Epidemiologie, Risikostratifizierung und Behandlungsergebnisse nach schwerem kindlichen Trauma

Kipfmueller, Florian; Wyen, H.; Borgman, Matthew A.; Spinella, Philip C.; Wirth, Stephan; Maegele, Marc

doi:10.1055/s-0032-1329945

Cited by 8 publications

(7 citation statements)

References 13 publications

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“…In contrast to adults, massive bleeding is less common after pediatric trauma. TBI appears to be the common trigger of TIC and mortality in children [16, 17]. The complex pathophysiological mechanisms of the coagulation abnormalities associated with TBI are not yet fully understood, but might differ from coagulation disturbances associated with massive systemic bleeding.…”

Section: Introductionmentioning

confidence: 99%

Coagulopathy After Severe Pediatric Trauma

Christiaans¹,

Duhachek-Stapelman

Russell

et al. 2014

Shock

109

106

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Trauma remains the leading cause of morbidity and mortality in the United States among children from the age 1 year to 21 years old. The most common cause of lethality in pediatric trauma is traumatic brain injury (TBI). Early coagulopathy has been commonly observed after severe trauma and is usually associated with severe hemorrhage and/or traumatic brain injury. In contrast to adult patients, massive bleeding is less common after pediatric trauma. The classical drivers of trauma-induced coagulopathy (TIC) include hypothermia, acidosis, hemodilution and consumption of coagulation factors secondary to local activation of the coagulation system following severe traumatic injury. Furthermore, there is also recent evidence for a distinct mechanism of TIC that involves the activation of the anticoagulant protein C pathway. Whether this new mechanism of posttraumatic coagulopathy plays a role in children is still unknown. The goal of this review is to summarize the current knowledge on the incidence and potential mechanisms of coagulopathy after pediatric trauma and the role of rapid diagnostic tests for early identification of coagulopathy. Finally, we discuss different options for treating coagulopathy after severe pediatric trauma.

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Section: Introductionmentioning

confidence: 99%

Coagulopathy After Severe Pediatric Trauma

Christiaans¹,

Duhachek-Stapelman

Russell

et al. 2014

Shock

109

106

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“…Even at low speeds, there is a high risk of head injuries, linked to the absence of age-appropriate child restraint systems and the child's positioning in the center seat [21,22]. Furthermore, severe head injuries appear to be the key determinant of mortality in pediatric trauma [23][24][25][26]. This held true both for injuries to a single organ system and injuries involving multiple organ systems [26].…”

Section: Discussionmentioning

confidence: 99%

Injury Pattern and Current Early Clinical Care of Pediatric Polytrauma Comparing Different Age Groups in a Level I Trauma Center

Schuster,

Klute,

Kerschbaum

et al. 2024

JCM

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Introduction: Pediatric polytrauma is a complex condition with unique characteristics and requirements for early clinical care. This study aimed to analyze the injury patterns, early clinical care, and outcomes of pediatric polytrauma patients in a Level I trauma center. The focus was on evaluation between different age groups and the recognition of injuries as potential factors influencing outcomes. Methods: A prospective cohort study model of pediatric polytrauma patients (ISS ≥ 16) was conducted over a 13-year period, stratified by age groups (Group A: 0–5 years; Group B: 6–10 years; Group C: 11–15 years; and Group D: 16–18 years). A comparison of the groups was conducted to examine variations in early clinical care, trauma mechanisms, distribution of affected body regions (as per AIS and ISS criteria), and trauma-related mortality. Additionally, factors contributing to mortality were evaluated. Results: The median age of patients was 16 years, with a male predominance (64.7%). The Injury Severity Score (ISS) varied across age groups, with no significant difference. The 30-day mortality rate was 19.0%, with no significant age-related differences. Trauma mechanisms varied across age groups, with motor vehicle accidents being the most common mechanism in all age groups except 0–5 years, where falls were prevalent. Analysis of injury patterns by AIS body regions indicated that head trauma was a significant predictor of mortality (Hazard Ratio 2.894, p < 0.001), while chest, abdominal, and extremity trauma showed no significant association with mortality. Multiple regression analysis identified the ISS and preclinical GCS as valid predictors of mortality (p < 0.001 and p = 0.006, respectively). Conclusions: While age-related differences in injury severity and clinical interventions were limited, head trauma emerged as a critical predictor of mortality. Early recognition and management of head injuries are crucial in improving outcomes. Additionally, the ISS and preclinical GCS were identified as valid predictors of mortality, emphasizing the importance of early assessment and resuscitation. A tailored approach to pediatric polytrauma care, considering both age and injury patterns, might contribute to survival benefits in this vulnerable population.

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“…Dabei müssen die anatomischen, physiologischen und bewegungsphysiologischen Besonderheiten der jeweiligen Altersgruppe mitberücksichtigt werden. Erkenntnisse und Wissen, die in der Versorgung schwerverletzter Erwachsener zur Anwendung kommen, können daher nicht unkritisch auf Kinder übertragen werden [40].…”

Section: Polytraumaunclassified

Versorgung von Notfällen in der Kinder- und Jugendtraumatologie

Wintges¹,

Reinshagen²,

Frosch³

et al. 2021

OP-JOURNAL

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ZusammenfassungMit zunehmendem Alter und Bewegungsradius kommt es bei der Entdeckung der Umwelt zu alterstypischen Unfällen und Verletzungen im Kindes- und Jugendalter. Diese führen häufig zur Vorstellung in einer pädiatrischen Notaufnahme. Neben Unfällen im Haushalt kommt es dabei am häufigsten beim Spielen auf Spielplätzen, der Sportausübung sowie im Straßenverkehr zu Verletzungen. Durch ihre anatomischen und physiologischen Unterschiede zum Erwachsenen sind Verletzungen im Kindesalter nicht immer mit denen Erwachsener zu vergleichen und benötigen daher kindgerechte Behandlungskonzepte. So muss zum Beispiel bei der Versorgung von Frakturen immer das noch ausstehende Korrekturpotenzial aufgrund der noch offenen Wachstumsfugen berücksichtigt, jedoch auch immer die Gefahr einer drohenden Wachstumsstörung bedacht werden. Neben Frakturen kommt es bei Kindern häufig zu Weichteilverletzungen vor allem am Kopf oder den Händen. Dabei reichen die Verletzungen von einfachen Rissquetsch- oder Schnittwunden bis hin zu Teilamputationen oder (Tier-)Bisswunden sowie thermischen Verletzungen. Luxationen der großen Gelenke stellen im Kindesalter eine Rarität dar, können aber falsch behandelt zu persistierenden Bewegungseinschränkungen oder chronischer Instabilität führen. Das Polytrauma im Kindesalter sollte aufgrund der Seltenheit und einer dadurch an kleineren Häusern oft fehlenden routinierten Behandlung wenn möglich in spezialisierten kindertraumtologischen Zentren erfolgen. Bei inadäquatem Unfallmechanismus, widersprüchlicher Anamnese oder auffälligen Verletzungen muss im Kindesalter auch immer an eine Kindesmisshandlung gedacht werden.

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Epidemiologie, Risikostratifizierung und Behandlungsergebnisse nach schwerem kindlichen Trauma

Cited by 8 publications

References 13 publications

Coagulopathy After Severe Pediatric Trauma

Coagulopathy After Severe Pediatric Trauma

Injury Pattern and Current Early Clinical Care of Pediatric Polytrauma Comparing Different Age Groups in a Level I Trauma Center

Versorgung von Notfällen in der Kinder- und Jugendtraumatologie

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