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Thoracic trauma in children: an indicator of increased mortality
M H Peclet1, K D Newman, M R Eichelberger
1Department of Surgery, George Washington University School of Medicine, Washington, DC.
Insights
Thoracic trauma in children significantly increases morbidity and mortality, with chest injuries often occurring alongside other severe injuries. Prompt assessment and treatment are crucial for improving outcomes in pediatric trauma patients.
Area of Science:
- Pediatric Trauma Surgery
- Emergency Medicine
- Critical Care Pediatrics
Background:
- Thoracic trauma is a critical concern in pediatric injuries.
- Understanding its impact on morbidity and mortality is essential for effective management.
Purpose of the Study:
- To evaluate the significance of thoracic trauma as an indicator of poor outcomes in children.
- To analyze the characteristics, injuries, and survival rates associated with pediatric thoracic trauma.
Main Methods:
- Prospective data collection over 34 months in a Level I pediatric trauma center.
- Inclusion of 2,086 children under 15 with blunt or penetrating trauma.
- Recording of Trauma Score (TS), Injury Severity Score (ISS), and etiological data for thoracic trauma cases.
Main Results:
- 104 children (4.4%) sustained thoracic trauma, primarily from pedestrian incidents and motor vehicle crashes.
- Common injuries included pulmonary contusion, pneumothorax/hemothorax, and rib fractures, with 82% experiencing multisystem trauma.
- Thoracic trauma patients had significantly worse TS (11) and ISS (27) compared to controls (15 and 7).
- The mortality rate was 26%, highest for heart/great vessel injuries (75%) and lower for isolated chest trauma (5%).
- Combined injuries, especially head and chest trauma, markedly increased mortality risk.
Conclusions:
- Thoracic trauma is a significant predictor of severe outcomes and mortality in pediatric patients.
- Multisystem involvement is common and exacerbates the severity of thoracic injuries.
- Targeted interventions for pediatric thoracic trauma are vital, particularly when associated with head or abdominal injuries.
Abstract:
This study was undertaken to assess the significance of thoracic trauma as a marker of morbidity and mortality in children. During a 34-month period, 2,086 children younger than 15 years old were consecutively admitted to a Level I pediatric trauma center with blunt or penetrating trauma. For each child we prospectively recorded Trauma Score (TS), Injury Severity Score, (ISS), medical, and etiologic data. One hundred four children (4.4%) presented with thoracic trauma. The most common mechanisms of injury were pedestrian injury (36%), motor vehicle crashes (32%), and armed assault (12%). The most common injuries were pulmonary contusion (48%), pneumothorax, hemothorax, or pneumohemothorax (39%), and rib fractures (32%). Multisystem injury was present in 82% of the children. The mean TS and ISS were 11 and 27, respectively, significantly worse than scores for children without thoracic injury (15 and 7; P less than .0001). Seventy-one percent of the children were admitted to the intensive care unit, where they stayed an average of 6 days; 20% required surgery. The mortality rate was 26%. Injuries to the heart or great vessels had the highest mortality rate (75%), followed by hemothorax (53%), lung laceration (43%), and rib fracture (42%). Mortality for children with isolated chest injury was 5%, compared with rates of 20% for abdominal and chest trauma, 35% for head and chest trauma, and 39% for trauma to the head, chest, and abdomen. Less than 5% of the admissions to a pediatric trauma center incurred thoracic injury.(ABSTRACT TRUNCATED AT 250 WORDS)