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Predicting Thoracic Injury in Children With Multitrauma

Kirstin D Weerdenburg1, Paul W Wales, Derek Stephens2

  • 1From the Division of Pediatric Emergency Medicine.

Pediatric Emergency Care
|May 10, 2017
PubMed

Insights

In high-risk pediatric trauma, thoracic symptoms, abnormal auscultation, low saturation, low blood pressure, and femur fractures predict thoracic injury (TI). Even without these predictors, TI can occur, supporting chest radiography in all trauma resuscitations.

Area of Science:

  • Pediatric Trauma Care
  • Thoracic Injury Diagnosis
  • Emergency Medicine

Background:

  • Previous pediatric trauma research often focused on abnormal chest radiographs or low injury severity.
  • Identifying predictors of thoracic injury (TI) in high-risk pediatric populations is crucial for accurate diagnosis and management.

Purpose of the Study:

  • To identify predictors of thoracic injury (TI) diagnoses in a high-risk pediatric trauma population.
  • To determine the rate of TI in children without identified predictors.

Main Methods:

  • Retrospective analysis of a trauma registry including previously healthy children (0-17 years) with multisystem blunt trauma.
  • Patients requiring trauma team activation and chest radiography were assessed for TI and potential predictors.
  • Plausible TI predictors included Glasgow Coma Scale score ≤13, abnormal thoracic/abdominal signs/symptoms, abnormal chest auscultation, abnormal respiratory parameters, and femur fracture.

Main Results:

  • Thoracic injury (TI) was diagnosed in 141 (29%) of 493 eligible children.
  • Independent predictors of TI included thoracic symptoms/signs (OR, 6.0), abnormal chest auscultation (OR, 3.5), saturation <95% (OR, 3.1), blood pressure <5th percentile (OR, 3.7), and femur fracture (OR, 2.5).
  • Five percent (6 of 119) of children without these predictors still had TI.

Conclusions:

  • Thoracic symptoms/signs, abnormal chest auscultation, low oxygen saturation, low blood pressure, and femur fracture are significant predictors of TI in pediatric trauma.
  • A notable proportion of children without these predictors still sustained TI, underscoring the continued importance of chest radiography in pediatric trauma resuscitation.
Abstract

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