Pediatric Polytrauma

Trauma is the leading cause of mortality in children over 1 year of age. A child with multiple injuries incurred as the result of a significant trauma should be cared for in a trauma center with a dedicated and coordinated trauma system.

Head injuries tend to be responsible for the most morbidity and mortality in pediatric patients. Despite open cranial sutures, elevated intracranial pressures (ICPs) are common in head injured children, and should be assessed and monitored by trained neurosurgical personnel. Head injured patients should be treated with rigid fixation of long bones for two specific reasons. First, it simplifies other aspects of hospital care such as hygiene, scans, transport, operations and skin care relative to the encumbrance imposed by traction equipment. As well, head injured patients will often go through a period of agitation or spasticity that can complicate traction or cast treatments. There is, however, no evidence to suggest that rigid fixation of long bones serves to decrease ICPs as is sometimes suggested.

Unlike in the care of adults, routine prophylaxis for thromboembolic disease is not required, as DVT and PE are rarely observed in children under the age of sixteen. As well, multi-system organ failure is far less likely given the resilience of pediatric organ systems, and therefore does not impose a mandate for rigid internal fixation in the severely traumatized youngster.