Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

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). (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.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jun 22, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Lavoie M, Nance ML. An approach to the injured child. In: Fleisher & Ludwig's Textbook of Pediatric Medicine, 7th ed, Bachur RG, Shaw KN (Eds), Lippincott Williams & Wilkins, Philadelphia 2015. p.9.
  2. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support (ATLS) Student Course Manual, 9th ed, American College of Surgeons, Chicago 2012.
  3. Sola JE, Cheung MC, Yang R, et al. Pediatric FAST and elevated liver transaminases: An effective screening tool in blunt abdominal trauma. J Surg Res 2009; 157:103.
  4. Haasz M, Simone LA, Wales PW, et al. Which pediatric blunt trauma patients do not require pelvic imaging? J Trauma Acute Care Surg 2015; 79:828.
  5. Braungart S, Beattie T, Midgley P, Powis M. Implications of a negative abdominal CT in the management of pediatric blunt abdominal trauma. J Pediatr Surg 2017; 52:293.
  6. Schonfeld D, Lee LK. Blunt abdominal trauma in children. Curr Opin Pediatr 2012; 24:314.
  7. Cotton BA, Nance ML. Penetrating trauma in children. Semin Pediatr Surg 2004; 13:87.
  8. Stone ME Jr, Farber BA, Olorunfemi O, et al. Penetrating neck trauma in children: An uncommon entity described using the National Trauma Data Bank. J Trauma Acute Care Surg 2016; 80:604.
  9. Golden J, Isani M, Bowling J, et al. Limiting chest computed tomography in the evaluation of pediatric thoracic trauma. J Trauma Acute Care Surg 2016; 81:271.
  10. Perkins C, Scannell B, Brighton B, et al. Orthopaedic firearm injuries in children and adolescents: An eight-year experience at a major urban trauma center. Injury 2016; 47:173.
  11. Naranje SM, Gilbert SR, Stewart MG, et al. Gunshot-associated Fractures in Children and Adolescents Treated at Two Level 1 Pediatric Trauma Centers. J Pediatr Orthop 2016; 36:1.