Management of the multiply injured child

Injury is the commonest cause of death and morbidity in children and accounts for most attendances at paediatric emergency departments. Optimal management of the multiply injured child relies on anticipation and preparation, followed by a standardized, consistent and structured response from healthcare professionals. Staff must be appropriately trained and supported by a regional tertiary paediatric trauma centre. Initial management involves a primary survey with resuscitation, using an ‘ABC’ approach, and treatment of life-threatening injuries as they arise. The details of this are outlined in this review, highlighting important child-specific factors. Once stabilized, injured children must be assessed by secondary survey to rule out all possible injuries and, if necessary, transferred to an appropriate tertiary unit. Support from regionalized tertiary centres and ongoing training for staff is paramount in optimizing outcome of the multiply injured child.