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Approach to the initially stable child with blunt or penetrating injury

Lois K Lee, MD, MPH
Gary R Fleisher, MD
Section Editor
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH


The initial approach to the management of the stable child who has sustained traumatic injury is reviewed here. Initial trauma management in the unstable child is discussed separately. (See "Trauma management: Approach to the unstable child".)


For this review, the stable pediatric trauma patient refers to an injured child who initially has normal or near normal vital signs, normal vital functions (airway, breathing, circulation, mental status), and no readily apparent critical injury. It is imperative for the trauma provider to use normative values for children as opposed to adults when assessing vital signs (table 1) (calculator 1 and calculator 2). (See "Trauma management: Unique pediatric considerations".)

Many seriously injured children, who ultimately require hospitalization and/or surgical intervention initially appear stable. It is incumbent on the emergency provider to thoroughly evaluate initially stable appearing traumatized children and to identify those at high risk for serious injury based on mechanism and physical findings (table 2 and table 3).

Injury classification — Traumatic injuries can range from minor to life-threatening. Several methods for measuring severity of injury exist. In order to appropriately triage the management of the trauma patient, one useful method to categorize injuries uses the following parameters (see "Classification of trauma in children"):

Injury extent – Multiple trauma is defined by apparent injury to two or more body areas. Localized trauma involves only one anatomic region (eg, head and neck, chest and back, abdomen, extremities) of the body. Sometimes the extent of injury may be obvious; at other times this may not be readily apparent, and the clinical picture may evolve over time.


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Literature review current through: Apr 2017. | This topic last updated: Oct 08, 2015.
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