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Emergency department thoracotomy in children: rationale for selective application
1Department of Pediatrics, University of California, Davis, Medical Center, Sacramento 95817.
The Journal of Trauma
|March 1, 1993
Summary
Emergency department (ED) thoracotomy for pediatric trauma patients with no cardiac rhythm is rarely successful. This study suggests limiting ED thoracotomy in children to the same strict criteria used for adults to improve outcomes and reduce hospital costs.
Area of Science:
- Pediatric Trauma Surgery
- Emergency Medicine
- Critical Care
Background:
- Emergency department (ED) thoracotomy is frequently performed in pediatric trauma cases, unlike in adults.
- A liberal policy for ED thoracotomy in children may not be justified given outcomes.
Purpose of the Study:
- To evaluate the efficacy and outcomes of ED thoracotomy in pediatric trauma patients.
- To determine if current indications for ED thoracotomy in children are appropriate.
Main Methods:
- Retrospective chart review of 23 pediatric trauma victims undergoing ED thoracotomy over 5 years.
- Analysis of injury mechanisms, pre-hospital care, in-hospital interventions, survival rates, and financial costs.
Main Results:
- Only one of 23 children (4.4%) survived to discharge; transient restoration of spontaneous circulation occurred in 17.4%.
- No survivors were recorded in the blunt trauma group, and all penetrating trauma patients without pre-hospital vital signs died.
- The procedure incurred significant financial losses for the hospital due to low reimbursement rates.
Conclusions:
- Pediatric trauma patients arriving in the ED with no cardiac rhythm are unsalvageable with ED thoracotomy.
- Indications for ED thoracotomy in pediatric trauma should align with those for adult trauma victims.
- The current liberal use of ED thoracotomy in children is not supported by survival data and incurs substantial costs.