the hospital for sick children: manual of pediatric trauma

MEDIA REVIEWS

THE HOSPITAL FOR SICK CHILDREN: MANUAL OF

PEDIATRIC TRAUMA

Edited by Angelo Mikrogianakis, Rahim Valani, andAdam Cheng.Philadelphia: Lippincott, Williams & Wilkins, 2007, 304pages, $54.95 (softcover).

The Hospital for Sick Children Manual of PediatricTrauma is a thorough and excellent reference for anyhealth care professional. It would be most useful to anyresident or fellow caring for pediatric trauma patients.The book is divided into 22 chapters, with each chaptercovering different traumatic injuries, system surveys, ortrauma-specific management topics. The tables aredata-rich. The illustrations and images are clear withrelevant findings well identified. The brief outline formwith bulleted lists used throughout this book wouldmake it an excellent pocket guide to pediatric trauma.However, its quick reference intent necessitates apocket-sized or PDA format.

Of the 25 contributing authors, 24 are from Canadaand 1 is from Chile, with 23 of them being associatedwith the University of Toronto’s Hospital for Sick Chil-dren. The information provided adheres to currentadvanced trauma life support (ATLS) guidelines and iscompatible with the current practices in the UnitedStates.

The book begins with an introductory chapter, cover-ing basic epidemiology and trauma scoring systems,followed by a chapter on primary and secondary sur-veys, providing a condensed, high-yield review of ATLSguidelines. Chapter 3 covers the relevant data neededfor pediatric airway management. The chapter beginswith a review of anatomy and moves from bag valvemask through intubation, failed intubations, and post-intubation care, including reviews of equipment andmedications used.

Chapter 4 covers diagnostic imaging and has over 30images that are clear and easy to read and representthe most common traumatic injuries. Discussionsinclude practical approaches to reading images and thecommon injuries and pitfalls associated with each typeof image. Given the growing utility of ultrasound in theemergency department, it is very disappointing thatultrasound images are not covered in this book.

The next several chapters cover the most commontraumatic pediatric injuries by body system, beginningwith head trauma (Chapters 5 and 6) and movingthrough craniofacial injury (Chapter 7), neck and air-way (Chapter 8), cervical spine injuries (Chapter 9),thoracic trauma (Chapter 10), abdominal and pelvictrauma (Chapter 11), orthopedic trauma (Chapter 12),thoracic and lumbar spine injuries (Chapter 13), thermalinjury (Chapter 14), smoke inhalation (Chapter 15), elec-trical injury (Chapter 16), and drowning and submer-

sion injuries (Chapter 17). Each body system chapter isorganized in a similar outline fashion with sections cov-ering epidemiology, pathophysiology, initial manage-ment (primary survey), evaluation (secondary survey),and definitive management. Each chapter concludeswith boxed ‘‘clinical pearls’’ (do’s and don’ts).

The final chapters review pain management andsedation (Chapter 18), nonaccidental trauma (Chapter19), injury prevention (Chapter 20), procedures (Chap-ter 21), and finally, transport of the pediatric traumapatient (Chapter 22).

As part of our review process, some common ques-tions were asked of this text. The first question welooked to answer was ‘‘What are the indications for ahead CT in pediatric head trauma?’’ The chapter onmedical management of head trauma (Chapter 5) indi-cates that all head trauma patients should get a CT.However, in the following chapter on surgical manage-ment of head trauma (Chapter 6), the indications werequickly located and clearly defined under the ‘‘Role ofComputed Tomography’’ portion of the ‘‘Imaging’’heading. Duplicating the indications in both chapters orplacing them in the first of the two chapters would havemade this information more readily available.

The next question we asked of the text was ‘‘How dopediatric spinal injuries differ from adult spinal inju-ries?’’ On the first page of the cervical spine injurychapter (Chapter 9), expected spinal injury patterns arelisted by age. For instance, children < 14 years havehigher c-spine injuries (C1-C4). Children > 14 yearshave lower c-spine injuries (C5-C7). A brief statementfollows explaining that the spinal fulcrum movesslightly with age. The follow-up question of how todetect spinal cord injury without radiologic injury wasreadily located under the spinal cord injury withoutradiologic abnormality (SCIWORA) heading, along withdiagnostic criteria and management goals.

Assuming that most readers will be reasonably com-fortable with adult trauma, a valuable question to beaddressed when using this book is the important differ-ences between the care of the adult and pediatrictrauma patients. It would be helpful to turn to a singlechapter and quickly find this type of list. For instance,under airway management (Chapter 3), it would begood to immediately know that a roll should be placedunder the pediatric patient’s shoulders to alleviateupper airway obstruction and facilitate intubation, thata straight blade is preferred for intubation, and that theproper tube size is (age ⁄ 4) + 4. In the chapter on tho-racic trauma (Chapter 10), it would be helpful to seethat rapid decompensation is a common pitfall. Finally,in the pediatric thermal injury chapter (Chapter 14),it would be useful to immediately see the Parklandformula for fluid resuscitation and total body surfacearea estimation guide.

ISSN 1069–6563 ª 2009 by the Society for Academic Emergency Medicinee22 PII ISSN 1069–6563583

In conclusion, The Hospital for Sick Children: Manualof Pediatric Trauma is organized in an easy-to-followoutline format that makes finding the information quickand easy. While the goal of this book is not to providea definitive reference text, it has succeeded in providinga consistently organized reference source that can actas a quick reminder and resource for the care of thepediatric trauma patient. For this reason, it deservesconsideration for a place on every emergency medicineresident, attending, and departmental bookshelf.doi:10.1111/j.1553-2712.2009.00377.x

Anthony Mills, MD(amills@synergymedical.org)Emergency Medicine ResidencySynergy Medical Education AllianceSaginaw, MI

Jason M. White, MD(jwhitemd@umich.edu)Emergency MedicineSt. Mary’s of MichiganSaginaw, MI

ACAD EMERG MED • April 2009, Vol. 16, No. 4 • www.aemj.org e23