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Pulmonary contusion: are children different?
G S Allen1, C S Cox, F A Moore
1Department of Surgery, University of Texas-Houston Medical School, 77030, USA.
Insights
Children and adults with pulmonary contusion (PC) exhibit similar injury severity and outcomes, challenging previous beliefs. This study found no significant differences in intubation, ventilation, or mortality rates between pediatric and adult patients with PC.
Area of Science:
- Trauma Surgery
- Pediatric Critical Care
- Thoracic Injury Research
Background:
- Pulmonary contusion (PC) is a frequent consequence of blunt force trauma.
- Previous studies indicated better outcomes for children with PC due to distinct injury patterns and physiological responses.
- This research aimed to compare outcomes of PC in pediatric versus adult populations.
Purpose of the Study:
- To investigate and compare the outcomes of pulmonary contusion (PC) in children versus adults.
- To determine if pediatric patients with PC experience more favorable results than their adult counterparts.
Main Methods:
- Retrospective review of a Level I Trauma Registry over a 4-year period.
- Inclusion of 251 consecutive patients diagnosed with PC.
- Analysis of demographics, injury mechanisms, severity scores, associated injuries, and clinical outcomes including intubation, ventilation duration, pneumonia, ARDS, and mortality.
Main Results:
- The study included 41 children (ages 2-16) and 210 adults (ages 17-80).
- Injury severity scores and the incidence of associated injuries (head, abdomen, skeletal fractures) were comparable between children and adults.
- No significant differences were observed in the need for intubation, ventilator days, pneumonia, acute respiratory distress syndrome (ARDS), or death between the two groups.
Conclusions:
- Despite differences in injury mechanisms, children and adults with pulmonary contusion demonstrate similar overall injury severity, associated injuries, and clinical outcomes.
- Contrary to prior reports, this study concludes that children do not possess a more favorable outcome following pulmonary contusion compared to adults.
Background:
Pulmonary contusion (PC) is a common sequelae of blunt trauma in adults and children; previous reports suggest that children have more favorable outcomes because of differences in mechanisms of injury, associated injury, and physiologic response. Our objective was to determine whether children who sustain PC have different outcomes compared with similarly injured adults.
Study Design:
Our Level I Trauma Registry was reviewed for a 4-year period and identified 251 consecutive patients who sustained PC. Their charts were reviewed retrospectively for demographics, injury mechanism, injury severity scores, associated injuries, and outcomes (measured by the need for intubation, ventilation days, pneumonia, acute respiratory distress syndrome, and death). Data are expressed as the mean +/- SEM. The Student's t-test was used to compare the groups. A p value less than 0.05 was considered significant.
Results:
Of the study patients, 41 (16%) were children (ages 2-16, mean 10 years) and 210 (84%) were adults (ages 17-80, mean 34 years). The most common injury mechanisms in children were motor vehicle accidents (56%) and auto-pedestrian accidents (39%), but in adults, motor vehicle accidents (80%, p = 0.02) predominated. Injury severity score was not significantly different between groups (children, 26 +/- 2 and adults 25 +/- 1). Similarly, the incidence of associated injuries was not different between children and adults: head 78% versus 62%, abdomen 59% versus 43%, and skeletal fractures 41% versus 29%, respectively. Neither need for intubation, ventilator days, pneumonia, acute respiratory distress syndrome, or death differed significantly between groups.
Conclusions:
Although children and adults differ in regard to injury mechanism, their overall injury severity, associated injuries, and outcomes are quite similar. Thus, contrary to previous reports, children do not have a more favorable outcome after PC.