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Blunt diaphragmatic rupture in children
Katherine A Barsness1, Denis D Bensard, David Ciesla
1Division of Pediatric Surgery, The Children's Hospital, Denver, CO 80262, USA. katherine.barsness@uchsc.edu
Insights
Pediatric blunt diaphragmatic rupture is rare but serious, occurring in children with injuries similar to adults. However, children appear to have better survival rates from this trauma.
Area of Science:
- Pediatric Trauma Surgery
- Thoracic Injuries
- Diaphragmatic Injuries
Background:
- Blunt diaphragmatic rupture is well-documented in adults but poorly understood in children.
- This study addresses the knowledge gap regarding pediatric blunt diaphragmatic rupture.
Purpose of the Study:
- To characterize blunt diaphragmatic rupture in pediatric patients.
- To compare the injury's frequency, severity, and outcomes in children versus adults.
Main Methods:
- A 10-year retrospective review of a Level I pediatric trauma registry.
- Identification of all pediatric patients admitted with blunt diaphragmatic rupture.
Main Results:
- Six pediatric cases (0.4% of admissions) were identified, with ages ranging from 2 to 15 years.
- All children had associated injuries (mean 4.5 per child) and a high mean Injury Severity Score (32).
- No deaths occurred, and all patients were discharged without long-term complications, suggesting better survival than in adults.
Conclusions:
- Blunt diaphragmatic rupture in children presents with severity comparable to adults.
- Pediatric patients may experience improved survival outcomes compared to their adult counterparts for this specific injury.
Background:
Although several series of blunt diaphragmatic rupture in adults have been published, this injury remains largely uncharacterized in the pediatric population.
Methods:
We queried our trauma registry for all children admitted with blunt diaphragmatic rupture over a 10-year period at a Level I pediatric trauma center.
Results:
Six children (aged 2-15 years; mean, 7 years) were identified with blunt diaphragmatic rupture (three right, two left, one bilateral), representing 0.4% of admissions. All of the children had associated injuries (4.5 per child), with a mean Injury Severity Score of 32. Four diaphragmatic injuries were identified during the initial evaluation. The two missed injuries were diagnosed at postinjury days 5 and 8. There were no deaths and all children were eventually discharged without sequelae.
Conclusion:
Blunt diaphragmatic rupture occurs in children with a frequency and severity commensurate with that observed in adults. Our data suggest improved survival compared with adults with this injury.
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