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Abstract
Summary
Trauma is the leading cause of death in children aged 1-18 years. Traumatic injury is a major cause of disability. It has been said that inadequate evaluation contributes to approximately 30% of early deaths in children with severe trauma.
In contrast to trauma in adults, evaluation of the pediatric patient is often confounded by the patients inability to participate in the history and physical examination.
Prehospital medical case is an essential part of trauma management as the “golden hour” starts immediately after the accident occur and not at the entrance of the hospital.
This study is retrospective cross sectional analytical research for the types of trauma and different lines of management.
The study included 4.647 children sustained trauma in emergency room of Zagazig university hospital during the period from January 2003 to December 2003. they aged from 1-12 years.
The patients were primarily surveyed according to the method “ABCDEFG”, initial abdominal US was included in the primary survey as well as plain X-ray films for the cervical spine, chest, abdomen and pelvis. Ablood sample was withdrawn for laboratory tests.
Secondary survey included detailed history taking, from head - to - toe physical examination, imaging studies and measurement of intra- abdominal pressure.
The collected data were statistically analyzed.
More than half of the total cases (67.4%) were managed on an outpatient basis, and the admitted cases constituted 32.6% of total cases.
Head trauma was responsible for 35.5% of the total admission. Head injury was the most common cause of mortality among, the other causes (71.5%).
The multiply injured patients comprised 10.4% of the total admission.
The abdominal injured patients comprised 4.4% of the total admission trends in management of solid viscera lesions have changed over the past 2 decades and a conservative approach is now preferred whenever possible.
The spleen was found to be the commonest intra-abdominal organ to be injured after blunt trauma followed by the liver.
Approximately 19.7% of abdominal injured children were managed conservatively and renal injury was the commonest to be managed non operatively.
Pitfalls that were observed during this study are, lack of a unified approach in assessment of head trauma, lack of established criteria for CT scanning, lack of attention to neck immobilization.
The children who enjoyed a good recovery were about 87.6%, while of them suffered complications 6.2% and about 6.2% died.
After this study, we believe that most of childhood injuries are preventable, and the host-agent-environment model can be used to structure interventions for prevention of trauma.