its diagnosis goes unnoticed.
The aim of this study was to assess risk factors and outcomes of suspected crush injuries in polytrauma children and to assess the knowledge, practice and competence of the emergency doctors aiming at improving the management process to increase survival rate after guidelines applications.
This is an interventional study was conducted at Emergency department in Suez Canal University Hospital. The study included all severely injured polytrauma children suspected of having crush injuries presented to emergency department and emergency physicians in Suez Canal University Teaching Hospital. Assessment of patients management and outcomes was done for 200 polytrauma children included in the study subdivided into 2 groups; pre (n= 100) and post (n= 100) Guidelines implementation.
The main results of this study were as follows:
Both groups were perfectly matched in terms of age, gender, residency, prehospital time, transportations and interventions, trauma mechanisms and severity, skeletal injury profiles and interventions, vital signs at presentation, initial lab values, coagulopathy or lethal triad, and in terms of FAST examinations. The only difference was in management.
The mean age was around 11 years with the males comprising around 70% of the injured.
Majority of injuries were due to road traffic injuries (pedestrians and vehicle occupants),