Epidemiology and Management of Injuries to the Spinal Cord and Column in Pediatric Multiple-Trauma Patients

[Preclinical care of children with multiple trauma]

Severe multiple trauma in children is rare with approximately 380-550 cases per year in Germany. In addition to the S3 guideline "Polytrauma", which was published more than a decade ago, the S2K guideline "Severe multiple trauma care in childhood" was published in 2020. Accidents and especially the resulting traumatic brain injuries still represent the most frequent cause of death in children. While prehospital treatment according to Prehospital Trauma Life Support (PHTLS®) is basically analogous to that in adults which is based on the ABCDE concept (airway, breathing, circulation, disability, exposure), knowledge of age-dependent anatomical-physiological characteristics is essential. For simplification, various tools and dosing aids, such as the pediatric emergency ruler and specific emergency tables, are available. Further treatment after initial preclinical care should take place in an interdisciplinary manner in designated pediatric trauma centers.

Epidemiology of vertebral fractures in pediatric and adolescent patients

Spinal injuries in children and adolescents are rare injuries, but consequences for the growing skeleton can be devastating. Knowledge of accident causes, clinical symptoms and diagnostics should be part of every trauma department treating these patients. We retrospectively analyzed patients with radiographically proven vertebral fractures of the spine. After clinical examination and tentative diagnosis the fractures and injuries were proven with conventional X-ray, computed tomography (CT) scans or magnetic resonance imaging (MRI). The study included 890 fractures in 546 patients with an average age of 12.8±6.2 (6.6-19.4) years. Females had an average age of 13.7±6.3 (7.4-20.0) years, whereas males were on average 12.0 (6.0-18.0) years old. Fall from height (58%) was the main cause of accident and the most common region of fracture was the thoracolumbar spine with a shift towards the thoracic spine the more fractures occurred. Merely 3.7% of all patients required operative treatment. If a vertebral fracture is found in children and adolescents, it is highly recommended to exclude synchronous additional spine fractures in other levels; prevention should concentrate on fall and traffic accidents.

Epidemiology of pediatric head trauma in guilan

Background

Head injury (HI) is preventable and knowledge of the epidemiology of children's HI is essential for developing preventive strategies.

Objectives

The aim of this study was to survey pediatric HI patients admitted to emergency wards at Poursina Hospital in Rasht, Iran, from 2009 to 2010, and to identify the cause of HI in these children.

Patients and Methods

In this retrospective study, all HI patients under the age of 18 who were admitted to emergency wards between March 2009 and March 2010 were enrolled in the study. Demographic, etiologic, and injury data were collected and a descriptive analysis was performed.

Results

A total of 668 patients were included in this study. The mean age was 10.4 ± 5.3 years. The most frequent cause of HI was traffic accidents. The mean Glasgow Coma Scale (GCS) score was 14.5 ± 1.6. The ratio of boys to girls was approximately 3 to 1. The ratio of boys to girls increased with increasing age (P < 0.01). Moreover, an association was found between age at injury and etiology of HI as well as a significant association between age at injury and the place of event (P < 0.01).

Conclusions

The incidence of childhood HI due to traffic accidents is high (81% of pediatric trauma cases). Thus, motorcyclist education and improvement in traffic engineering for pedestrians and bicyclists should be included in prevention programs.

[Fracture stabilization in polytraumatized children]

Polytrauma is a rare diagnosis in childhood. Even after high-energy accidents isolated injuries of the skull and brain or extremities are more common. Injury is still the most frequent cause of death in childhood in industrialized countries. The lethality of polytraumatized children is about 19%. Injuries of the extremities do not play such an important role for the survival of polytraumatized children but for the definitive outcome. The diagnostic algorithm for polytraumatized children is related to adults and includes spiral computed tomography in the emergency room. Plain radiographs are still the gold standard for the diagnostic workup of fractures. Generally therapeutic approaches in the treatment of fractures in children are often conservative. Because of the special situation in polytrauma with ICU care and the need for venous catheters, fast mobilization and positioning in bed, indications for operative treatment and definitive stabilization of fractures are required for polytraumatized children.