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Survival after emergency department thoracotomy in the pediatric trauma population: a review of published data

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Abstract

Background/purpose

The utility of EDT in the adult trauma population, using well-defined guidelines, is well established, especially for penetrating injuries. Since the introduction of these guidelines, reports on the use of EDT for pediatric trauma have been published, and these series reveal a dismal, almost universally fatal, outcome for EDT following blunt trauma in the child. This report reviews the clinical outcomes of EDT in the pediatric population.

Materials/methods

We performed a review of EDT in the pediatric population using the published data from 1980 to 2017. Variables extracted included mechanism of injury and mortality. To minimize bias, single case reports were not included in the review.

Results

Upon review of four decades of published literature on the use of emergency department thoracotomy (EDT) in the pediatric population, mortality rates are comparable between adults and pediatric patients for penetrating thoracic trauma. In contrast, in pediatric patients sustaining blunt trauma, no patient under the age of 15 has survived.

Conclusion

In patients between 0 and 14 years of age presenting with no signs of life following blunt trauma, withholding EDT should be considered. Patients between the ages of 15 and 18 should be treated in accordance with adult ATLS principles for the management of thoracic trauma.

Level of evidence

Level IV

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Authors and Affiliations

  1. Department of Surgery, Denver Health Medical Center and the University of Colorado School of Medicine, Denver, CO, USA

    Eliza E. Moskowitz, Clay Cothren Burlew, Ann M. Kulungowski & Denis D. Bensard

  2. Department of Surgery, University of Colorado, 12631 E. 17th Ave., C302, Aurora, CO, 80045, USA

    Eliza E. Moskowitz, Clay Cothren Burlew, Ann M. Kulungowski & Denis D. Bensard

Authors
  1. Eliza E. Moskowitz
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  2. Clay Cothren Burlew
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  3. Ann M. Kulungowski
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  4. Denis D. Bensard
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Correspondence to Denis D. Bensard.

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This article does not contain any studies with animals or with human participants performed by any of the authors.

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Moskowitz, E.E., Burlew, C.C., Kulungowski, A.M. et al. Survival after emergency department thoracotomy in the pediatric trauma population: a review of published data. Pediatr Surg Int 34, 857–860 (2018). https://doi.org/10.1007/s00383-018-4290-9

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  • DOI: https://doi.org/10.1007/s00383-018-4290-9

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