Book Review

Pediatric Trauma: Initial care of the injured child

N Engl J Med 1996; 334:276-277January 25, 1996

Article

Pediatric Trauma: Initial care of the injured child
Edited by Robert M. Arensman, with Mindy B. Statter, Daniel J. Ledbetter, and Thomas Vargish. 272 pp. Philadelphia, Lippincott–Raven, 1995. $59. ISBN: 0-7817-0260-7

The authors of this concise textbook on pediatric trauma have followed closely the format of the manual of the Advanced Trauma Life Support course produced by the American College of Surgeons. Since trauma is the most common cause of death and disability among children in this country, a book designed to be a practical clinical guide to the initial care of the injured child deserves our attention.

The book opens with an overview of problems and solutions related to pediatric trauma and is followed by the ABCs of resuscitation. Subsequent chapters deal with specific areas, such as cervical-spine injuries, thoracic trauma, urologic trauma, and burns. These are followed by chapters on stabilization and transport, antibiotic use in cases of trauma, and child abuse. The book concludes with a section on procedures, specifically peritoneal lavage, chest-tube insertion, tracheal intubation, and pericardial aspiration. The authors have emphasized the similarities and differences between adults and children. A positive feature of the book is the use of algorithms summarizing the management of particular injuries.

Given the compact size of this book, the editors should have provided a better balance in the length of the chapters. For example, cervical-spine injuries, which occur much less frequently than head injuries, are given twice as much space. The conciseness of the text leads at times to a dogmatic approach. For example, in the chapter on head trauma it is stated that the arterial partial pressure of carbon dioxide should be maintained between 22 and 30 mm Hg. Recently this approach has been challenged, and practice is shifting toward maintaining normocapnia and applying hyperventilation to treat increases in intracranial pressure. Also, pentobarbital therapy for coma, the value of which is debatable, is presented as standard practice. The editors acknowledge that peritoneal lavage is infrequently used as a diagnostic procedure in pediatric trauma, yet give more attention to it than to the more valuable technique of ultrasonography. The section on procedures is not helpful from a practical standpoint; more details with illustrative aids are needed. In the section dealing with pediatric thoracic trauma, the formula for determining the size of the endotracheal tube has an unfortunate typographical error: the multiplication sign should be an addition sign. The reference lists in some chapters need updating.

Overall, this book would serve well as an introduction to pediatric trauma for medical students and physicians in emergency rooms who occasionally treat children. Future editions would benefit greatly from re-editing and reconsideration of priorities with respect to the book's content and goals.

I. David Todres, M.D.
Massachusetts General Hospital, Boston, MA 02114