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Severe blunt thoracic trauma: differences between adults and children in a level I trauma centre
Insights
Children with blunt thoracic trauma have similar injury severity to adults but lower mortality rates. They are more often injured as pedestrians and sustain fewer rib fractures and blunt cardiac injuries but more lung contusions.
Area of Science:
- Trauma surgery
- Pediatric critical care
- Injury epidemiology
Background:
- Blunt thoracic trauma is a significant cause of mortality globally, particularly in developing nations.
- While common in both adults and children, differences in injury patterns and outcomes between these groups are understudied.
- Understanding these disparities is crucial for targeted interventions and improved patient care.
Purpose of the Study:
- To conduct a comparative analysis of blunt thoracic trauma in pediatric versus adult patients.
- To investigate differences in injury mechanisms, clinical presentation, management strategies, and patient outcomes.
- To identify specific risk factors and injury patterns unique to each age group.
Main Methods:
- Retrospective analysis of patients admitted to a trauma intensive care unit in Durban, South Africa.
- Data extraction from a pre-existing trauma registry, focusing on demographics and injury details.
- Comparison of injury severity scores, lactate levels, specific thoracic injuries, and mortality rates between adult and pediatric cohorts.
Main Results:
- Children (<18 years) constituted 20.2% of the cohort; adults comprised 79.7%.
- Injury Severity Scores (ISS) were comparable (median 32 vs. 34, p=0.812).
- Children more frequently sustained injuries as pedestrians in motor vehicle collisions, experienced fewer rib fractures, flail chests, and blunt cardiac injuries, but had higher rates of lung contusions. Adults presented with higher lactate levels. Pediatric mortality was significantly lower (16.7% vs. 27.8%, p=0.037).
Conclusions:
- Pedestrian-related motor vehicle collisions are a more common mechanism for thoracic trauma in children compared to adults.
- Children exhibit distinct injury patterns, including fewer fractures and blunt cardiac injuries but more lung contusions, despite similar overall injury severity.
- Significantly lower mortality in children underscores the need for enhanced child safety measures and pedestrian injury prevention strategies.
Background:
Trauma is a leading cause of death in the developing world. Blunt thoracic trauma represents a major burden of disease in both adults and children. Few studies have investigated the differences between these two patient groups.
Objective:
To compare mechanism of injury, presentation, management and outcome in children and adults with blunt thoracic trauma.
Methods:
Patients were identified from the database of the trauma intensive care unit at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. Demographics and relevant data were extracted from a pre-existing database.
Results:
Of 415 patients admitted to the unit, 331 (79.7%) were adults and 84 (20.2%) children aged < 18 years. The median injury severity score (ISS) was similar for both age groups (32 v. 34; p = 0.812). Adults had a higher lactate level at presentation (3.94 v. 2.60 mmol/L; p = 0.001). Of the children, 96.4% were injured in motor vehicle collisions, 75.0% as pedestrians. Compared with adults, children had significantly fewer rib fractures (20.2% v. 42.0%; p < 0.001), flail chests (2.4% v. 26.3%; p<0.001) and.blunt cardiac injuries (BCIs) (9.5% v. 23.6%; p = 0.004), but sustained more lung contusions (79.8% v. 65.6%; p = 0.013). Mortality in children was significantly lower than in adults (16.7% v. 27.8%; p = 0.037).
Conclusion:
Thoracic injuries in children are the result of pedestrian collisions more often than in adults. They suffer fewer rib fractures and BCIs, but more lung contusions. Despite similar ISSs, children have significantly lower mortality than adults. More effort needs to be concentrated on child safety and preventing pedestrian injury.
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