PATTERN AND SURGICAL MANAGEMENT OF PEDIATRIC TRAUMA CASES IN A RURAL TERTIARY CARE HOSPITAL
Main Article Content
Keywords
Pediatric trauma, injury patterns, rural healthcare, falls, road traffic accidents, surgical management, prevention, follow-up compliance
Abstract
Background: Pediatric trauma remains a significant public health challenge and a leading cause of morbidity and mortality among children, particularly in low-resource settings. Understanding the patterns of injury, clinical presentations, and outcomes is critical for developing effective prevention and management strategies.
Objective: To evaluate the patterns, clinical presentations, management strategies, and outcomes of pediatric trauma cases in a rural tertiary care hospital.
Methods: This cross-sectional study was conducted for about 6 months from June, 2011 to Nov, 2011 in the Department of Paediatric Surgery, Khalifa Gulnawaz Teaching Hospital, Bannu Medical College, Bannu, Pakistan. A total of 300 pediatric trauma cases were analyzed. Data were collected using a structured proforma, including demographic details, injury patterns, clinical presentations, management approaches, and outcomes. Statistical analysis was performed to identify significant associations, with a P-value of less than 0.05 considered statistically significant.
Results: The majority of trauma cases occurred in children aged 6–10 years (40%), with a male predominance (68%). Falls (45%) and road traffic accidents (30%) were the leading mechanisms of injury, with 60% of injuries occurring at home. Most cases (75%) presented with mild injuries based on Glasgow Coma Scale scores, and 55% required surgical intervention. Postoperative complications were minimal (10%), and the recovery rate was high (80%). However, delays in presentation and poor follow-up compliance were identified as key challenges.
Conclusion: Pediatric trauma predominantly affects school-aged boys and is mainly attributable to falls and road traffic accidents. Although the study describes immediate management of acute cases with low complications and mortality rates, the study emphasizes the need to redouble preventive measures, increase parental sensitization, and develop postoperative follow-up programs to achieve optimal outcomes.
References
2. Roudsari BS, Shadman M, Ghodsi M. Childhood trauma fatality and resource allocation in injury control programs in a developing country. BMC Public Health. 2006;6:1-5.
3. Grossman DC. The history of injury control and the epidemiology of child and adolescent injuries. The future of children. 2000:23-52.
4. Bartlett SN. The problem of children's injuries in low-income countries: a review. Health policy and planning. 2002;17(1):1-13.
5. Sethi D. European report on child injury prevention: WHO Regional Office Europe; 2008.
6. Noordin S, Wright JG, Howard AW. Global relevance of literature on trauma. Clinical Orthopaedics and Related Research®. 2008;466(10):2422-7.
7. Haider AH, Efron DT, Haut ER, DiRusso SM, Sullivan T, Cornwell III EE. Black children experience worse clinical and functional outcomes after traumatic brain injury: an analysis of the National Pediatric Trauma Registry. Journal of Trauma and Acute Care Surgery. 2007;62(5):1259-63.
8. Nemeroff CB. Neurobiological consequences of childhood trauma. Journal of Clinical Psychiatry. 2004;65:18-28.
9. Heim C, Newport DJ, Mletzko T, Miller AH, Nemeroff CB. The link between childhood trauma and depression: insights from HPA axis studies in humans. Psychoneuroendocrinology. 2008;33(6):693-710.
10. Keenan HT, Bratton SL. Epidemiology and outcomes of pediatric traumatic brain injury. Developmental neuroscience. 2006;28(4-5):256-63.
11. Brehaut JC, Miller A, Raina P, McGrail KM. Childhood behavior disorders and injuries among children and youth: a population-based study. Pediatrics. 2003;111(2):262-9.
12. Reinberg O, Reinberg A, Mechkouri M. 24‐hour, weekly, and annual patterns in traumatic and non‐traumatic surgical pediatric emergencies. Chronobiology international. 2005;22(2):353-81.
13. Pitone ML, Attia MW. Patterns of injury associated with routine childhood falls. Pediatric emergency care. 2006;22(7):470-4.
14. Sawyer JR, Flynn JM, Dormans JP, Catalano J, Drummond DS. Fracture patterns in children and young adults who fall from significant heights. Journal of Pediatric Orthopaedics. 2000;20(2):197-202.
15. Imahara SD, Hopper RA, Wang J, Rivara FP, Klein MB. Patterns and outcomes of pediatric facial fractures in the United States: a survey of the National Trauma Data Bank. Journal of the American College of Surgeons. 2008;207(5):710-6.
16. Flavin MP, Dostaler SM, Simpson K, Brison RJ, Pickett W. Stages of development and injury patterns in the early years: a population-based analysis. BMC public health. 2006;6:1-10.
17. Cimpello LB, Khine H, Avner JR. Practice patterns of pediatric versus general emergency physicians for pain management of fractures in pediatric patients. Pediatric emergency care. 2004;20(4):228-32.
18. Agran PF, Anderson C, Winn D, Trent R, Walton-Haynes L, Thayer S. Rates of pediatric injuries by 3-month intervals for children 0 to 3 years of age. Pediatrics. 2003;111(6):e683-e92.
19. Rothrock SG, Green SM, Morgan R. Abdominal trauma in infants and children: prompt identification and early management of serious and life-threatening injuries. Part I: injury patterns and initial assessment. Pediatric emergency care. 2000;16(2):106-15.
20. Damore DT, Metzl JD, Ramundo M, Pan S, Van Amerongen R. Patterns in childhood sports injury. Pediatric emergency care. 2003;19(2):65-7.