CHILDHOOD TRAUMA: Now and in the New Millennium

Injury is the leading cause of death among children more than 1 year of age—in fact, it exceeds all other causes of death, combined, for children. 4,11,12 In the past 25 years, prevention initiatives and systems of trauma care have reduced the morbidity and mortality rates of injured children, 77,84,139,163 but injury remains the leading health problem for children. 23 Currently, mortality rates and care of minor injury in regional pediatric trauma centers are no different than those of adult centers with pediatric commitment, 10 but the overall survival rate for children with certain severe critical illnesses or injuries is better in regional pediatric centers. 7,43,89,118,129,130,189 These more severe injuries include isolated head injury, multisystem injury, and isolated blunt abdominal injury. The establishment of statewide trauma systems for children has also reduced the risk for death from severe injury. 84 Children's hospitals provide not only tertiary medical and nursing care but also support services distinct from adult hospitals. Despite the special needs of injured children, the large number of injuries precludes care solely by children's hospitals and adult centers with pediatric commitment. 10,77,155 Thus, how physicians treat injured children may be the primary theme to lead us into the new millennium. 55,155 The concept of "trauma as a national disease" 2,92 led to the founding of emergency medical services. 111 The establishment of pediatric trauma centers, in 1973, 41,76 called attention to the special needs of injured children, and standards of their care were finally implemented in 1982. 9 Most importantly, a landmark conference for childhood trauma, emergency medical services for children, 73 focused for the first time on the overlooked emergency health needs of injured children. An integrated systems approach to the management of life-threatening childhood illnesses and injury was developed as a result of emergency medical services for children. This led to nationwide awareness of the unique health needs of children and physicians' responsibility for prevention and injury control. 133,155 Subsequently, the National Pediatric Trauma Registry (NPTR), sponsored by the National Institute of Disability and Rehabilitation Research and by the American Pediatric Surgical Association, was created in 1984 to serve as a multi-institutional database for injuries in children aged 0 to 19 years. 178 To date, 85,000 childhood injuries ranging from life-threatening to minor trauma have been entered into the registry (personal communication, DiScala, 1999). It provides physicians with information regarding epidemiology, demographics, mechanisms, and patterns of common childhood injuries that have facilitated standards of management, prevention strategies, and injury-control interventions. Federal, state, and community interest in childhood trauma is, as yet, sporadic and thus not adequate for the magnitude of the problem. Gaps in effective care still exist in the current algorithm for the optimal care of injured children. This article reviews epidemiology, injuries unique to children, components of acute care, and prevention.