Pediyatrik Travma Hastasına Yaklaşım: Güncellenmiş Gözden Geçirme

Abstract

Travma, 1 yaş üstü çocuklarda başta gelen ölüm nedenidir. Pediyatrik hastaların anatomik ve fizyolojik farklılıkları ve bu hastalara yaklaşım konusunda standart sağlanamamış olması klinisyenlerin karşılaştıkları zorluklardır. Organize olmayan yaklaşımlar bu hasta grubunda mortalitenin artmasına neden olmaktadır. Pediyatrik travma konusunda özelleşmiş merkezlerin kurulması en iyi yöntemdir. Bu mümkün olamıyorsa acil servis çalışanlarının eğitim ve tecrübe seviyesi arttırılmalı ve diğer bölümlerle iş birliği içinde belli standartların saptanması gerekmektedir. Travmalı hastalar için belli algoritmaların belirlenmesi ve uygulanması hastalar için hayati önem taşıdığı kadar, acil serviste çalışanlar açısından iş yükünün azaltılmasında ve zaman kazanmada fayda sağlayacaktır. Biz bu çalışmamızda, güncel literatür ışığında pediyatrik travmaya yaklaşımın sistematik hale getirilmesine katkı sağlamayı amaçladık.

Keywords

• Pediyatrik travma
• Travma yönetimi
• Kafa travması
• Göğüs travması
• Batın travması
• Sistematik yaklaşım

References

1. American College of Surgeons Committee on Trauma (ACS COT): Transfer to definitive Care in ACS COT: Advanced Trauma Life Support for Doctors (ed 6), Chicago, IL, American College of Surgeons, 1997, pp 327–335.
2. Amick, L.F., 2001. Penetrating trauma in pediatric patient. Clinical Pediatric Emergency Medicine. 2, 63–70.
3. Banerjee, S., Barry, M.J., Paterson, J.M.H., 2009. Pediatric pelvic fraktures: 10 years experience in trauma centre. Injury. 40, 410–413.
4. Barsness, K.A., Bensard, D.D., Ciesla, D., Patrick, D., Hendrickson, R., Karrer, F.M., 2004. Blunt diaphragmatic rupture in children. J. Trauma-Inj. Infect Crit. Care. 56, 80–82.
5. Blackwell, C.D., Gorelick, M., Holmes, J.F., Bandyopadhyay, S., Kuppermann, N., 2007. Pediatric head trauma: changes in use of computed tomography in emergency departments in the United States over time. Ann Emerg. Med. 49, 320–324.
6. Bond, S.J., Eichelberger, M.R., Gotschall, C.S., Sivit, C.J., Randolph, J.G., 1996. Nonoperative management of blunt hepatic and splenic injury in children. Ann. Surg. 223, 286–289.
7. Caffey, J., 1946. Multiple fractures in the long bones of infants suffering from subdural hematoma. Am J. Roentgenol. 56, 163–173.
8. Chu, F.Y., Lin, H.J., Guo, H.R., Liu, T.H., Foo, N.P., Chen, K.T., 2009. A reliable screening test to predict liver injury in pediatric blunt torso trauma. Eur. J. Trauma Emerg. Surg. 36, 44–48.

