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Clinical considerations for blunt laryngotracheal trauma in children
Jeffrey Cheng1, Matthew Cooper2, Elisabeth Tracy3
1Pediatric Otolaryngology, Department of Surgery, Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC 27710, United States.
Insights
This systematic review highlights variations in managing pediatric blunt laryngeal and tracheal trauma. A tailored approach based on injury severity and clinical findings is crucial for optimal outcomes in children.
Area of Science:
- Pediatric Trauma Surgery
- Otolaryngology
- Emergency Medicine
Background:
- Blunt trauma to the larynx and trachea in children is uncommon but can lead to severe morbidity.
- Existing management strategies show significant variation in clinical practice.
- Understanding the natural history and potential complications is vital for effective care.
Purpose of the Study:
- To systematically review blunt pediatric laryngeal and tracheal trauma.
- To develop a proposed strategy for the evaluation and management of these injuries.
Main Methods:
- A comprehensive systematic review of literature was conducted using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials.
- A medical librarian assisted in the review process.
- A clinical consideration algorithm was proposed based on the findings.
Main Results:
- Fifty reports involving 66 pediatric patients (76.1% male, average age 9.5 years) were analyzed.
- Computed tomography (CT) had a false-negative rate of 29.5%.
- Treatments ranged from observation to open neck exploration, with tracheotomy used in 33.3% of cases. Mortality was rare (1.5%).
Conclusions:
- Clinical practice deviates from established management algorithms for pediatric blunt airway trauma.
- Computed tomography and laryngoscopy may have limited roles, and clinical evaluation is paramount.
- Operative endoscopy is recommended for positive physical findings, with treatment individualized to injury extent.
Objective:
Systematic review of blunt pediatric laryngeal and tracheal trauma and development of proposed evaluation and management strategy.
Study Design:
Systematic review and proposed clinical consideration algorithm.
Data Sources:
PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials.
Review Methods:
A medical librarian was utilized.
Results:
329 titles and abstracts were identified, and 50 reports were included. A total of 66 children were identified, with a majority of males (76.1%). Average age was 9.5±4.4years [range 2-17]. CT was employed in 66.7% of cases. False negative CT occurred in 29.5% of cases. Treatment consisted of observation (9.1%), endoscopy alone (31.8%), endoscopic repair (7.6%), and open neck exploration with repair/open reduction internal fixation (ORIF) (51.5%). Tracheotomy was utilized in 33.3% of the cases. Mortality was rare, with only one (1.5%) reported and occurred within one hour after presentation.
Conclusions:
Significant deviation and variation from recommended previously proposed management algorithms exists in reported cases. Awareness of the natural clinical history, potential for severe morbidity or mortality, and associated complications are extremely important. CT and fiberoptic, bedside laryngoscopy may not play a significant role but may add to clinical evaluation prior to operative intervention. If employed, care must be taken to not create an unstable clinical scenario. Operative endoscopy is recommended in cases with positive physical examination findings, and treatment tailored to extent of injury.
Level Of Evidence:
IV.
Type Of Study:
Systematic review.
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