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Blunt cardiac injuries in children: a postmortem study
R J Scorpio1, D E Wesson, C R Smith
1Hospital for Sick Children, Toronto, Canada.
Insights
Pediatric cardiac trauma is more common than previously thought, with many children dying before reaching the hospital. Early detection and treatment of these blunt trauma injuries are crucial for survival.
Area of Science:
- Pediatric Trauma Surgery
- Cardiovascular Pathology
- Forensic Pathology
Background:
- Cardiac injuries in pediatric trauma are often underreported.
- Blunt trauma is a significant cause of mortality in children.
Purpose of the Study:
- To determine the incidence and patterns of cardiac injuries in pediatric trauma fatalities.
- To analyze the causes of death in children with cardiac trauma.
Main Methods:
- Retrospective review of autopsy records for pediatric trauma fatalities in Ontario (1988-1990).
- Analysis of 282 cases with complete autopsy data, focusing on cardiac injuries.
Main Results:
- Cardiac injuries were present in 14.5% of pediatric trauma fatalities.
- Rupture of a cardiac chamber was the primary cause of death in 8 cases.
- Cardiac contusion was common but not a direct cause of death; brain injury was the leading cause in these cases.
Conclusions:
- Cardiac injuries are a significant, often fatal, consequence of pediatric blunt trauma.
- Many children with severe cardiac trauma die before hospital arrival.
- Improved emergency medical services and prompt diagnosis/treatment can improve outcomes.
Abstract:
We reviewed the records of the Chief Coroner for all pediatric (< 16 years of age) trauma fatalities in Ontario (pediatric population of 2 million) for the period January 1, 1988 through December 31, 1990. Forty-one (14.5%) of 282 patients for which complete autopsy data were available had sustained cardiac injuries. Nineteen patients (46%) died at the scene of the accident, 15 patients (37%) died in an emergency department, and seven patients (17%) died during hospitalization. Rupture of a cardiac chamber occurred in 16 cases; it was the main cause of death in eight cases and a contributing factor in the remainder. Cardiac contusion without chamber rupture was present in 25 cases, but in none of the cases was it the cause of death. Brain injury was the cause of death in 16 (64%) of the cases of cardiac contusion. Cardiac injuries are more common among children who die from blunt trauma than previous reports have suggested. However, because these injuries are often rapidly fatal, many patients die before they reach a hospital. With improvements in emergency medical services and the resulting reduction in transit time, more patients may reach trauma centers alive. A high index of suspicion and rapid diagnosis and treatment of these injuries can save the lives of some of these patients.