A Critical Review of Urban Pediatric Trauma

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Abstract
Accidents are the leading single cause of childhood mortality in the USA. While prevention plays a major role in reducing morbidity and mortality, improvement in all aspects of management is a crucial goal. This study was designed to critically evaluate the prevalence and significant features of childhood injuries as experienced at Cook County Children''s Hospital [Chicago, Illinois], including the transport system utilized. During a 2-yr period (April 1, 1979 to March 31, 1981) 719 pediatric patients with trauma were admitted. Forty-six percent had lacerations fractures, or wringer injuries serious enough to warrant hospitalization; 35% had isolated head injuries; 10% had multiple injuries. Gunshot wounds, straddle injuries and stab wounds formed the bulk of the rest. Patients (41) were directly admitted to the intensive care unit with serious injuries, half of whom were transferred after initial care (or no care) from an outlying hospital with an average transport time of 4 h. Four of the transferred patients died within 24 h and 3 had serious sequelae. A review of their injuries showed that early, aggressive and coordinated management would have significantly reduced the morbidity and mortality. There were no deaths and only 1 serious sequela in the patients brought directly to the institution. A detailed presentation of the direct correlation between improved survival and early initiation of specialized care to these traumatized children is discussed.

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