Thermal injury frequently occurs in traumatized patients in North America and causes serious morbidity and mortality, predominantly to children and young adults. Over the past decade, considerable technologic advances have improved survival after burn injury. Ongoing research coupled with current surgical advances in equipment, technique, early wound closure and alternative forms of wound coverage offer the potential for greater survival with enhanced quality of life for traumatized patients with burn injuries. However, sepsis and inhalation injury remain important ongoing causes of death, for which the understanding and solutions appear to be unfolding as research into the multisystem effects of the inflammatory process continues.
Selective conservatism is the key to the rational management of pediatric trauma, realizing that children may harbour severe occult injuries. The modern treatment of childhood abdominal trauma best exemplifies this approach: nonoperative management of splenic trauma is now standard for children, and a selective conservative approach is advised in the handling of childhood liver and pancreatic injuries. Prevention of childhood injuries should be the goal. The development of a national database of childhood trauma should provide the basis for action to educate and legislate for prevention. When prevention fails, however, up-to-date quality pediatric trauma care is the key.