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Survival after emergency department thoracotomy in the pediatric trauma population: a review of published data

Eliza E Moskowitz1,2, Clay Cothren Burlew1,2, Ann M Kulungowski1,2

  • 1Department of Surgery, Denver Health Medical Center and the University of Colorado School of Medicine, Denver, CO, USA.

Pediatric Surgery International
|June 8, 2018
PubMed

Insights

Emergency department thoracotomy (EDT) shows comparable survival to adults for pediatric penetrating trauma. However, blunt trauma in children under 15 undergoing EDT has a universally fatal outcome.

Area of Science:

  • Trauma Surgery
  • Pediatric Critical Care
  • Emergency Medicine

Background:

  • Emergency department thoracotomy (EDT) is a well-established procedure in adult trauma care, particularly for penetrating injuries.
  • Published reports indicate a dismal outcome for EDT in pediatric blunt trauma patients.
  • This review examines the clinical outcomes of EDT in the pediatric population.

Purpose of the Study:

  • To review the clinical outcomes of emergency department thoracotomy (EDT) in pediatric trauma patients.
  • To compare the efficacy of EDT in pediatric versus adult populations for different injury mechanisms.
  • To evaluate the impact of age on EDT outcomes in pediatric trauma.

Main Methods:

  • A comprehensive review of published literature on pediatric EDT from 1980 to 2017 was conducted.
  • Data extracted included mechanism of injury and mortality rates.
  • Single case reports were excluded to minimize bias.

Main Results:

  • Mortality rates for pediatric penetrating thoracic trauma treated with EDT are comparable to adult rates.
  • No pediatric patient under the age of 15 has survived EDT following blunt trauma.
  • Survival outcomes differ significantly based on injury mechanism and age.

Conclusions:

  • Withholding EDT may be considered for pediatric patients (0-14 years) with no signs of life after blunt trauma.
  • Pediatric patients aged 15-18 with thoracic trauma should be managed according to adult Advanced Trauma Life Support (ATLS) principles.
  • Age and injury mechanism are critical factors in determining the utility of EDT in pediatric trauma.
Abstract

Keywords:
AdolescentCardiac arrestChildrenEmergency department thoracotomyPediatricResuscitative thoracotomy

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