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Pediatric emergency department thoracotomy: a large case series and systematic review

Casey J Allen1, Evan J Valle1, Chad M Thorson1

  • 1Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.

Journal of Pediatric Surgery
|January 20, 2015
PubMed

Insights

Emergency department thoracotomy (EDT) survival in children is low but comparable to adults. Blunt trauma patients without signs of life have no survival, while penetrating trauma patients show some salvageability.

Area of Science:

  • Pediatric Surgery
  • Trauma Surgery
  • Emergency Medicine

Background:

  • Emergency department thoracotomy (EDT) is rarely performed in pediatric patients, limiting understanding of survival factors.
  • Limited data exists on factors influencing survival after EDT in children.

Purpose of the Study:

  • To review institutional experience and systematically analyze published data on pediatric emergency department thoracotomy.
  • To identify factors associated with survival in pediatric patients undergoing EDT.

Main Methods:

  • Retrospective review of pediatric patients (age ≤18) who underwent EDT (1991-2012) at a single institution.
  • Systematic review of published case series of pediatric EDT.
  • Analysis of patient demographics, injury mechanism, vital signs, return of spontaneous circulation, and survival outcomes.

Main Results:

  • 252 pediatric patients analyzed; 84% male, median age 15 years.
  • Survival rates: 1.6% for blunt trauma, 10.2% for penetrating injuries, 6.0% overall.
  • Signs of life (SOL) or return of spontaneous circulation (ROSC) were associated with improved survival, particularly in penetrating trauma.

Conclusions:

  • Pediatric EDT survival is comparable to adult outcomes.
  • Blunt trauma in children without SOL is uniformly unsalvageable.
  • Penetrating trauma patients with SOL, or those without SOL for a short pre-arrival period, demonstrate salvageability.
Abstract

Keywords:
AdolescentsChildrenKidsResuscitative thoracotomy

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