Injuries to Children from Trains

Children have a higher likelihood of being injured or killed from trains than adults. They like to play on train tracks and have a lesser ability to detect the speed of a train coming towards them. Their bodies are more frail than adult bodies and the forces on the bodies from the train are great.

One study looked at the pattern of sustained injuries in kids who are injured in train tracks and train accidents. It was a retrospective review of those patients who showed up on two different trauma registries for the years 1984 through 1994. The patients attended a level I trauma center in a single metropolitan area. A total of 17 patients were treated for injuries at the level I trauma center. Those who were injured in a car that was struck by a train and those that were pronounced deceased at the scene were excluded from the study.

In all cases the Advanced Trauma Life Support (ATLS) protocols were followed. All open injuries of the musculoskeletal region were treated with debridement and significant irrigation. Antibiotics were used in open musculoskeletal injures as prophylaxis. The different variables include the mechanism of injury, the age and gender of the child, circumstances of the accident, injuries sustained, operations necessary while in the hospital, later operations, level of amputations, complications, the cost and the length of the hospitalization.

The results showed that there were eight patients with ten incomplete amputations and eight patients with ten complete amputations. Each patient received on average a total of 6 operations. Five extremities needed amputation revision to a more proximal degree after the initial operation. Secondary operations were needed in half of the survivors. The cost of the hospital stay for pediatric patients struck by a train was up to $61,000 on average.

The researchers concluded by saying that children who are survivors of a serious pedestrian-train accident are likely to have severe musculoskeletal injuries mostly lower extremity amputations. They require a lot of different surgeries including debridement and irrigation, along with a revision or more. It ends with a nice stump that the person can learn how to use a prosthesis with. The high amount of kids getting injured with trains as pedestrians means that there should be limited access of tracks by children and better education of children as to the dangers of playing on the tracks.

Some kids get more than one amputation, such as an amputated leg and an amputated hand or arm. This poses very difficult rehabilitation measures as the child may have to learn how to put on two separate prostheses and learn how to do things like ambulate with an above the knee amputation or eat with an above the elbow arm amputation. These things are extremely difficult to do and things like hygiene are difficult to accomplish without help. The patient may remain disabled due to amputations or may grow to use them so efficiently that they can go on to have a normal life after amputations.

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