9. Collins, J.N., Cole, F.J., Weireter, L.J., Riblet, J.L., Britt, L.D., Flynn, T.C., 2001. The usefulness of serum troponin levels in evaluating cardiac injury. Am. Surg. 67, 821–825.
10. Copes, W.S., Champion, H.R., Sacco, W.J., Lawnick, M.M., Keast, S.L., Bain, L.W., 1988. The Injury Severity Score Revisited. J. Trauma. 28, 69–77.
11. Cornwell, E.E. 2000. Initial Approach To Trauma. In: Tintinalli JE, Kelen GD, Stapczynski JS (eds).Emergency Medicine: A Comprehensive Study Guide 5th ed. New York: McGraw Hill; p.1609–1614.
12. Costello, B.J., Papadopoulos, H., Ruiz, R., 2005. Pediatric Craniomaxillofacial Trauma. Clin. Pediatr. Emerg. Med. 6, 32–40.
13. DeRoss, A.L., Vane, D.W., 2004. Early evaluation and resuscitation of the pediatric trauma patients. Semin Pediatr. Surg.13, 74–79.
14. Ford, E.G., Senac, M.O., 1993. Clinical presentation and radiographic identification of small bowel rupture following blunt trauma in children. Pediatr. Emerg. Care. 9, 139–142.
15. Gentry, L.R., 1994. Imaging of closed head injury. Radiology. 191, 1–17.
16. Greaves, I., Porter, K.M., Revell, M.P., 2002. Fluid resuscitation in the pre-hospital trauma care: a consensus view. J. R. Coll. Surg. Edin. 47, 451–457.
17. Hauda, W.E., 2000. Pediatric Trauma. In: Tintinalli JE, Kelen GD, Stapczynski JS (eds).Emergency Medicine: A Comprehensive Study Guide 5th ed. New York: McGraw Hill; p.1615–1623.
18. Hymel, K.P., Abshire, T.C., Luckey, D.W., Jenny, C., 1997. Coagulopathy in pediatric abusive head trauma. Pediatrics. 99, 371–375.
19. İpekci, F., 2005. İlk ve Acil Yardım. In: Ertekin C, Taviloğlu K, Güloğlu R, Kurtoğlu M (editörler). Travma 1. baskı. İstanbul: İstanbul Tıp Kitabevi 123–133.
20. Isaacman, D.J., Scarfone, R.J., Kost, S.I., Gochman, R.F., Davis, H.W., Bernardo, L.M., Nakayama, D.K., 1993. Utility of routine laboratory testing for detecting intra-abdominal injury in the pediatric trauma patient. Pediatrics. 92, 691–694.
21. Jimenez, R.R., 2010. Radiographic Evaluation of The Pediatric Trauma Patient and Ionizing Radiation Exposure. Clin. Pediatr. Emerg. Med. 11, 22–27.
22. Junkins, E.P., O’Connell, K.J., Mann, N.C., 2006. Pediatric Trauma Systems in The United States: Do They Make a Difference? Clin. Pediatr. Emerg. Med. 7, 76–81.
23. Kelly, C.A., Upex, A., Bateman, D.N., 2004. Comparison of consciousness level assessment in the poisoned patient using the alert/verbal/painful/unresponsive scale and the Glasgow Coma Scale. Ann Emerg. Med. 44, 108–113.
24. Khine, H.H., Corddry, D.H., Kettrick, R.G., Martin, T.M., McCloskey, J.J., Rose, J.B., Theroux, M.C., Zagnoev, M., 1997. Comparison of cuffed and uncuffed endotracheal tubes in young children during general anesthesia. Anesthesiology. 86, 627–631.
25. Kincaid, E.H., Chang, M.C., Leton, R.W., Chen, J.G., Meredith, J.W., 2001.Admission base deficit in pediatric trauma: A study using the national trauma data bank. J. Trauma. 51, 332–335.
26. King, B.R., Baker, M.D., Braitman, L.E., Seidl-Friedman, J., Schreiner, M.S., 1993. Endotracheal tube selection in children: A comparison of four methods. Ann Emerg. Med. 22, 530–534.
27. Leonard, M., Sproule, J., McCormack, D., 2007. Pediatricspinal trauma and associated injuries. Injury. 38, 188–193.
28. Levin, H.S., Culhane, K.A., Mendelsohn, D., Lilly, M.A., Bruce, D., Fletcher, J.M., Chapman, S.B., Harward, H., Eisenberg, H.M., 1993. Cognition in relation to magnetic resonance imaging in head-injured children and adolescents. Arch Neurol. 50, 897–905.
