379 Challenging Pediatric Cases Resulting from Train Injuries

B A Burkey; A Nanassy; L K Meyer; W J Davis; P M Glat

doi:10.1093/jbcr/irz013.284

Abstract Introduction Traumatic injuries sustained by pediatric patients involving trains result in a large number of injuries requiring high resource utilization. Prior research suggests that survivors of train accidents are likely to suffer from isolated lower extremity musculoskeletal injuries. Methods In the last two years, three pediatric train accident patients have presented to our center. The first patient was a 15 year old male who fell onto a live 700 volt subway track and sustained a full-thickness electrical burn to the right ankle. The second patient was a 14 year old male who attempted to jump onto a moving train, but failed and resulted in the amputation of his right lower extremity. The third patient was a 16 year old male who attempted to jump from one train to another when he came into contact with a 1200 high voltage wire, sending him 30 feet head first. Results The first patient underwent multiple visits to the OR consisting of debridement, placement of a dermal regeneration template, and subsequent free flap surgery. The second patient was managed by a multidisciplinary team over the course of multiple OR visits to repair femoral vessels, revise the femur, debride the wound, myoplasty, and ultimately close the wound. The third patient’s injuries ultimately resulted in the need to amputate his left and right lower extremities and apply split thickness skin grafts to his neck, left hand, and left shoulder. Additional information surrounding the incidents, resulting injuries, clinical management, outcomes, and challenges will be discussed for each patient. Conclusions Patients presenting to our institution have had complex traumatic and electrical injuries, as opposed to isolated musculoskeletal injuries. Hospitalizations from pediatric train accidents require an interdisciplinary approach, not just for the injury itself, but also for the ongoing support to implement changes to daily routines and provide assistance to patients and families to deal with the physical, psychological, and social challenges associated with significant physical impairment. Applicability of Research to Practice The three pediatric train injuries reviewed in this case report demonstrate why triage to a center providing the highest level of care is imperative. Although the literature suggests that train injury survivors are likely to suffer from musculoskeletal injuries, these cases suggest that pediatric train injuries in the urban setting are complex and likely to require multidisciplinary collaboration and high resource utilization.

379 Challenging Pediatric Cases Resulting from Train Injuries

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379 Challenging Pediatric Cases Resulting from Train Injuries

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