Schöneberg C, Schweiger B, Metzelder M, Müller D, Tschiedel E, Lendemans S
Klinik für Unfallchirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland,
Unfallchirurg. 2014 Sep;117(9):829-41. doi: 10.1007/s00113-014-2656-6.
The diagnosis of an injured child in the emergency room requires interdisciplinary collaboration and should be performed in a level 1 or 2 trauma center, if possible. Here, the basic trauma team could be complemented with (pediatric) surgeons. In a pediatric trauma center, specially trained pediatric surgeons or trauma surgeons, anesthetists, and radiologists who are experienced in the treatment of children should be available. The initial emergency room treatment does not differ significantly from that of adults. Ionizing radiation is the greatest hazard for children in the diagnosis of trauma patients. The CT scan is responsible for most of the radiation. To reduce the risk of developing a malignancy, the most harmful consequence of radiation, differentiated use is necessary. This can be achieved by using the presented algorithms. However, the differentiated use of the CT should not result in additional risk to the child. If the child is in a critical condition and obviously has multiple life-threatening injuries, the use of a whole-body CT is justified, due to time saving and targeted therapy of the child.
在急诊室对受伤儿童进行诊断需要多学科协作,如有可能,应在一级或二级创伤中心进行。在这里,基本创伤团队可以由(儿科)外科医生补充。在儿科创伤中心,应配备经过专门培训、在儿童治疗方面经验丰富的儿科外科医生或创伤外科医生、麻醉师和放射科医生。急诊室的初始治疗与成人的初始治疗没有显著差异。在创伤患者诊断中,电离辐射对儿童危害最大。CT扫描产生的辐射占大部分。为降低发生恶性肿瘤(辐射最有害的后果)的风险,必须进行差异化使用。这可以通过使用所提供的算法来实现。然而,CT的差异化使用不应给儿童带来额外风险。如果儿童病情危急且明显有多处危及生命的损伤,由于节省时间并能对儿童进行有针对性的治疗,使用全身CT是合理的。