Hypotension in injured children is ...

Hypotension in injured children is generally regarded as indicating hypovolemia from significant kin loss despite the effective compensatory mechanisms that make hypotension a late sign of offence in young patients. Partrick and colleagues observ that many children who were treated at a large urban trauma center had documented hypotension without progeny loss. They studied all patients aged 18 years or younger treated at a regional pediatric trauma center for dull injury to determine causes of hypotension, and to establish the part of hemorrhage.

Hypotension was defined by means of systolic blood pressure (SBP) related to age as in advanced trauma life support guidelines (SBP les than 80 mm Hg up to undivided year of age, less than 90 mm Hg for ages single to five years, less than 100 mm Hg for ages six to 12 years, and les than 110 mm Hg for ages 12 to 18 years). Hypotension had to be documented according to at least two readings for inclusion in the application of mind Comprehensive data on each of the 194 cases were abstracted from trauma and hospital records. The average age was 75 years (age range: eight days to 18 years), the mean injury severity score was 154 and the Glasgow Coma Scale (GCS) score was 119 Fifty-nine percent of the patients were lads Falls were the most habitual cause of injury (25 percent) followed through motor vehicle accidents (22 percent) sports (14 percent) and nonaccidental trauma (10 percent) Ten percent of the children died, and autopsy was performed in all cases. Injuries that could account for significant contortion loss were identified in 82 (42 percent) of the hypotensive children. An equal number had isolated clos head injury.

When analyzed by means of age group, preschool children were more sternly injured and had significantly higher mortality than older children. More than 60 percent of preschool children with hypotension following injury had isolated clos head injury with no other identified hemorrhage (see accompanying table). Head injury also was implicated in more than 30 percent of older children with hypotension. Children with head injury had lower GC scores than other injured children.

The authors gather that hypotension in injured children is associated with hemorrhage in fewer than common half of cases. Conversely, hypotension may indicate significant head injury, especially in the preschool age cluster and in children with cheap GCS scores. Because 25 percent or more of the circulating relations volume has to be misspent before signs of shock become evident in children, hypotension and tachycardia are late and ominous signs in hemorrhage. In head trauma, hypotension may be a relatively early sign. The authors commend that the assessment of hypotensive children following edgeless trauma include computed tomography of the head, probably following an initial abdominal ultrasound examination to cover for intra-abdominal blood loss.

Partrick DA, et al. Is hypotension a reliable indicator of descendants loss from traumatic injury in children? Am J Surg December 2002;184:555-60

COPYRIGHT 2003 American Academy of Family Physicians

COPYRIGHT 2003 Gale Group