Injury is the leading cause of death in children and teens in the United States, claiming more lives than congenital abnormalities, cancer, heart disease and infections combined. Most pediatric fatalities are vehicle related — collisions, auto vs. pedestrian mishaps, ATV accidents — but children also drown or, less commonly, die in falls.
Pediatric surgeon D. Dean Potter, Jr., M.D., of Mayo Clinic in Rochester, Minn., says some of these deaths can be prevented if young patients are evaluated and treated at pediatric trauma centers.
"Recent studies show that nearly three-quarters of injured children don't make it to a pediatric trauma center, and up to half of the most severely injured aren't transported to Level I centers, which are capable of providing the highest level of care in the shortest possible time."
Yet regional pediatric trauma centers have precisely the resources necessary to successfully treat life-threatening injuries. "Field triage guidelines recommend that children be triaged preferentially to pediatric-capable trauma centers because we know that outcomes are better there," Dr. Potter says.
He stresses that understanding the fundamental physiologic and anatomical differences between kids and adults is critically important. For example, children have big heads for their frames, so in a fall, they tend to hit headfirst. They have small mouths and funnel-shaped airways. Their bones are softer, and they have different fracture patterns. "The ABCs of trauma care are the same," Dr. Potter notes, "but things just work differently."
In an accident, children are also less likely to break a rib or bruise a lung than adults are but are far more susceptible to concussion and other brain injuries. And even when adults and children have similar injuries — say, a lacerated liver, spleen or pancreas — treatment may differ significantly.
"After the head and extremities, the abdomen is the most injured part of the body in kids and the most common site of unrecognized fatal injury," Dr. Potter points out.
But unlike in adults, severe abdominal trauma may be managed nonoperatively in children.
"Adults often undergo splenectomies, but we rarely remove a child's spleen. Kids tolerate blood loss better than adults do; they perfuse well, are physiologically stronger and less likely to have associated injuries. We have excellent data to support the nonoperative management of solid organ injuries in children and teens. Most injured kids heal quickly, and after a few months of restricted activity can resume a fully normal life."
He emphasizes that such successful outcomes are possible because Level I pediatric trauma centers have the equipment and expertise to assess and manage children with serious injuries.
"Having appropriately sized equipment is important, but even more so is having medical providers who are trained to identify the different injury and physiologic patterns that occur in children and who can respond immediately when problems arise."
At Saint Marys, one of Mayo Clinic's hospitals in Rochester, Minn., doctors treat about 250 severely injured children each year.
"Obviously, kids with minor scrapes and bruises don't need a Level I trauma center," Dr. Potter says. "But for those with life-threatening injuries, the outcomes in a pediatric trauma center are much better. Everything we do is predicated on the understanding that kids are not smaller versions of adults."