One-year experience in a regional pediatric trauma center

Abstracts

head injury in children, the authors reviewed the medical records of 84 infants under 1 year of age with head injuries severe enough to require admission. Excluding uncomplicated skull fracture, 64% of the injuries and 95% of the severe intracranial injuries were found to be the result of child abuse. The authors conclude that their results concur with previous studies that indicated that accidental trauma rarely, if ever, causes intracranial injury in infants. The occurrence of such injury in the absence of a history of significant accidental trauma, such as a motor vehicle accident, constitutes grounds for an investi[David Johnston, MD] gation of child abuse. Editor's Note: It is vital to become familiar with the motor capabilities of infants, since this is often the best clue that NAT has occurred (e.g., a 4-week-old infant who “has rolled off the couch.”

[? ONE-YEAR EXPERIENCE IN A REGIONAL PEDIATRIC TRAUMA CENTER. Colombani PM, Buck JR, Dudgeon DL, et al. JPediutr Surg 1985; 20:8-13. The authors describe their 1982 experience in the Regional Pediatric Trauma Center at the Johns Hopkins Hospital. Of the 267 patients under aged 15 seen during the year, 55% were the victims of motor vehicle accidents (75% of these were auto versus pedestrian), 27% had sustained falls, and 8% were assault victims. Fifty one percent had injuries involving a single organ system, 29% two systems, and 20% had involvement of three or more organ systems. Overall mortality was 6.7070, correlating closely with the presence of head injury, and not with the number of organ systems injured. Of liver and spleen injuries, 80% were managed nonoperatively. At one year of follow-up, 93% of the survivors had made an uneventful recovery without residual functional impairment. Outcome was similar for the subgroup of head-injured patients. These data support previous findings that head injury is the major determinant of mortality in childhood trauma and that an excellent quality of life may be achieved with aggressive management of [David Johnston, MD] the head-injured child. Editor’s Note: Also of interest is the 80% nonoperative management of liver and spleen injuries. This result is causing many centers (in-

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cluding our own at Denver General Hospital) to become more conservative in operative management of abdominal trauma.

0 BLUNT HEPATIC INJURY AND ELEVATED HEPATIC ENZYMES: A CLINICAL CORRELATION IN CHILDREN. Oldham KT, Guice KS, Kaufman RA, et al. J Pediutr Surg 1984; 19:457-461. A retrospective review of 95 hemodynamically stable children with blunt abdominal trauma revealed a correlation between elevated SCOT and SGPT and significant liver injury. Forty four children had elevations of hepatic enzymes immediately after trauma; 19 (43%) of these children were subsequently found to have significant liver injuries. SCOT and SGPT in the injured group averaged 890 + 142 IU and 536 + 105 IU, respectively; SCOT and SGPT in the noninjured group were 273 + 44 IU and 115 + 19 IU (P< BOO1for both values). No child with a liver injury had normal enzymes. The authors suggest that immediate enzyme determinations may help select injured children for lavage or imaging pro[David Johnston, MD] cedures.

0 CARDIAC DECOMPENSATION FOLLOWING VERAPAMIL THERAPY IN INFANTS WITH SUPRAVENTRICULAR TACHYCARDIA. Epstein ML, Kiel EA, Victoria BE. Pediatrics 1985; 751737-740. The authors report on three infants, aged 2, 3, and 6 weeks, who developed severe cardiac decompensation following verapamil therapy for supraventricular tachycardia (SVT) complicated by severe congestive heart failure (CHF). Each required cardiopulmonary resuscitation; the dysrhythmia was eventually controlled with digoxin and calcium. No evidence of structural heart disease was subsequently discovered, and no infant developed CHF after the initial presentation. The authors recommend avoidance of verapamil in favor of direct current cardioversion or digoxin in the treatment of infants with SVT complicated by CHF. [David Johnston, MD]