Vol. 3 -- # 9

           "The Injured Child"
        Presented as the Robert E. Gross Lecture
To Students and Faculty of the University of Texas Health Science Center
              Houston, TX
            February 19,1983

This is a compassionate and hard-hitting lecture I gave to my peers on the subject of the
injured child. I minced no words about the fact that children do not get a fair shake in the
adult world of surgery, and I made a plea for better consideration of those elements that
contribute to the child's recovery, which take place before admission to an emergency
facility and after discharge from the hospital.

This is a vintage Koop lecture in reference to pediatric surgery, and I was especially frank
about competition between hospitals, the need for facilities dedicated to children, and `8~
the appalling statistics that one in four patients injured dies unnecessarily because the
right things were not done, at the right time, and in the right place.

It is interesting to compare my insight in 1983 with the lecture I gave to the Circle of
Care in 2002, where I am still harping on the same subject: for all our advances in
training of people, we are not giving as good surgical care to our grandchildren as our
children received. The reason: too many surgeons, not enough experience, and each one #~7
learning repeatedly only from his own mistakes.

My team approach will be reiterated over and over again. I say in this lecture: "I have no
intention of disparaging the surgical specialties. Far from it. Nevertheless, children do
not live according to vertical medical specialties.. . they are generally not injured only by
specialty area.. . and we know they do not recover on a specialty - by specialty basis.
Hence, I would encourage a development of the team approach with primary
responsibility resting in the hands of a generalist."

Causes of injury to children
Emergency Medical System
Family abuse of children
Home care
Hospital competition
Post treatment care
Pediatric surgery
Physical abuse of children
Pre-injury treatment care
Sexual abuse
Support Services

American College of Surgeons
"Early care of the injured patient"
Glasgow Coma scale


Robert E. Gross
Journal of Pediatric Surgery
"Major Trauma Outcomes Study"