title: Isolated head injury is a cause of shock in pediatric trauma patients.
abstract: OBJECTIVE
  Current trauma resuscitation protocols from the American College of Surgeons, Committee on Trauma, recommend intravascular volume expansion to treat shock after major trauma, assuming that hemorrhage is present. However, this assumption may not be correct. The purpose of this study was to identify the proportion of children with severe shock after trauma presenting with isolated head injury versus hemorrhagic injury.
  
  
  METHODS
  A retrospective review of all pediatric trauma patients (aged 0-15 years) was conducted over a 5-year period. Severe shock was defined as the presence of both an elevated blood lactate level and low blood pressure for age. Traumatic injuries were classified as hemorrhagic injuries, head injuries, combined hemorrhagic and head injuries, or other injuries, by analyzing International Classification of Diseases, Ninth Revision diagnostic codes.
  
  
  RESULTS
  A total of 31 (5%) of 680 pediatric trauma patients presented with severe shock. Among these 31 pediatric trauma patients, 9 (29%) had isolated head injury. Isolated head injury among children with shock was most frequently observed among children younger than 5 years (50%), and a decreased trend was noted with increasing age (23% for children 5-11 years and 0% for children 12-15 years [P = 0.03, Cochran-Armitage exact trend test]).
  
  
  CONCLUSIONS
  Isolated head injury was observed in 29% of children 0 to 15 years of age with severe shock after trauma and in 50% of children younger than 5 years. Head injury is an important cause of severe shock in pediatric trauma, particularly among young children.
authors.affiliation: Departments of Pediatrics, Wake Forest Health Sciences, Winston-Salem, NC 27157, USA. agardner@wakehealth.edu
authors.forename: Alison
authors.initials: A
authors.lastname: Gardner
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Poehling
authors.forename: Chadwick D
authors.initials: CD
authors.lastname: Miller
authors.forename: Janet A
authors.initials: JA
authors.lastname: Tooze
authors.forename: John
authors.initials: J
authors.lastname: Petty
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006470:Hemorrhage / Q000150:complications; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology*; D014947:Wounds and Injuries / Q000150:complications