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