Damage control laparotomy in a paediatric trauma patient in a regional hospital

INTRODUCTION: Trauma is a major cause of death in children (Brown et al., 2001). It has far-reaching impacts on a child’s development and function, and is a major contributing factor to disability in the young. Pediatric patients in trauma demonstrate different clinical signs and have different resuscitation requirements, often masking symptoms and compensating well before rapidly deteriorating. CASE PRESENTATION: The authors present a case of a 13-year-old patient with major trauma receiving surgical management in an adult regional hospital. The patient was involved in a high-speed head on motorcar collision. This report emphasizes the importance of early mobilisation of a trauma team and appropriate surgical stabilisation of a child in an adult regional centre without access to specialised pediatric surgeons. DISCUSSION: Approximately 600 individuals aged 19 or less are fatally injured in Australia each year. Management of pediatric trauma requires early mobilization of a trauma team, to ensure high levels of expertise are available. However, managing these patients with specialized pediatric surgery teams is not always possible. As such, peripheral hospitals need to have trained general surgeons who can manage the deteriorating pediatric patient. CONCLUSION: All peripheral hospitals with access to emergency operating should have general surgeons willing and able to manage pediatric trauma, with the confidence for a low threshold for laparotomy.