Pediatric trauma management in low-resource emergency departments: from first contact to safe disposition - a narrative review.

Document Type

Article

Publication Date

3-24-2026

Abstract

BACKGROUND: Pediatric trauma is a leading cause of childhood mortality worldwide, with a disproportionate burden in low- and middle-income countries (LMICs) where up to 90% of injury-related deaths occur. Most deaths happen within 24 h in facilities lacking essential resources. A critical gap exists between high-resource trauma protocols like Advanced Trauma Life Support (ATLS) developed for settings with trauma teams, advanced imaging, and immediate specialist availability and the realities of care delivery in low-resource emergency departments (EDs).

OBJECTIVE: This review synthesizes evidence to develop context-adapted pathways for optimizing pediatric trauma care in LMICs from first contact with the health system through stabilization to safe disposition.

METHODS: We conducted a narrative synthesis of literature published between 2014 and 2025 on epidemiology, low-resource assessment, damage-control interventions, and system-level adaptations following JBI scoping review framework principles.

RESULTS: Pediatric trauma in LMICs is dominated by road traffic crashes, falls, and burns, with males aged 11-18 years most affected. We describe a "low resource xABCDE" approach prioritizing clinical signs, a tiered strategy distinguishing local stabilization from immediate referral across specific injury types, and core system elements including structured checklists, minimum documentation datasets, and safeguarding pathways.

CONCLUSION: Outcomes associated with pediatric trauma in LMICs can be improved through context-adapted approaches that move beyond direct replication of high-resource protocols. We advocate for the adoption and validation of "Pediatric Trauma-Lite" models simplified, scalable pathways that empower frontline providers with knowledge of what can be done immediately, what can be safely improvised, and what requires urgent transfer. Global and national leadership must prioritize the development, implementation, and evaluation of these context-appropriate trauma systems.

Publication Title

Int J Emerg Med

Volume

19

Issue

1

First Page

72

Last Page

72

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