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Risk factors and outcomes in pediatric blunt cardiac injuries
Brent Emigh1,2, Areg Grigorian3, Joshua Dilday4
1Division of Trauma and Critical Care, Department of Surgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA. Brent_Emigh@Brown.edu.
Insights
Pediatric blunt cardiac injury (BCI) is rare but deadly. Pulmonary contusions and hemothorax are key indicators for BCI screening in children after trauma.
Area of Science:
- Pediatric trauma care
- Cardiovascular injury research
- Emergency medicine
Background:
- Blunt cardiac injury (BCI) is poorly understood in children compared to adults.
- Identifying pediatric BCI risk factors can improve trauma screening.
Purpose of the Study:
- To identify risk factors and predictors for blunt cardiac injury (BCI) in pediatric patients.
- To inform targeted screening protocols for children sustaining blunt trauma.
Main Methods:
- Retrospective analysis of the Trauma Quality Improvement Program (TQIP) database (2017-2019).
- Inclusion of pediatric patients (≤16 years) with blunt trauma.
- Regression analysis to determine independent risk factors for BCI.
Main Results:
- BCI incidence was <0.2% in 266,045 pediatric trauma patients.
- All-cause mortality for pediatric BCI was 26%.
- Pulmonary contusions (OR 15.4) and hemothorax (OR 8.9) were strongest predictors of BCI.
Conclusions:
- Pulmonary contusions and hemothorax in pediatric trauma patients warrant further investigation for BCI.
- These findings support enhanced screening for BCI in children presenting with specific thoracic injuries.
Purpose:
Unlike adults, less is known of the etiology and risk factors for blunt cardiac injury (BCI) in children. Identifying risk factors for BCI in pediatric patients will allow for more specific screening practices following blunt trauma.
Methods:
A retrospective review was performed using the Trauma Quality Improvement Program (TQIP) database from 2017 to 2019. All patients ≤ 16 years injured following blunt trauma were included. Demographics, mechanism, associated injuries, injury severity, and outcomes were collected. Univariate and multivariate regression was used to determine specific risk factors for BCI.
Results:
Of 266,045 pediatric patients included in the analysis, the incidence of BCI was less than 0.2%. The all-cause mortality seen in patients with BCI was 26%. Motor-vehicle collisions (MVCs) were the most common mechanism, although no association with seatbelt use was seen in adolescents (p = 0.158). The strongest independent risk factors for BCI were pulmonary contusions (OR 15.4, p < 0.001) and hemothorax (OR 8.9, p < 0.001).
Conclusions:
Following trauma, the presence of pulmonary contusions or hemothorax should trigger additional screening investigations specific for BCI in pediatric patients.
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