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Traumatic injuries and death are considered a major health issue with a quarter of the deaths occurred in children younger than 15years. Majority of the cases happen after school hours. We describe a case of predicted poor outcome with conservative treatment and successful discharge home.
A 7 year old girl was hit by car and thrown forward. She was brought in unconscious with multiple petechial over the head, neck cutaneous emphysema, unequal chest rise and deformed left shoulder. FAST showed free fluid in Morrison Pouch. Child was asystole and CPR was performed for 5mins then revived. Injury Severity Score (ISS) 33; Revised Trauma Score (RTS) 4.3; Paediatric Trauma Score (PTS) 3 CT scan showed left temporal bone, left clavicle, multiple left ribs fracture, bilateral lungs contusions with large hemopneumothorax, extensive neck emphysema and parapharygeal region with minimal pneumomediastinum, free fluid in pelvis. Child was admitted to ICU and treated conservatively, discharged home after 19days without neurological deficits.
Discussion and conclusion
Children whose PTS is between 0 and 8 had an increasing mortality related to their decreasing PTS, and those below 0 has 100% mortality. Hence there is a direct linear relationship between PTS and injury severity. For children with low PTS and high ISS, if treated conservatively may reduce the risks of blood transfusion and decrease the length of hospital stay compared with a surgical approach. In addition, a careful and close follow-up is essential in these injured patients with good collaboration with other teams.
The goals of managing severe paediatric trauma are the same as adult. The scoring systems enable us to identify and predict the severity and outcome. The core success within a trauma team is rapidly identifying the severity, resuscitation within the golden hour and good co-management with the other teams.
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