What is Waddell Triad?
Waddell’s triad is a medical term that describes a serious emergency situation for young patients, primarily because of the high risk of injuries associated with a broken thigh bone or femur. This term encompasses three distinct injuries usually seen in children who’ve been hit by a car or experienced a similar type of strong physical impact. These injuries are a broken femur on one side of the body, injury to the chest or belly on that same side, and a head injury on the opposite side.
This combination of injuries can lead to significant blood loss from internal bleeding. That’s why it’s very important to swiftly take these young patients to a pediatric trauma center, where specialized care can be provided. Studies have shown that children suffering from severe injuries have a better chance of survival when treated at centers specially equipped for children or at hospitals with pediatric intensive care units.
In such accidents, the child pedestrian bears the full force of the impact. The degree of injuries is influenced by factors like the speed of the vehicle, the child’s weight, and the design of the vehicle’s front. The injuries also have the potential to cause serious bleeding in the belly, so these patients should have their blood type identified in case an immediate blood transfusion is needed. Besides, it’s vital to watch these patients closely for low blood pressure and other signs of shock when Waddell’s triad injuries are present.
What Causes Waddell Triad?
The Wadell Triad refers to the series of injuries often seen in pedestrians who are struck by a motor vehicle. Typically, these injuries occur in three stages. First, when the bumper hits the person, usually causing injuries to the legs or hips. Second, the person might hit the hood or windshield, leading to chest or stomach injuries. The final stage happens when the person falls and hits the ground, which can result in head or neck injuries.
Any person suspected to have experienced the Wadell Triad should be considered as seriously hurt, as these injuries can be severe, potentially leading to major blood loss and a condition called hypovolemic shock. This shock happens when the body loses too much blood or fluid, causing the heart to not pump enough blood to the body.
Risk Factors and Frequency for Waddell Triad
The World Health Organization (WHO) points out that unintentional injuries are the main reason for fatalities in children aged 10 to 20 years globally. In America, over 12,000 kids lose their lives annually due to these unforeseen injuries, with car accidents being the top cause. Every year, about 9.2 million children get medical treatment in US emergency departments because of injuries from falls. However, across the world, injuries from car accidents are among the top 15 causes of disability in children.
Signs and Symptoms of Waddell Triad
When a patient comes in after experiencing trauma, the first thing doctors do after making sure that the patient is stable is to gather a full history and conduct a physical examination. Sometimes, the patient might be too young or too unwell to provide certain information. In these cases, doctors will have to turn to family members, anyone who witnessed the accident, and the emergency medical services team that brought the patient in.
To help remember which details to ask about, health professionals use a memory tool called AMPLE:
- Allergies the patient might have
- Medications the patient is currently taking
- The patient’s past medical history
- When the patient last ate
- Any events related to the trauma, including actions taken by the emergency team
It’s essential for doctors to understand how the injury took place, as even minor details can offer important information.
Sometimes, a serious incident might cause a range of symptoms commonly called the ‘Waddell triad’. This usually happens in high-energy impacts like car accidents. The main aim at the first check-up should be to recognize any connected injuries and treat those requiring immediate care. If a child shows one or two signs of the triad after a car accident, doctors need to watch for the third sign, which might show up a bit later.
Testing for Waddell Triad
When dealing with a traumatic injury, a CT scan of the entire body is usually one of the first steps. This type of scan can quickly help doctors identify injuries to your brain, chest, abdomen, or any bones in your body. This scanning procedure is typically part of a more thorough check-up known as the tertiary trauma survey. This survey follows a detailed check of your medical history and a physical examination, aiming to spot any signs of injury.
During this check up in the emergency room, doctors may also take blood samples and carry out more imaging tests. While these can be helpful, they can sometimes miss significant issues. For example, an X-ray of the neck might miss some important injuries; a measurement of your red blood cell count and concentration might not accurately reflect a recent severe bleeding event; and some blood tests may show abnormal liver function as a result of an injury to the abdomen. However, these patients immediately have a CT scan and proceed to surgery irrespective of their liver test results. These additional tests aren’t used for every patient and could slow down the emergency response process.
Doctors have made guides to help identify those patients who have a low risk of injury and worsening condition. For these patients, it might not be necessary to carry out more specific imaging tests and laboratory studies.
Treatment Options for Waddell Triad
When managing a patient with Waddell triad – a condition typically present in children following a severe injury -, the usual process involves assessing their airway, breathing, circulatory status, neurological deficits, and overall exposure to their environment. This is also termed the ABCDE approach to trauma.
Professionals must ensure that the patient’s airway is clear, maintaining the spine still as they do so. Usually, to ensure optimal oxygen flow and safeguard the spine, medical professionals will use various devices to secure the patient. If the airway is obstructed, professionals will act accordingly – obstruction may be due to various causes such as facial fractures, aspirations, or injuries affecting the voice box.
Breathing assessment involves checking the rate, symmetry and effectiveness of the respiratory motions, and using a pulse oximeter to monitor the patient’s oxygen saturation. In situations where the patient’s own breathing is inadequate, professionals will aid with bag-mask ventilation and potentially proceed to place a tube in the windpipe to maintain air flow.
Circulation refers to how well the body’s organs are being supplied with blood, and particularly detecting signs of inadequate blood supply or shock – rapidly reacting to control hemorrhages or bleeding. Professionals may set up intravenous access and infuse fluids rapidly to maintain the patient’s hydration status.
Neurological deficits or losses are assessed by determining the patient’s level of consciousness using the AVPU (Alert, Verbal, Pain, Unresponsive) scoring system and, in severe cases of trauma, the Glasgow Coma Scale (GCS). The latter helps assess the potential degree of brain injury and allows healthcare providers to monitor the patient’s condition over time. Prompt action is taken if there are signs of increasing pressure inside the skull due to conditions such as brain swelling or blood clots within the skull.
Lastly, upon arrival in the emergency department, professionals will fully expose the patient by removing their clothes to check for any hidden injuries, and quickly warm them up if needed due to their susceptibility to low body temperature after traumatic incidents.
Femur fractures often present in children with Waddell triad are treated based on certain factors such as the child’s age, type of fracture, associated injuries and the treating physician’s expertise, among other considerations. Tools like the Pediatric trauma score (PTS) can help healthcare providers prioritize their patient’s needs based on how severe their injuries are and forecast potential outcomes.
What else can Waddell Triad be?
The bullet list implies that these are various types of injuries that could occur or be associated with physical abuse towards children. These include:
- Abusive head trauma
- Chest abdomen trauma
- Countercoup head injury
- Failure to recognize associated life-threatening injuries
- Leg injury
- Physical child abuse
