Overall Approach to Trauma in the Emergency Department

Daniel M. Fein; Michele J. Fagan

doi:10.1542/pir.2017-0246

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Daniel M. Fein, MD*
Michele J. Fagan, MD^†

^*Division of Pediatric Emergency Medicine, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
^†Division of Pediatric Emergency Medicine, Maimonides Infants and Children’s Hospital, Brooklyn, NY

AUTHOR DISCLOSURE
Drs Fein and Fagan have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

ABCs:: Airway, Breathing, and Circulation
ATLS®:: Advanced Trauma Life Support®
BSA:: body surface area
CSF:: cerebrospinal fluid
EMS:: emergency medical services
FAST:: Focused Assessment with Sonography for Trauma
GCS:: Glasgow Coma Scale
MVA:: motor vehicle accident
TBI:: traumatic brain injury

Practice Gap

Assessing a child who has sustained a multisystem trauma requires a structured assessment of the airway, breathing, and circulation to promptly identify life-threatening injuries and allow for timely lifesaving interventions. This is followed by a more detailed evaluation of the entire body to evaluate for all injuries.

Objectives

After completing this article, readers should be able to:

Identify the steps of the primary and secondary surveys used during evaluation of a child who has sustained trauma.
Describe the potential life-threatening injuries that may occur after trauma and their treatment.
Understand the evaluation and management of a child who has sustained a significant burn.

Introduction

The importance of trauma in children is readily apparent in that injury is the leading cause of death and disability in children from infancy to young adulthood in the United States. Each year, more than 9,000 children die of serious injury, and approximately 8.7 million children require emergency department care for treatment of their injuries. (1) This surpasses all major diseases in children and young adults. Specifically, motor vehicle accidents (MVAs) are 1 of the top 2 causes of death in children of all age groups. Childhood injuries result in costs exceeding $87 billion annually (1) when accounting for direct medical costs as well as costs to the economy, cost of rehabilitation, and costs to the families of children who survive childhood injury but have resultant lifelong disabilities.

Childhood injury is a public health problem that has multiple facets, ranging from injury prevention to rehabilitation and reintegration into society. The American College of Surgeons created the Advanced Trauma Life Support® (ATLS®) course to help train physicians to face …