0094
Trauma Unit, Child Accident Prevention Foundation
of Southern Africa, Department of Paediatric Surgery, Institute of Child
Health, Red Cross War Memorial Children’s Hospital, University of Cape
Town, South Africa Introduction Despite many
efforts in accident prevention during recent years, trauma remains the
leading cause of death in the paediatric age group. Although the adult
shock syndrome has been described in detail, little is known about
traumatic shock in children. Aim
To
study prognostic indicators in all children presenting to our trauma unit
with clinical signs or symptoms of shock. Materials
and methods A retrospective study was conducted from the 1st of
January 1997 till the 1st of January 2000. (36 month period) The
records of 57 patients were analysed. Information was gathered regarding
age, sex, weight, initial vital signs, pre-hospital management, type of
injury, in-hospital management, urine output, blood investigations and
outcome. Results
The
majority of patients were involved in a motor vehicle accident (65%), other
causes were gunshots (12%), fire burns (9%) and non-fire burns (5%). The
outcome of 45% of all patients was good, while in 32% the shock was fatal.
21% recovered, but was left with permanent neurological dysfunction, while
2% suffered permanent orthopaedic deficits. Mortality was the highest
amongst the very young (47% amongst the children younger than 2 years
versus only 16% amongst the 9-12 years old) and the very small (55% amongst
the children lower than 10 kg versus 29% amongst the children from 21-30
kg). Mortality was 68% from the children presenting with an initial blood
pressure of less than 50 mmHG (mean arterial pressure) versus 14% from the
children with a blood pressure of more than 50 mmHg. Mortality was the
highest in children presenting with fire burns (90%), less in gunshots
(42%) and motor vehicle accidents (24%), while no child presenting with
non-fire burn died. All children with cardiopulmonary resuscitation in
progress or children that received pre-hospital atropine or adrenaline,
died. 66% of all children with an Hemoglobin level of less than 7 (mg/dl)
died versus only 10% of children with a level of more than 10 (mg/dl). From
all children with a base excess of less than 7, 44% died, while 80% died of
all children with a base excess of more than 12. All children (100%) who
received less than 10 ml/kg resuscitation fluid in the first hour died,
while only 13% died if fluid resuscitation was between 10 and 80 ml/kg in
the first hour. Conclusion
Specific
bad prognostic indicators in paediatric traumatic shock are: low age,
weight, pre-hospital adrenaline or atropine, low blood pressure on arrival,
cardiopulmonary resuscitation in progress on arrival and fire burns, as
well as under-resuscitation in the first hour after arriving in the
hospital. Early aggressive fluid resuscitation should take priority in all
children presenting with traumatic shock, especially the very young and
very small.
PROGNOSTIC INDICATORS IN PAEDIATRIC
TRAUMATIC SHOCK
AB van As, TF Lutz, AJ
Millar, H Rode