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[Characteristics of thoracic injuries in children]
1Service de Chirurgie Pédiatrique, CHUV, Lausanne, Switzerland.
Insights
Pediatric thoracic trauma requires specialized management distinct from adult protocols. This study highlights unique diagnostic and treatment approaches for severe chest injuries in children, emphasizing Glasgow Score
Area of Science:
- Pediatric Trauma Surgery
- Thoracic Medicine
- Emergency Medicine
Background:
- Thoracic trauma is infrequent in pediatric populations.
- Management strategies for adult thoracic trauma are not directly applicable to children.
- Severe thoracic trauma in children presents unique diagnostic and therapeutic challenges.
Purpose of the Study:
- To present findings from a cohort of children with severe thoracic trauma.
- To delineate specific features of diagnosis, treatment, and outcomes in pediatric thoracic trauma.
- To compare pediatric thoracic trauma characteristics with adult trauma patterns.
Main Methods:
- Retrospective review of 85 children (ages 1-16) with severe thoracic trauma treated between 1976 and 1990.
- Analysis of injury mechanisms, injury severity scores, clinical presentation, diagnostic findings (auscultation, percussion, chest X-ray), and interventions.
- Evaluation of mortality predictors and treatment outcomes.
Main Results:
- Traffic accidents were the most common cause (62%), with 55% experiencing multisystemic injuries.
- Mortality correlated with the Glasgow Coma Scale score, not the Injury Severity Score.
- Intrathoracic lesions presented with dyspnea (65%), cyanosis (25%), or suspected pleural effusion/pneumothorax (47%); 12 patients were asymptomatic.
- Chest X-rays identified lesions in 76% of cases; pneumothorax was associated with rib fractures in only 30% of cases.
- No pediatric patients developed flail chest, even with multiple rib fractures.
Conclusions:
- Pediatric thoracic trauma management must be individualized and distinct from adult protocols.
- Glasgow Coma Scale is a critical prognostic indicator in pediatric thoracic trauma.
- Early physiotherapy and appropriate ventilation strategies are crucial for favorable outcomes in pediatric thoracic trauma patients.
Abstract:
Thoracic trauma is uncommon in children. It should not be managed any more as adult's trauma. We present our experience with 85 children form 1 to 16 years of age, presenting severe thoracic trauma treated in Lausanne, Switzerland, between 1976 and 1990. The specific features of diagnosis, treatment and outcome are presented. Most of them were involved in traffic accidents (62%), 55% had multisystemic injuries. The mortality rate was not a function of the Injury Seventy Score as in adults, but was only related to the Glasgow Score. Only 3 patients (3.5%) had hemodynamic instability on admission in relation with their thoracic injury. Patients with intrathoracic lesions showed dyspnoea (65%), cyanosis (25%), or clinical suspicion of a pleural effusion or a pneumothorax (47%). However 12 children had an asymptomatic severe thoracic injury. In 53 patients (62%) the auscultation was found abnormal either with absent or diminished breath sounds or other pathological findings. 10 out of 26 cases of pneumothorax could be suspected by percussion dullness. Chest X-rays showed a lesion in 76% of cases. Only 30% of the pneumothorax were associated with visible rib fractures. 10 children suffered from 4 to 12 fractures of the ribs (mean 6.6). None of these patients presented a flail chest as in adults, even when multiple rib fractures existed. 31 thoracic drainages were performed, during a mean period of 3.3 days. 30 patients were intubated and ventilated, 22 of these due to a neurosurgical condition. All patients had physiotherapy starting on day 2, under analgesia if necessary.(ABSTRACT TRUNCATED AT 250 WORDS)