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Cardiac and great vessel injuries in children after blunt trauma: an institutional review
G M Tiao1, P M Griffith, J R Szmuszkovicz
1Division of Pediatric Surgery, Children's Hospital of Los Angeles and the University of Southern California-Keck School of Medicine, 90027, USA.
Insights
Blunt trauma in children rarely causes cardiac or great vessel injury. Cardiac contusions were most common but usually minor, with other heart injuries being rare.
Area of Science:
- Pediatric Trauma Surgery
- Cardiovascular Injury
- Blunt Force Trauma Research
Background:
- Blunt trauma in children can lead to significant injuries.
- Understanding the incidence of cardiac and great vessel injuries is crucial for pediatric trauma care.
Observation:
- A retrospective review analyzed 2,744 pediatric patients with blunt trauma injuries.
- The study focused on identifying and characterizing cardiac and great vessel damage.
Findings:
- Cardiac and great vessel injuries were uncommon in this pediatric cohort.
- Cardiac contusions occurred in 4 patients, all recovering, and were also found incidentally at autopsy in 4 others.
- Rare noncontusion cardiac injuries included a traumatic ventricular septal defect and a ventricular septal aneurysm.
- Great vessel injuries were infrequent, including a superior vena cava disruption and a periaortic hematoma.
Implications:
- Cardiac contusions are the most frequent cardiac injury in pediatric blunt trauma but generally have minimal clinical impact.
- Noncontusion cardiac injuries and great vessel injuries are rare but require prompt recognition and management.
- The absence of aortic transection cases highlights the rarity of this specific severe injury in pediatric blunt trauma.
Purpose:
The purpose of this study was to review the incidence of cardiac and great vessel injury after blunt trauma in children.
Method:
A retrospective review of 2,744 patients with injuries from blunt mechanisms was performed.
Results:
Eleven patients sustained cardiac injury. Four patients had clinically evident cardiac contusions. All recovered. Four patients who died from central nervous system injury were found to have cardiac contusions at autopsy. None had clinical evidence of contusion before demise. One patient had a traumatic ventricular septal defect (VSD) that required operative repair. Autopsy findings showed a VSD in another patient, and a third patient was found to have a ventricular septal aneurysm that was treated medically. Two patients had great vessel injuries. One patient had a contained disruption of the superior vena cava that was managed nonoperatively. Another patient had a midthoracic periaortic hematoma without intimal disruption found at autopsy. One patient had cardiac and great vessel injuries. Discrete aneurysms of 2 coronary artery branches and the pulmonary outflow tract were identified by cardiac catheterization. This patient was treated nonoperatively.
Conclusions:
Cardiac and great vessel injury after blunt trauma are uncommon in children. Cardiac contusion was the most common injury encountered but had minimal clinical significance. Noncontusion cardiac injury is rare. No patient with aortic transection was identified.
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