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Resuscitative thoracotomy for pediatric trauma in Illinois, 1999 to 2009
Norman G Nicolson1, Steven Schwulst1, Thomas A Esposito2
1Division of Trauma and Critical Care, Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Suite 650, Chicago, IL 60611, USA.
Insights
Resuscitative thoracotomy in pediatric trauma is rare, with low survival rates. However, selected penetrating trauma cases show potential for positive outcomes, warranting continued use in specific emergency department scenarios.
Area of Science:
- Pediatric Trauma Surgery
- Emergency Medicine
- Critical Care
Background:
- Resuscitative thoracotomy outcomes are generally poor in adults.
- Limited research exists on its application in pediatric trauma cases.
Purpose of the Study:
- To evaluate the utilization and outcomes of resuscitative thoracotomy in pediatric patients.
- To identify factors influencing survival in this population.
Main Methods:
- Data from the Illinois State Trauma Registry (1999-2009) was analyzed.
- Included patients aged 0-15 undergoing emergency department thoracotomy.
- Examined injury mechanisms, vital signs, and mortality, controlling for injury severity.
Main Results:
- Resuscitative thoracotomy was infrequently performed (2.3 cases/year) in pediatric trauma.
- Most patients sustained penetrating injuries and presented in extremis (17% with signs of life).
- Initial survival was 24% (6 patients), with only 8% (2 patients) surviving to hospital discharge.
Conclusions:
- Resuscitative thoracotomy is rarely performed in pediatric emergency departments.
- Overall survival is low, but positive outcomes were observed in select penetrating trauma cases.
- Supports a continued, selective role for emergency department resuscitative thoracotomy in pediatric patients.
Background:
Outcomes in adults who undergo resuscitative thoracotomy are poor. Few studies have examined the procedure's use in pediatric trauma.
Methods:
The Illinois State Trauma Registry was queried for thoracotomy performed in the emergency department from 1999 to 2009, for patients aged 0 to 15. Injury mechanism, vital signs, and mortality were examined while controlling for injury severity.
Results:
Resuscitative thoracotomy was infrequently performed in pediatric trauma (n = 25; 2.3/year). Most patients had suffered penetrating injury. Patients who underwent resuscitative thoracotomy were in extremis, with only 17% demonstrating signs of life upon presentation. Although 6 patients (24%) survived initially, only 2 (8%) survived to hospital discharge.
Conclusions:
Resuscitative thoracotomy was rarely performed in children in Illinois emergency departments. Survival is low for thoracotomy in the emergency department, but some patients who presented with penetrating injuries did have positive outcomes, supporting a continued role for the procedure in select cases.
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