Paediatric polytrauma. (English)

Enfant polytraumatisé (French)

Trauma is the leading cause of both morbidity and mortality in the paediatric population. An early and aggressive management might improve survival and functional outcome. Optimal paediatric trauma patient care includes adequate initial assessment, aggressive resuscitation and conservative surgical management as often as possible. Acute respiratory failure is frequent in trauma paediatric patient and endotracheal intubation should be performed without delay. Haemorrhage is the leading cause of circulatory failure. Resuscitative fluids and vasoactive drugs, if needed, are given before possible surgical control of haemorrhage. Since severe head trauma is preponderant in this population, one of the major goals of initial critical care management is aimed at preventing secondary brain damage, especially hypoxia and hypotension. Improvement in diagnosis imaging represents a crucial advance in paediatric trauma care, with ultrasonography used as the first line investigation, and CT scan as the gold standard in stabilised and adequately monitored children. This effective management should decrease mortality and morbidity of severe trauma. [Copyright &y& Elsevier]

Les traumatismes graves de l''enfant repre´sentent le tiers de la mortalite´ infantile et la premie`re cause de de´ce`s apre`s l''aˆge de 1 an. L''expe´rience accumule´e chez les enfants polytraumatise´s a montre´ que les meilleures chances de survie e´taient obtenues lorsque ces patients be´ne´ficiaient des soins optimaux dans les premie`res heures apre`s l''accident. La prise en charge d''un enfant polytraumatise´ comprend l''e´valuation et le traitement des de´tresses vitales imme´diates. La de´tresse ventilatoire est fre´quente chez l''enfant et l''intubation orotrache´ale a des indications larges. Le choc he´morragique est la principale cause de de´tresse circulatoire. Son traitement passe par le controˆle des he´morragies exte´riorise´es, le remplissage vasculaire parfois associe´ a` la prescription de vasopresseurs. Enfin, la prise en charge de la de´tresse neurologique associe le maintien d''une normoxie, d''une normocapnie et d''une pression de perfusion ce´re´brale suffisante. La strate´gie de prescription des examens comple´mentaires chez l''enfant polytraumatise´ est comparable a` celle de´veloppe´e chez l''adulte. Le bilan prescrit vise a` obtenir un bilan le´sionnel aussi pre´cis que possible sans retarder le traitement e´tiologique. Ces pratiques, mises en œuvre pre´cocement, doivent permettre de diminuer la mortalite´ infantile post-traumatique pre´coce. [Copyright 2004 Elsevier]

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