TRAIN INJURIES IN CHILDREN

Objective: To describe the pattern of injuries sustained in pediatric victims of train accidents. Design: Retrospective review of patients i dentified in a search of two trauma registries for the years 1984-1994 . Setting: Two pediatric level one trauma centers in one metropolitan area. Patients: Between 1984 and 1994, seventeen children were identif ied as treated for injuries sustained in train accidents. Children pro nounced dead at the scene and those injured when a car was struck by a train were excluded. Intervention: ATLS protocols were followed. All open musculoskeletal injuries were treated with multiple operative irr igation and debridement procedures and broad spectrum antibiotics. Mai n Outcome Measurements: Variables included the following: age, sex, me chanism of injury, circumstances surrounding the injuries, all injurie s sustained, operations performed during the acute hospitalization, su bsequent operations, level of amputation(s), complications, and cost a nd length of hospitalization Results: Presenting injuries included eig ht patients with ten complete amputations and eight patients with ten near-complete amputations. The average number of operative procedures for the survivors during the initial hospitalization was 5.7 (range th ree to sixteen). Five patients (five extremities) required amputation revision to a more proximal level after the initial surgical intervent ion but prior to definitive wound closure. Secondary surgical procedur es have been required in 50% of survivors to date. The financial cost of these injuries is substantial, with acute hospitalization costs ave raging $61,000. Conclusion: Pediatric survivors of train-pedestrian ac cidents are likely to suffer isolated musculoskeletal injuries, the ma jority of which are amputations of the lower extremity. These injuries require multiple operative debridements and frequent revision to high er levels of amputation are expected. The percentage of these injuries in children at play around railroad tracks emphasizes the need for li mitation of access to railroad areas and for prevention through public education.