29. Linzer, J.F., 2010. Do Routine Laboratory Tests Add to the Care of the Pediatric Trauma Patients? Clin. Pediatr. Emerg. Med. 11, 18–21.
30. Moss, R.L., Musemeche, C.A., 1996. Clinical judgement is superior to diagnostic tests in the management of pediatric small bowel injury. J. Pediatr. Surg. 31, 1178–1182.
31. Namias, N., McKenney, M.G., Martin, L.C., 1996. Utility of admission chemistry and coagulation profiles in trauma patients: a reappraisal of traditional practice. J. Trauma. 41, 21–25.
32. Newman, K.D., Bowman, L.M., Eichelberger, M.R., Gotschall, C.S., Taylor, G.A., Johnson, D.L., Thomas, M., 1990. The lap belt complex: intestinal and lumbar spine injuries and seatbelt use. J. Trauma. 30, 1133–1138.
33. Osler, T.M., Vane, D.W., Tepas, J.J., Rogers, F.B., Shackford, S.R., Badger, G.J., 2001. Do pediatric trauma centers have better survival rates than adult trauma centers? An examination of the national pediatric trauma registry. J. Trauma. 50, 96–101.
34. Patel, J.C., Tepas, J.J., Mollitt, D.L., Pieper, P., 2001. Pediatric cervical spine injuries: Defining the disease. J. Pediatr. Surg. 36, 373–376.
35. Patrick, D.A., Bensard, D.D., Moore, E.E., Karrer, F.M., 1999. Nonoperative management of solid organ injuries in children results in decreased blood utilization. J. Pediatr. Surg. 34, 1695–1699.
36. Phipps, L.M., Thomas, N.J., Gilmore, R.K., Raymond, J.A., Bittner, T.R., Orr, R.A., Robertson, C.L., 2005. Prospective assessment of guidelines for determining appropriate depth of endotracheal tube placement in children. Pediatr. Crit. Care Med. 6, 519–522.
37. Potoka, D.A., Saladino, R.A., 2005. Blunt Abdominal Trauma in the Pediatric Patient. Clin. Pediatr. Emerg. Med. 6, 23–31.
38. Ruddy, R.M., 2005. Trauma and pediatric lung. Paediatric Respiratory Reviews. 6, 61–67.
39. Ruppert, M., Van Hee, R., 2001. Creatinine-kinase-MB determination in noncardiac trauma: its difference with cardiac infarction and its restricted use in trauma situations. Eur. J. Emerg. Med. 8, 177–179.
40. Scaife, E.R., Fenton, S.J., Hansen, K.W., Metzger, R.R., 2009. Use of focused abdominal sonography for trauma at pediatric and adult trauma centers: a survey. J. Pediatr. Surg. 44, 1746–1749.
41. Simon, H.K., Muehlberg, A., Linakis, J.G., 1994. Serum amylase determinations in pediatric patients presenting to the ED with acute abdominal pain or trauma. Am J. Emerg. Med. 12, 292–295.
42. Sözübir, S., Tander, B., Bernay, F., Arıtürk, E., Rızalar, R., Gürses, N., 2005. Traumatic diaphragmatic rupture in children. Ulus Travma Acil Cerrahi Derg. 11, 64–68.
43. Stylianos, S., Ford, H.R., 2008. Outcomes in pediatric trauma care. Seminars in Pediatr. Surg. 17, 110–115.
44. Testerman, G.M., 2006. Surgeon-performed ultrasound in the diagnosis and management of pericardial tamponade in a 20-month-old blunt injured toddler. Tenn Med. 99, 37–38.
45. Wilson, R.H., Moorehead, R.J., 1992. Management of splenic trauma. Injury. 23, 5–9.
46. Woodcock, R.J., Davis, P.C., Hopkins, K.L., 2001. Imaging of head trauma in infancy and childhood. Semin Ultrasound, CT, and MRI,. 22, 162–182.
47. Woosley, C.R., Mayes, T.C., 2008. The pediatric patient and thoracic trauma. Semin Thorac Cardiovasc Surg. 20, 58– 63.
48. Vella, A.E., Wang, V.J., McElderry, C., 2006. Predictors of fluid resuscitation in pediatric trauma patients. J. Emerg. Med. 31, 151–155.