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Chest injuries in childhood.

D K Nakayama1, M L Ramenofsky, M I Rowe

  • 1Department of Pediatric Surgery, Children's Hospital, Pittsburgh, Pennsylvania.

Annals of Surgery
|December 1, 1989
PubMed
Summary

Pediatric chest trauma is predominantly blunt, often occurring without rib fractures. Associated injuries significantly increase severity and hospitalization, but ventilatory support is rarely needed and typically brief.

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Area of Science:

  • Pediatric Trauma Surgery
  • Thoracic Injury Management
  • Childhood Injury Epidemiology

Background:

  • Childhood thoracic trauma presents unique challenges due to anatomical and injury mechanism differences.
  • Blunt trauma, particularly from traffic accidents, is the leading cause of chest injuries in children.
  • Significant intrathoracic injuries can occur without obvious signs like rib fractures.

Purpose of the Study:

  • To characterize the scope and consequences of chest injuries in pediatric patients.
  • To identify factors influencing injury severity, treatment needs, and outcomes in children with thoracic trauma.
  • To compare the incidence of specific injuries and interventions in children versus adults.

Main Methods:

  • Retrospective review of 105 pediatric patients (1 month to 17 years) admitted with chest injuries between 1981 and 1988.
  • Analysis of injury mechanisms, types of thoracic and associated injuries, interventions (e.g., intubation, ventilation), and outcomes (hospitalization duration, mortality).
  • Correlation of injury severity scores (e.g., Injury Severity Score, Chest Abbreviated Injury Scale) with mortality and other outcomes.

Main Results:

  • Nearly all injuries (97.1%) were blunt, with traffic accidents being common (over 50%).
  • Rib fractures (49.5%) and pulmonary contusions (53.3%) were frequent, but significant injuries occurred without rib fractures in 52% of blunt trauma cases.
  • Associated injuries (head, abdominal, orthopedic) were present in 68.6%; intubation was needed in 20%. Longer hospitalizations and higher Injury Severity Scores were linked to associated injuries, intubation, pneumothorax, and hemothorax.

Conclusions:

  • Blunt mechanisms dominate pediatric chest trauma, frequently involving injuries beyond rib fractures.
  • While associated injuries and specific thoracic injuries (pneumothorax, hemothorax) worsen outcomes, the need for prolonged ventilatory support is uncommon.
  • Severe injuries like aortic transection and flail chest are rare in children, and thoracotomy is infrequently required.

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