Vella AE, Wang VJ, McElderry C. The Journal of Emergency Medicine. 2006;31:151-155.

REVIEWER INTRODUCTION

The standard for trauma care, advanced trauma life support, was designed primarily for the adult patient. There are important epidemiological differences between pediatric and adult trauma patients that may require different standards for resuscitation. It is imperative for all emergency department staff to understand these differences to provide the best patient care.

ABSTRACT

The mechanism of injury and the resultant fluid resuscitation may be different for pediatric patients, compared with their adult counterparts. The objective of this study was to establish predictors of fluid resuscitation and to determine whether all pediatric level-1 trauma patients require 2 intravenous catheters (IVs).

The authors note that traumatic injuries are the number one cause of death among children older than 1 year, pediatric patients have a high incidence of head injuries (88%), and blunt trauma is the usual type (94%) experienced by most pediatric patients. Because of the treatment of these injuries, children may not need the standard fluid boluses that accompany severe traumatic injuries. Children also are noted to have smaller veins and increased subcutaneous fat tissues, making vascular access more difficult and time-consuming, compared with most adult patients.

A total of 152 charts were reviewed for patients seen at Children's Hospital Los Angeles that met level 1 criteria. The mechanism of injury, changes in vital signs, Injury Severity Score, and IV placement was noted. Only 10% of the patients required more than 1 fluid bolus. Nearly 50% of patients reviewed did not have a second IV catheter placed during their ED evaluation. The only common predictive measurement for those patients receiving a second bolus was the Injury Severity Score. The retrospective analysis revealed that those patients with a higher Injury Severity Score are more likely to receive a second IV catheter and more than 1 fluid bolus.

The authors note multiple limitations to this study because of its retrospective design and recommend further research to be completed on this topic.

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COMMENTARY

For those emergency department staff members that do not commonly treat pediatric trauma patients, this article offers information to consider regarding the most appropriate treatment of a pediatric trauma patient. The lack of the need for a second IV catheter proves that the pediatric trauma patient can do well and be treated appropriately with 1 IV line. While considering their Injury Severity Score, trauma members can calculate the potential need for a second IV catheter (and fluid boluses) and continue to monitor the pediatric trauma patient.