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Management and outcomes of traumatic hemothorax in children

Pamela M Choi1, Shannon Farmakis2, Thomas J Desmarais1

  • 1Division of Pediatric Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, 660 South Euclid Avenue, Saint Louis, MO 63110, USA.

Journal of Emergencies, Trauma, and Shock
|May 8, 2015
PubMed

Insights

Pediatric traumatic hemothorax management differs by injury type. Observation is safe for small-volume blunt hemothorax in children, avoiding mandatory tube thoracostomy and reducing complications.

Area of Science:

  • Pediatric Trauma Surgery
  • Thoracic Surgery
  • Emergency Medicine

Background:

  • Established adult guidelines for traumatic hemothorax lack pediatric counterparts.
  • Pediatric traumatic hemothorax management and outcomes require specific investigation.

Purpose of the Study:

  • To evaluate the management strategies and clinical outcomes of pediatric patients diagnosed with traumatic hemothorax.
  • To identify optimal treatment pathways for pediatric hemothorax based on injury mechanism and volume.

Main Methods:

  • Retrospective cross-sectional study of pediatric trauma patients with hemothorax (2007-2012).
  • Data collected from a Level-1 pediatric trauma center.
  • Analysis of management (observation vs. tube thoracostomy) and outcomes based on injury mechanism (blunt vs. penetrating).

Main Results:

  • Forty-six pediatric hemothorax cases were analyzed (23 blunt, 23 penetrating).
  • Penetrating injuries predominantly received tube thoracostomy (91.3%), while blunt injuries were more often observed (69.6%).
  • Blunt hemothorax patients managed with chest tubes had larger volumes; observed patients showed no progression and required no delayed procedures. CT-identified hemothorax after negative X-ray needed no intervention. No delayed empyema or fibrothorax occurred.

Conclusions:

  • Small-volume traumatic hemothorax from blunt mechanisms in children can be safely managed with observation.
  • Mandatory tube thoracostomy may not be necessary for all pediatric blunt hemothorax cases.
  • Observation strategies for pediatric blunt hemothorax are associated with low complication rates.
Abstract

Keywords:
Hemothoraxthoracic traumatube thoracostomy

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