Interfacility Transport of Children with Traumatic Pneumothorax: Does Elevation Make a Difference?

Area of Science:

• Trauma Surgery
• Pediatric Critical Care
• Aeromedical Transport

Background:

• Traumatic pneumothorax (PTX) is a significant concern in pediatric trauma.
• Current management often involves tube thoracostomy for transport, even for small PTX.
• Pediatric trauma patients frequently require transport at high altitudes.

Purpose of the Study:

• To evaluate the impact of transport at elevation on pediatric traumatic pneumothorax.
• To inform management recommendations for these patients.

Main Methods:

• Retrospective analysis of 412 pediatric trauma patients with PTX from 2010-2022.
• Data included mechanism of injury, transport mode, PTX size, and elevation change.
• Assessed PTX changes and respiratory decompensation during and after transport.

Main Results:

• Most patients (94.1%) had small PTX that resolved without intervention.
• No patients experienced acute respiratory decompensation during transport.
• Elevation gain averaged 2337 feet; no association found between elevation change and need for chest tube placement.

Conclusions:

• Transport at elevation did not lead to meaningful PTX enlargement in pediatric trauma patients.
• Transferring pediatric trauma patients with small, stable PTX without tube thoracostomy is safe, even with significant elevation changes.