Pediatric Trauma

By: Cory Saucier

Objectives

➔By the end of this presentation you should understand:a. The difference between the four subpopulations of Pediatrics

b. Why children under 18 years of age are more susceptible to injury

c. The pediatric injury statistics for the United States

d. Current interventions to reduce child injury

Disclaimer!

★ I’m NOT a specialist or doctor of any kind!

★ I AM a Master of Public Health (MPH) student.

Who am I?

➔My name is Cory and I’m greatly interested in

➔My name is Cory, and I’m interested in Emergency Medicine.

➔During my time at Brown University I’ve had the opportunity to study injury as a public health problem.

Why do I feel pediatric trauma is a major problem?

➔Unintentional injury is the leading cause of death of all people ages 1-44 in the United

States!

➔Of course Pediatrics covers just a fraction of all individuals ages 1-44…

➔So what’s the difference!?

Pediatrics

According to the Merriam-Webster dictionary:

➔Pediatrics is defined as “a branch of medicine dealing with the development, care, and diseases of children.”

Subpopulations of Pediatrics

➔Pediatrics is divided up into four categories of patients.

Newborn

➔“Newborn” represent everyone from birth until one month of age.

Infant

➔Infants are one month to two years of age.

Child

➔Children age from two years to 12 years old.

Adolescent

➔After 12 years until 18 years of age individuals are considered as adolescents.

How are they different than adults?

➔Children are NOT just little people!

➔These groups have special needs and are much more susceptible to injury than adults!

1) Smaller Body Mass

➔Since children have a smaller body mass they are more likely to be injured than adults when hit with the same force.

2) Less Blood

➔Children have less blood than adults.

➔What may seem like a minor cut to an adult may be causing more harm to a child.

3) Pliable Bones

➔Children’s bones are more pliable than adults’.

➔A child could have internal organ damage without signs of broken bones.

4) Drug Doses

➔Children and adults need different doses of drugs.

➔Calculating appropriate doses for children quickly and under pressure can be challenging.

5) Hypothermia

➔Children have a larger surface area to body volume ratio.

➔This puts them at higher risk for developing hypothermia.

6) Child Abuse

➔Arguably most sad of all are injuries resulting from child abuse.

What is Trauma?

According to the Merriam-Webster dictionary:

➔Trauma is defined as

◆ “an injury (as a wound) to living tissue caused by an extrinsic agent.”

◆ “a disordered psychic or behavioral state resulting from mental or emotional stress or physical injury.”

Types of Trauma

➔Given that definition of trauma, it is necessary to consider both physical and psychological trauma.

➔Both can have a serious impact on a child’s development.

Physical Trauma

➔ Physical trauma can be both blunt force to the child or a penetrating wound.

◆ Blunt force trauma trauma occurs when the child is struck with force causing a concussion and/or fractures

◆ Penetrating trauma results in an open wound after an object pierces the child’s body

Psychological Trauma

➔ Negative childhood experiences can have immeasurable effects and could lead to problems later in life.

➔ The focus of this presentation is on the result of physical injuries

◆ I do suggest learning more about potential causes of psychological trauma

Just how prevalent is

pediatric trauma?

Vital Signs

➔According to the Centers for Disease Control and Prevention (CDC):

◆One child dies every hour as a result of an injury

Vital Signs

➔Nearly one in five child deaths is a result from an injury

➔Every four seconds a child gets treated at an emergency department for an injury

The Injury Pyramid

-For every one death there are

-25 hospitalizations,

-925 children treated in the ER,

-Many more treated at DRs offices,

- And even more untreated!

Causes of Death by Age➔ So by now you’re probably

wondering, “What could possibly be the cause of these statistics?”

➔ To the right is a section of a document produced by the CDC demonstrating the leading causes of death

Types of Injury

➔As previously mentioned, unintentional injury is the leading cause of death for all people ages 1-44 years old.

➔Homicide and Suicide also play a significant role in deaths among the pediatric populations.

Leading Causes of Injury Deaths

➔ The image to the right is a section of the CDC’s “Leading Causes of Injury Deaths by Age” document

➔ Unfortunately, these graphs fail to separate ages 15-18 and 18-24 years as defined by the subcategories in Pediatrics

Motor Vehicle Crashes

➔As is demonstrated in the figure on the previous slide, unintentional motor vehicle crashes play a significant role in pediatric trauma

➔What is being done to protect children?

