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Emergency Department thoracotomy in children--a critical analysis.
S S Rothenberg1, E E Moore, F A Moore
1Department of Surgery, Denver General Hospital, CO 80204-4507.
The Journal of Trauma
|October 1, 1989
Summary
Emergency Department (E.D.) thoracotomy in pediatric patients shows low survival, especially with blunt trauma. Selective use is recommended, favoring penetrating injuries over blunt trauma in critically injured children.
Area of Science:
- Pediatric Trauma Surgery
- Emergency Medicine
- Thoracic Surgery
Background:
- Clinical reviews have clarified the role of Emergency Department (E.D.) thoracotomy in critically injured adults.
- Guidelines for pediatric E.D. thoracotomy remain ill-defined.
Purpose of the Study:
- To examine the yield of E.D. thoracotomy in patients 18 years or younger.
- To inform a more cost-effective application of this critical intervention in children.
Main Methods:
- Retrospective review of 689 consecutive E.D. thoracotomies over 11 years.
- Analysis of 83 pediatric patients (≤18 years) including injury mechanism, age, sex, and vital signs on presentation.
- Survival rates were analyzed by injury mechanism and initial physiologic status.
Main Results:
- Pediatric patients represented 12% (83/689) of E.D. thoracotomies, with a mean age of 15 years.
- Overall survival was low, with higher rates for stab wounds (9%) and gunshot wounds (4%) compared to blunt trauma (2%).
- Patients presenting with vital signs had a 14% survival rate, contrasting sharply with those without vital signs (1 survival out of 69).
Conclusions:
- E.D. thoracotomy outcomes in children are comparable to adults.
- Blunt trauma, the leading cause of pediatric trauma deaths, has a poor prognosis with E.D. thoracotomy.
- A selective approach is supported: liberal use for penetrating injuries, but limited use for blunt trauma in patients without vital signs.