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Injury in the Young.
  1. Consultant Paediatrician

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    Injury in the Young. Edited by MP Ward Platt, RA Little. (Pp 317 hardback; £55.) Cambridge University Press, 1998. ISBN 0 521 48117 1 .

    Paediatricians tend to forget that injury is the most common cause of death in school age children, responsible for just over a third of deaths in this age group. Even in children aged 1 to 4 years, nearly a quarter of deaths are traumatic in origin. In the past decade there has been increasing interest in the prevention and epidemiology of childhood injuries with advances in initial resuscitation and treatment, which depend on a basic understanding of the underlying pathophysiological processes.

    Some deaths from trauma result from overwhelming damage and are inevitable. Children with less severe injuries may deteriorate quite rapidly and develop respiratory, circulatory or secondary brain problems with death occurring within several hours. The changes in training of paramedics and improved resuscitation training of doctors and hospital staff have helped improve the outlook for these children while advances in intensive care, improved interhospital transport, and faster high quality imaging have also been of benefit. Finally, there is a smaller number of children who die later from infection, multiple organ failure or brain damage secondary to raised intracranial pressure—some of these are preventable.

    Therefore it is timely for Injury in the Young,which tries to bring together the mechanisms of injury and some of the abnormal physiological processes that supervene. The authors review experimental and empirical data to look at more rational treatment regimens for injured children. A wide panel of experts have been brought together in this well edited book, from disciplines including paediatrics, accident and emergency medicine, anaesthetics, and paediatric public health. Although the list of contributors is named and their work place stated it would have been helpful to have details of the authors’ current posts to give readers an idea of the diversity of their skills.

    The editors have had a difficult job squeezing all this information into a book of just over 300 pages, so they have rightly concentrated on the most common life threatening injuries in children including head injury, near drowning, burns, and chest injury. Unfortunately, they omit severe abdominal trauma; there should have been two or three pages of text about immediate treatment as ruptured spleen, liver or viscus can cause major diagnostic problems and death in the multiply injured child.

    What about child abuse? This is covered in almost two pages of text with just two references, one to fractures caused by child abuse and another general review of the subject from the BMJin 1995. This is disappointing, although the final chapter is on children’s rights and child protection.

    Overall the book is well laid out and carefully produced. The authors state its targets as accident and emergency specialists, paediatric surgeons, anaesthetists, and intensive care specialists, as well as paediatricians. There is no doubt that trainees in these disciplines will find the book a useful reference source. My preference would have been for more illustrations to complement the text. The academic approach to many topics, such as acute respiratory distress syndrome, will mean that this text is useful for researchers.

    The emphasis on primary prevention is covered well. Reducing injury from road traffic accidents is of major interest to community paediatricians. Other paediatricians are likely to be involved in initial resuscitation during the first hour or so of admission to hospital. In many units they will have an ongoing role in the acute management of some patients, such as those with severe head injury. Indeed, injury treatment is rapidly becoming multidisciplinary and no particular doctor has all the answers. If there are to be advances in management, basic mechanisms of injury and secondary damage must be understood. This books helps with this process and will be useful to staff in units treating paediatric trauma patients.