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Mortality and truncal injury: the pediatric perspective
A Cooper1, B Barlow, C DiScala
1Division of Pediatric Surgery, Harlem Hospital Center, College of Physicians & Surgeons of Columbia University, New York, NY 10037.
Journal of Pediatric Surgery
|January 1, 1994
Summary
Major truncal injuries in children, including thoracic and abdominal trauma, are often caused by blunt mechanisms like car accidents. While penetrating injuries are less common, they are more frequently fatal, especially thoracic trauma.
Area of Science:
- Pediatric Trauma Surgery
- Emergency Medicine
- Injury Epidemiology
Background:
- Truncal injuries represent a significant cause of morbidity and mortality in pediatric populations.
- Understanding the mechanisms and consequences of thoracic and abdominal trauma is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the incidence, causes, and outcomes of major thoracic and abdominal injuries in children.
- To identify specific organ systems and injury types associated with higher fatality rates.
Main Methods:
- Prospective analysis of data from the National Pediatric Trauma Registry (NPTR) between 1985 and 1991.
- Inclusion of 25,301 pediatric patients with detailed injury information and outcomes.
- Categorization of injuries by mechanism (blunt vs. penetrating) and affected region (thoracic vs. abdominal).
Main Results:
- Of 25,301 patients, 6% had thoracic and 8% had abdominal injuries, predominantly from blunt mechanisms (86% T, 83% A).
- Penetrating thoracic injuries had a high fatality rate (14%), with the injury being the cause of death in 97% of cases.
- Blunt abdominal injuries had a lower mortality rate (9%), but abdominal injury was the cause of death in 22% of these cases. Penetrating abdominal injuries had a 6% mortality rate, with abdominal injury causing death in 67% of cases.
- Frequently injured thoracic organs included the pleural space, lung, and ribs, with >50% fatality rates except for lung contusion. Frequently injured abdominal organs included the liver, spleen, kidneys, and GI tract, with ≤15% fatality rates unless major blood vessels were involved.
Conclusions:
- Thoracic and abdominal injuries in children, particularly those from penetrating mechanisms, carry significant risks.
- While blunt trauma is more common, penetrating injuries have a higher likelihood of being the direct cause of death.
- Specific organ injuries, especially those involving major blood vessels in the abdomen, require urgent attention due to high fatality rates.