This is an interesting article concerning children with multiple injuries, including spinal cord injury. Very few epidemiological studies of multiple injured children have been published. This study examined 682 multiple trauma children and adults. The comparisons of pediatric and adult patients are instructive.

1. The causes of injury differ significantly depending on age. Older children (6-17 years old) were more commonly injured as pedestrians and cyclists while younger (<6 years old) and older [>18) were more likely to be injured as car passengers.

2. Death from spinal cord injury is much more frequent in multiply injured children than in adults, particularly cervical spinal cord injury where the mortality rate in multiply injured children was 36.8% versus 18.9% in multiply injured adults. The general death rate from cervical spinal cord injury in adults or children that don't have multiple injuries is between 5 to 10%.

3. In general, children have a much higher rate of death from multiple injuries, with a threefold increased risk of death when injured, compared to adults. It is not clear why this is so.

One of the reasons that I posted this study is because we are having an increasing number of parents coming to this site. Although this study does not carry good news for children with multiple injuries, it may help provide information for decisions.

Meier R, Krettek C, Grimme K, Regel G, Remmers D, Harwood P and Pape HC (2005). The Multiply Injured Child. Clin Orthop 127-131. The treatment of multiple traumas in children requires knowledge of common injury patterns, incidence, mortality, and the consequences and differences between these injuries in children and adult patients. However, epidemiological studies concerning pediatric multiple trauma are rare. To address this, data were collected and analyzed from 682 multiple trauma patients treated at a Level I trauma center. The patients were divided into four age-related groups (< 6 years, 6-12 years, 13-18 years, and 18-40 years) and were evaluated for trauma mechanism, injury distribution, and cause of death. Children aged 6 to 17 years mostly were injured as pedestrians and cyclists whereas infants, preschoolers, and adults more commonly were injured as car passengers. Pediatric patients suffered a significantly higher mortality than adults, with a threefold increased risk of death when injured as passengers in car accidents. Injuries to the head and the legs were most common. A lower incidence of thoracic [28% versus. 62%), abdominal [20% versus 36%), pelvic [22% versus 35%), and upper limb [32% versus 43%) trauma was observed in children [< 18 years) than in adults [18-40 years). Nevertheless, trauma to the thorax, abdomen, and head were associated with a high risk of death in all groups. Spinal cord injuries, especially in the cervical region, also carried a high risk of mortality [36.8 in the group of patients younger than 18 years and 18.9 in the group of patients 18-40 years). Children younger than 6 years had the most severe head injuries. The data show that there are important differences in incidence, mortality, and injury patterns between pediatric and adult patients with multiple traumas. From the *Trauma Department, the daggerDepartment of Anesthesiology, Hannover Medical School [MHH), Hannover, Germany; the double daggerDepartment of Trauma Surgery, Rosenheim, Germany; and the double daggerDepartment of Orthopaedic Trauma Surgery, St. James's University Hospital, Leeds, England.
[This message was edited by Wise Young on 03-06-05 at 03:59 AM.]