Advances in the management of pediatric trauma

BACKGROUND: Numerous important advances have been made in the management of trauma in childhood in prevention, prehospitalization and intrahospital care, postoperative management, and rehabilitation. As with adult trauma care, the development of trauma systems has impacted greatly on morbidity and mortality in injured children. DATA SOURCES: Recent literature was searched for information regarding selected aspects of pediatric trauma care where significant improvements in outcome have occurred. The specific areas selected because of their contribution to improved outcomes include changes in the organization of cave including the establishment of trauma centers and trauma systems, understanding trauma physiology as a basis for care, selective management of blunt trauma, management of burn injury, and prevention. CONCLUSION: Because of the various advances in the understanding of the effects of injury that have been translated to improved approaches to treatment, overall treatment mortality in childhood has dropped 45% over the last 20 years and mortality with burn injury has been reduced by half in patients with over 60% of body surface burn and almost eliminated below that level unless there are additional circumstances. Nonetheless, trauma is still the leading cause of death in childhood, so continuing commitment by pediatric surgeons to advancing trauma care for children is in order as well as providing education for adult surgeons willing to commit themselves to cave of the injured child. Am J Surg. 2000; 150:365-565. (C) 2000 by Excerpta Medica, Inc.