Lifespan: Rhode Island

➔One leap forward in injury prevention is the Injury Prevention Center (IPC) at Hasbro Children’s Hospital

➔The “Inpatient Car Seat Program” was established to ensure the safety of children under 13 years of age when leaving the hospital.

Inpatient Car Seat Program

➔ The goal of this program as stated on lifespan.org is, “to identify the most urgent cases, when a child needs a car or booster seat and there isn’t one in the vehicle they’ll be taken home in. The IPC’s team will then work to make sure the child has an appropriate car seat or booster before discharge.”

➔ This program is important as the risk of fatal injuries can be reduced by over 70% when passenger restraints are used correctly

Inpatient Car Seat Program

➔ Here are some guidelines as provided by the program coordinator, Dina Morrissey, MD:

• Keep children in a rear facing car seat as long as possible, at least until they are two years old.

• A child needs to be at least 4’9” to safely ride with just a seat belt.

• A child should be a minimum of four years old and 40 pounds before transitioning to a booster seat.

• Children should sit in the back seat if they are under the age of 13.

• Always refer to your specific car seat manufacturer’s instructions.

• Read the vehicle owner’s manual on how to install the car seat using the seat belt or LATCH system.

• Check height and weight limits on your car or booster seat.

•

Safely Securing Your Child

➔ Properly securing children is just one of many injury prevention techniques that can help save lives. Do your research to make sure your children are protected!

➔ To learn more about Hasbro Children’s Hospital visit:http://www.hasbrochildrenshospital.org/

➔ To learn more about Lifespan visit: http://www.lifespan.org/

Strategies for Improving Care

➔If you are a healthcare professional, there are specialized courses that cover

pediatric care such as PEARS and PALS.

Pediatric Emergency Assessment Recognition and Stabilization (PEARS)

➔ PEARS is a course designed to enhance pediatric care for providers who don’t regularly provide care for pediatric patients with injuries and illnesses.

➔Visit the American Heart Association for more details:◆ http://www.heart.org/HEARTORG/CPRAndECC/HealthcareProviders/Pediatrics/Pediatric-

Emergency-Assessment-Recognition-and-StabilizationPEARS_UCM_308135_Article.jsp

Pediatric Advanced Life Support (PALS)

➔PALS is a course designed for providers who respond to emergency situations involving infants and children.

➔Visit the American Heart Association for more details:◆ http://www.heart.org/HEARTORG/CPRAndECC/HealthcareProviders/Pediatrics/Pedi

atric-Advanced-Life-Support-PALS_UCM_303705_Article.jsp

Pediatric Assessment Triangle (PAT)➔ PAT is an effective tool, taught as a part of PALS,

that can be used to assess a child’s appearance, circulation, and work of breathing.

➔ To learn more about PAT visit: http://emedicine.medscape.com/article/1948389-technique

Summary

➔As the objectives stated you should now understand: a. The difference between the four subpopulations of Pediatrics

b. Why children under 18 years of age are more susceptible to injury

c. The pediatric injury statistics for the United States

d. Current interventions to reduce child injury

Resources

➔Firstly, I feel it is important to know where the nearest trauma center is relative to your location.

◆Get educated by visiting: http://www.traumamaps.org

Centers for Disease Control and Prevention (CDC)

➔The CDC offers:◆ The most up-to-date statistics regarding injuries

◆ Active campaigns and programs for injury prevention

◆ Information about current research within the field of injury prevention

◆ The opportunity to receive email updates about injury prevention directly from the CDC

➔ Visit http://www.cdc.gov/injury/ for more information!

Kollek and Karwowska (2009)

➔Below is a source of information explaining the unique medical attributes of children

➔The article: Kollek D, Kawowska A. Populations at risk-paediatrics. Radiat Prot Dosimetry. 2009;134(3-4)191-192. DOI:10.1093/rpd/ncp069.

Trauma Information

➔To learn more about various types of trauma visit the National Institute of General Medical Sciences site:◆ http://www.nigms.nih.gov/Education/pages/Factsh

eet_Trauma.aspx

THANK YOU!

I’d just like to say thank you to everyone who donated pictures

for this presentation.

Questions?

➔For any and all questions, comments, concerns or suggestions:

◆ Please contact me at cory_saucier@brown.edu

➔I will do my best to get back to you as soon as I can.