Pediatric emergency medicine trisk 0141 0141
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CHAPTER 7 ■ A GENERAL APPROACH TO THE ILL
OR INJURED CHILD
ANNA K. WEISS, MEGAN E. LAVOIE, KHOON-YEN E. TAY
BACKGROUND AND EPIDEMIOLOGY
Children account for approximately 20% of all emergency department (ED) visits in
the United States. In 2015, 30 million children <18 years of age were evaluated and
treated in U.S. EDs. Younger children have the highest utilization rates; while infants
<1 year old represent just 5% of the pediatric population, they comprise 11% of treatand-release ED visits and 21% of inpatient pediatric admissions. Children 1 to 4 years
of age comprise 20% of the pediatric population, and account for 30% of all pediatric
treat-and-release ED visits and 23% of all inpatient admissions. Approximately 5% of
children presenting to the ED will have severe illness. In such cases, it is vital that
emergency medicine clinicians promptly recognize an ill child and execute life-saving
interventions on his or her behalf.
In recent decades, the application of new medical knowledge has eradicated many
medical diseases and has extended the lives of children with previously untreatable
pathology. In the wake of these advances, ED providers must be ready to care for
greater numbers of children with complex health needs, and for those who rely on
medical devices or technologies when outside of the hospital setting. In the wake of
breakthroughs in the treatment of pediatric medical illness, traumatic injury has
emerged as the leading cause of pediatric ED visits, and is the leading cause of death
in children 1 to 19 years old in the United States. In 2017, more than 50% of all
childhood deaths were attributed to traumatic injury. Of these traumatic deaths, most
were caused by motor vehicle accidents, while homicide and suicide remain the
second and fourth most common causes of injury-related pediatric death. Other
common causes of traumatic morbidity and mortality in the pediatric population
include bicycle accidents, falls, drowning, fire and/or burn-related injuries, and
nonaccidental trauma.
PEDIATRIC DIFFERENCES
The evaluation of an ill or injured pediatric patient can be challenging for all
providers, but can be especially difficult for those who do not routinely care for
children. Knowledge of child development assists the clinician in determining the
overall severity of illness or injury. Fear or anxiety in acute situations is common, and
may contribute to observed changes in mental status (MS) and vital signs (VS).
Preverbal infants and toddlers are less able to localize pain or discomfort, and must
therefore be examined in a thorough and systematic fashion to ensure that signs of
