Occult pneumothoraces in children with blunt torso trauma
Lois K Lee1, Alexander J Rogers, Peter F Ehrlich
1The Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Summary
Most occult pneumothoraces in injured children are not identified on initial chest X-rays (CXRs) and are managed without tube thoracostomy. Observation is a viable initial management strategy for these cases.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Trauma Surgery
Background:
- Plain chest X-rays (CXRs) are standard for identifying pneumothoraces in trauma patients.
- Computed tomography (CT) scans can detect occult pneumothoraces missed by CXR.
- The clinical significance of occult pneumothoraces in children is not well-established.
Purpose of the Study:
- To determine the proportion of occult pneumothoraces in injured children.
- To assess the rate of tube thoracostomy treatment for occult pneumothoraces in this population.
Main Methods:
- A substudy of a prospective multicenter observational cohort of children (<18 years) with blunt torso trauma.
- Analysis of CXRs and subsequent CT scans for pneumothorax identification.
- Definition of occult pneumothorax as a pneumothorax seen on CT but not CXR.
Main Results:
- Occult pneumothoraces were found in 60.2% of children with pneumothoraces.
- Only 15.6% of children with occult pneumothoraces underwent tube thoracostomy, compared to 57.4% with CXR-identified pneumothoraces.
- Pneumothoraces were uncommon (4.6%) in the study population.
Conclusions:
- Pneumothoraces are infrequent in pediatric blunt torso trauma, with most being occult.
- A significant majority of occult pneumothoraces are managed non-operatively.
- Observation should be considered for initial management of pediatric occult pneumothoraces.
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