High Risk Predictors for Thoracic Aortic Injury in Pediatric Blunt Chest Trauma

Incidence of Blunt Thoracic Aortic Injuries (BTAIs) in children is low (0.03%) but has 40%-66% mortality [1, 2]. The gold standard for BTAI diagnosis is chest computed tomography angiogram. However, significant radiation exposure makes routine chest computed tomography angiogram for BTAI screening in children inappropriate. The purpose of this study is to identify predictors for children at high risk for BTAI based on simple history, clinical exam, and x-ray findings.

In this retrospective cohort study, the Trauma Quality Improvement Program database from 2017 to 2023 was queried for blunt thoracic injuries in children age<15 y. A multivariable logistic regression model was built to identify clinical and plain radiographic risk factors predictive of BTAI. The model was developed into a clinical risk score for BTAI based on risk factors weighted by their effect size. The risk score was then validated using the existing database.

We identified 41,721 pediatric patients with blunt thoracic injuries, 177 of which had BTAI (0.4%). Independent risk factors for BTAI included age >5 (odds ratio [OR] = 1.15 for every 5 y increment), intentional injury type (OR = 4.29), respiration rate <10 breaths/min (OR = 2.42), Glasgow Coma Scale score <13 (OR = 3.08), subluxation and dislocation of cervical vertebrae (OR = 2.17), multiple bilateral rib fractures(OR = 2.15), hemothorax (OR = 7.80), pneumohemothorax (OR = 3.46), and motor vehicle/cyclist/pedestrian collision (OR = 2.77). Our clinical risk score ranged from 0 to 15 and predicted probability of BTAI accurately for scores <10. Predicted and observed risk was <0.4% for scores <5.

We present a risk stratification tool for predicting BTAI in children utilizing history, clinical exam, and findings on chest and lateral cervical spine radiographic films. Future studies are needed for validation given the rarity of this injury.