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Trauma is the leading cause of death and disability in children >1 year of age.1 Because children have different anatomy and physiology compared with adults, the management of injuries in children differs in some respects. Many injuries can be managed initially in a general hospital ED, but care of the most seriously injured children requires prompt triage and transportation to a designated pediatric trauma center.

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In 2005, unintentional injuries accounted for 36% of all deaths in children 1 to 14 years of age and led all other causes of death.1 This percentage was a decline from 45% of all deaths in 1980. For children <1 year of age, unintentional injury accounts for 3.8% of fatalities.2 Traumatic brain injury from unintentional trauma remains the primary cause of death among children.3 Motor vehicle crashes are the leading cause of death among children >1 year of age, accounting for 18% of all deaths and 44% of all deaths due to trauma.2 Motor vehicle crashes are also the most frequent cause of nonfatal injury, followed by pedestrian injuries. Motor vehicle fatalities among children <16 years of age have fallen an average of 5% per year for boys and 3.5% per year for girls.4 Alcohol use by a driver is a factor in about 2% of crashes leading to a fatal injury to a child.5 Falls account for only 1.6% of deaths, but are the most frequent cause of nonfatal injuries in children <10 years of age.2 Falls are also the most common cause of injury in infants presenting to the ED.6 Unintentional suffocation is the most frequent cause of death due to injury in infants.2 In 2005 the death rate for boys 10 to 14 years of age was nearly twice the rate for girls.2

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Homicides have increased 50% between 1980 and 2005 and now account for about 6% of deaths in children from 1 to 14 years of age.1 Homicide is the second leading cause of death due to injury in infants, and infants are 10 times more likely to die from homicide than are children 5 to 9 years of age.2

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Because most morbidity and mortality in pediatric trauma is due to traumatic brain injury, prehospital interventions should focus on airway and respiratory management, recognition of shock, spinal immobilization, and rapid transport to an appropriate facility based upon the predicted severity of injury. Prehospital care providers must be skilled in recognition and prevention of hypoxia and shock, because these are significant factors in causing secondary cerebral injury. Although establishment of IV access may be the prehospital ALS intervention that is most often performed, the beneficial effects of this intervention remain in doubt for the majority of pediatric trauma patients. Although airway management is crucial to prevent hypoxia, prehospital endotracheal intubation requires specialized skills and training, and it is not associated with better outcomes in children than is bag-valve mask ventilation.7 Most prehospital care providers have significant inexperience in pediatric endotracheal intubation. Shortening the time interval between injury and definitive care remains a priority; minimizing on-scene time is an important issue in ...

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