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Outcomes for Initially Hemodynamically Stable Pediatric Patients With Thoracic Trauma Undergoing Emergency Department
Hazem Nasef1, Sanjan Kumar, Samuel Baum
1Author Affiliations: NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, Florida (Mr Nasef); University of Central Florida College of Medicine, Orlando, Florida (Mr Kumar); Louisiana State University Health Sciences Center, New Orleans, Louisiana (Mr Baum); William Carey University College of Osteopathic Medicine, Hattiesburg, Mississippi (Mrs Hernandez, Kumar); NOVA Southeastern University, Kiran Patel College of Osteopathic Medicine, Fort Lauderdale, Florida (Mr Awan); Department of Pediatric Surgery, Arnold Palmer Children's Hospital, Orlando Health, Orlando, Florida (Dr Plumley); Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida (Drs Plumley, Elkbuli); and Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida (Dr Elkbuli).
Background:
Resuscitative thoracotomy, performed in only 10%-15% of pediatric thoracic trauma cases, yields a dismally low survival rate of 3.4%. As such, an investigation into the mechanisms of such high mortality associated with this emergent procedure is warranted.
Objective:
This study aims to evaluate the clinical outcomes of initially hemodynamically stable pediatric patients requiring an emergency department thoracotomy (EDT) at pediatric trauma centers (PTC), combined adult/PTCs (CTC), and adult-only trauma centers (ATC).
Methods:
The American College of Surgeons-Trauma Quality Improvement Program database (2017-2021) was utilized in this retrospective cohort analysis to evaluate outcomes among initially hemodynamically stable pediatric (age <18) patients with moderate-severe Abbreviated Injury Score (AIS chest >2) blunt or penetrating thoracic trauma undergoing an EDT. The primary outcome of interest was mortality (defined as emergency department, 24-hour, and in-hospital mortality) evaluated by trauma center type.
Results:
A total of 314 patients were identified, with 219 patients (69.7%) treated at ATCs, 77 patients (24.5%) treated at CTCs, and 18 patients (5.7%) treated at PTCs. There was no significant association between 24-hour mortality and treatment at a CTC when compared to treatment at an ATC for patients with penetrating (odds ratio [OR] 0.02, 95% confidence interval [CI] [0.00, 1444.90], p = .501) or blunt (OR 0.26, 95% CI [0.01, 7.98], p = .440) injuries.
Discussion:
Among initially hemodynamically stable pediatric trauma patients with moderate-severe blunt or penetrating thoracic injuries undergoing EDT, patients treated at a CTC, when compared to an ATC, showed comparable mortality.
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