The diagnosis and management of children with blunt injury of the chest

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Abstract

Thoracic trauma remains a major source of morbidity and mortality in injured children, and is second only to brain injuries as a cause of death. The presence of a chest injury increases an injured child’s mortality by 20-fold. Greater than 80% of chest injuries in children are secondary to blunt trauma. The compliant chest wall in children makes pulmonary contusions and rib fractures the most common chest injuries in children. Injuries to the great vessels, esophagus, and diaphragm are rare. Failure to promptly diagnose and treat these injuries results in increased morbidity and mortality.

Section snippets

General pathophysiology

Thoracic injuries occur in 4% to 6% of children hospitalized for trauma, but are responsible for up to 25% of pediatric trauma deaths.1, 2 Blunt forces account for 80% to 85% of pediatric thoracic injuries, with motor vehicle crashes, pedestrian accidents, and falls the most frequent mechanisms.1, 2, 3, 4, 5 Children may develop significant intrathoracic injuries without any external evidence of trauma.1, 2, 3 Pulmonary contusions, rib fractures, and pneumothoraces are the most common chest

General evaluation and initial treatment of the child with chest injuries

When evaluating any injured child the principles outlined in the advanced trauma life support (ATLS) course should be followed.16 The critical point for the physician evaluating for a thoracic injury is maintaining a high index of suspicion for these injuries. Physical examination is highly unreliable.3, 9, 10, 17 Intrathoracic injuries such as pulmonary contusions, great vessel injuries, esophageal perforation, and diaphragmatic ruptures may not present immediately.1, 2, 3, 4, 5, 6 The

Summary

Blunt thoracic trauma produces a wide spectrum of injuries that are associated with significant morbidity and mortality in children. Associated thoracic injuries exert a significant influence on mortality in children with extrathoracic injuries. The surgeon caring for the injured child must have familiarity with the evaluation and management of common pediatric chest injures while maintaining a high index of suspicion for the presence of rare, life threatening thoracic great vessel, esophageal,

References (94)

  • B.J Hancock et al.

    Tracheobronchial injuries in children

    J Pediatr Surg

    (1991)
  • J Mordehai et al.

    Tracheal rupture after blunt chest trauma in a child

    J Pediatr Surg

    (1997)
  • K.H Sartorelli et al.

    Perforation of the intrabdominal esophagus from blunt trauma in a childcase report and review of the literature

    J Pediatr Surg

    (1999)
  • C.D Wright et al.

    Pediatric tracheal surgery

    Ann Thorac Surg

    (2002)
  • R Karmy-Jones et al.

    Management of traumatic rupture of the thoracic aorta in pediatric patients

    Ann Thorac Surg

    (2003)
  • G.D Trachiotis et al.

    Traumatic thoracic aortic rupture in children

    Ann Thorac Surg

    (1996)
  • Y Sato et al.

    Air bag injuries—A literature review in consideration of demands in forensic autopsies

    Forensic Sci Int

    (2002)
  • G.D Pearson et al.

    A retrospective review of the role of transesophageal echocardiography in aortic and cardiac trauma in a level 1 pediatric trauma center

    J Am Soc Echocardiogr

    (1997)
  • C.C Cox et al.

    Operative treatment of truncal vascular injuries in children and adolescents

    J Pediatr Surg

    (1998)
  • R Hirsch et al.

    Cardiac troponin I in pediatricsNormal values and use in the assessment of cardiac injury

    J Pediatr

    (1997)
  • P Mihos et al.

    Traumatic rupture of the diaphragmexperience with 65 patients

    Injury

    (2003)
  • G Pitcher

    Fiber-endoscopic thoracoscopy for diaphragmatic injury in children

    Semin Pediatr Surg

    (2001)
  • B.L Bufkin et al.

    Esophageal perforationEmphasis on management

    Ann Thorac Surg

    (1996)
  • A Cooper

    Thoracic trauma

    Semin Pediatr Surg

    (1995)
  • D.W Vane et al.

    Pediatric traumaCurrent concepts

    J Intensiv Care Med

    (2002)
  • D Bliss et al.

    Pediatric trauma

    Crit Care Med

    (2002)
  • D.K Nakayama et al.

    Chest injuries in childhood

    Ann Surg

    (1989)
  • J.P Riley et al.

    Thoracic trauma in children

    J Trauma

    (1993)
  • J Schalamon et al.

    Multiple trauma in pediatric patients

    Pediatr Surg Int

    (2003)
  • J.J Tepas et al.

    Pediatric trauma is very much a surgical disease

    Ann Surg

    (2003)
  • T.L Black et al.

    Significance of chest trauma in children

    South Med J

    (1996)
  • H Sarihan et al.

    Blunt thoracic trauma in children

    J Cardiovasc Surg

    (1996)
  • N Kisson et al.

    Pediatric traumaDifferences in pathophysiology, injury patterns and treatment compared with adult trauma

    Can Med Assoc J

    (1990)
  • R.M Schorr et al.

    Blunt thoracic traumaAn analysis of 515 patients

    Ann Surg

    (1987)
  • B.J Maron et al.

    Clinical profile of commotio cordisAn underappreciated cause of sudden death in the young person during sports and other activities

    J Cardiovasc Electrophysiol

    (1999)
  • F.A Pigula et al.

    The effect of hypotension and hypoxia on children with severe head injuries

    J Pediatr Surg

    (1993)
  • Advanced Trauma Life Support of the American College of SurgeonsAdvanced Trauma Life Support for Doctors

    (1997)
  • D Jaffe et al.

    Emergency management of blunt abdominal trauma in children

    N Engl J Med

    (1992)
  • J.E Holmes et al.

    A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma

    Ann Emerg Med

    (2002)
  • P.A Blostein et al.

    Computed tomography of the chest in blunt thoracic traumaResults of a prospective study

    J Trauma

    (1997)
  • D Demtetriades et al.

    Routine helical computed tomographic evaluation of mediastinum in high-risk blunt trauma patients

    Arch Surg

    (1998)
  • A Trupka et al.

    Value of thoracic computed tomography in the first assessment in severely injured patients with blunt chest trauma. Results of a prospective study

    J Trauma

    (1997)
  • V.F Garcia et al.

    Rib fractures in childrenA marker of severe injury

    J Trauma

    (1990)
  • G.J Harris et al.

    Pediatric first rib fractures

    J Trauma

    (1990)
  • K.A Barsness et al.

    The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children

    J Trauma

    (2003)
  • K Bergman et al.

    Thoracic vascular injuriesA post mortem study

    J Trauma

    (1990)
  • A.C Eddy et al.

    The epidemiology of traumatic rupture of the thoracic aorta in childrenA 13 year review

    J Trauma

    (1990)
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