Etiological And Demographic Profile Of Pediatric Abdominopelvic Trauma In Kashmir

摘要

Background: Pediatric abdominopelvic trauma, both accidental and willful, has become common in this era of increasing violence, automobile and industrial accidents. As a result there has been an increase in the incidence of pediatric trauma in Kashmir, too, a fact which activated us to undertake this study. Purpose: To evaluate the etiological and demographic profile of pediatric abdominopelvic trauma in Kashmir valley.Methods: Every consecutive pediatric patient, 1-16 years of age with abdominopelvic trauma, blunt as well as penetrating (n=300), admitted in the Department of Surgery, SMHS Hospital Srinagar, over a period of three years from June 2006 to June 2009 was included in the study. Both sexes were included. A proper history of the accident from the patients, or attendants or police accompanying, regarding the mode of injury, duration of injury, site where hit, mode of transport and the nature of injury, was taken.Results: In our series of 300 pediatric abdominopelvic traumata, about one fourth (24.33%) were due to penetrating injuries and the rest (75.67%) were blunt traumata. Firearm injury was the most common mode (45.20%) for penetrating injuries and road-traffic accidents were most common mode (40.09%) for blunt trauma. Both injuries were more common in males than females. Blunt injury predominated over penetrating injury. Most patients (67%) were from central Kashmir.Conclusion: From our study we conclude that blunt pediatric abdominopelvic injuries predominate over penetrating trauma, firearm injury was the most common mode for penetrating injuries and road-traffic accidents were most common mode for blunt trauma. Both injuries were more common in males than females. Pediatric abdominopelvic trauma is prevalent in urban (central) Kashmir. Introduction Trauma has been defined as damage to the body caused by an exchange with environmental energy that is beyond the body’s resilience.1 Trauma has plagued mankind since the times man learnt to roam around, in the beginning for food and shelter and then as part of his activities. The nature of trauma, the mode and the outcome is largely dependent on the age group. Trauma is the third leading cause of death regardless of age. In the age group between 1 and 15 years, trauma is the single most common cause of death in children in the USA. There is a trimodal mortality trend with 50% of deaths occurring in seconds to minutes of injury due to injury to major vessels, CNS or acute respiratory failure; 30% of the deaths occur within hours, the reason being haemorrhage, and 10% of deaths occur late after 24 hours and the cause is usually infection. This toll of death has installed momentum on the efforts to prevent this mode of death and the resulting disability.1-5 Penetrating injury occurs in only 20% of children who sustain pediatric trauma and are managed in a similar fashion as in adults.2 Not only are there significant physiologic and psychological differences between adults and children, there are also differences in the accident pattern. Most childhood injuries result from blunt trauma whereas in adults blunt trauma is not more common than penetrating injuries. More specifically, head trauma is far more common in children than in adults. After motor-vehicle accidents which are the major causes of trauma in both children and adults, the next most frequent causes of trauma in children are events that are less important causes in adults: falls, bicycle accidents, drowning, poisoning, playground injuries, stunt mimicking injuries, injuries due to toys and burns from fire. Child abuse is an important cause in children under 5 years of age. Birth trauma is a unique and important cause of trauma in neonates. Consideration of the cause of blunt pediatric trauma has been a major decision point for pediatric trauma system activation. Motor-vehicle accidents and falls are associated with the greatest risk of intra-abdominal injury. Firearm and violence injury are the causes of pe