Blunt thoracic trauma in children: review of 137 cases

Balcı, Akın Eraslan; Kazez, Ahmet; Eren, Şevval; Ayan, Erhan; Özalp, Koray; Eren, Mehmet Nesimi

doi:10.1016/j.ejcts.2004.04.024

Cited by 102 publications

(53 citation statements)

References 22 publications

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“…The overall mortality in the paediatric group of 16.7% is in keeping with other studies of paediatric thoracic trauma. [6][7][8][9] Although there was no difference in referral types (i.e. referral from the scene, with little or no resuscitation initiated, or IHT, with prior stabilisation), there was a significantly lower baseline lactate level in the paediatric group.…”

Section: Discussionmentioning

confidence: 82%

“…[6][7][8][9][10][11] Injury patterns are thought to differ between adults and children. [14,15] Our study indeed shows that children are far more likely than adults to sustain head injury together with their thoracic trauma.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10][11] We aimed to review and contrast the incidence and outcome of blunt thoracic trauma among adults and children in a single level I trauma centre over a 6-year period.…”

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confidence: 99%

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Severe blunt thoracic trauma: Differences between adults and children in a level 1 trauma centre

et al. 2014

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Background. Trauma is a leading cause of death in the developing world. Blunt thoracic trauma represents a major burden of disease in both adults and children. Few studies have investigated the differences between these two patient groups. Objective. To compare mechanism of injury, presentation, management and outcome in children and adults with blunt thoracic trauma. Methods. Patients were identified from the database of the trauma intensive care unit at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. Demographics and relevant data were extracted from a pre-existing database. Results. Of 415 patients admitted to the unit, 331 (79.7%) were adults and 84 (20.2%) children aged <18 years. The median injury severity score (ISS) was similar for both age groups (32 v. 34; p=0.812). Adults had a higher lactate level at presentation (3.94 v. 2.60 mmol/L; p=0.001). Of the children, 96.4% were injured in motor vehicle collisions, 75.0% as pedestrians. Compared with adults, children had significantly fewer rib fractures (20.2% v. 42.0%; p<0.001), flail chests (2.4% v. 26.3%; p<0.001) and blunt cardiac injuries (BCIs) (9.5% v. 23.6%; p=0.004), but sustained more lung contusions (79.8% v. 65.6%; p=0.013). Mortality in children was significantly lower than in adults (16.7% v. 27.8%; p=0.037). Conclusion. Thoracic injuries in children are the result of pedestrian collisions more often than in adults. They suffer fewer rib fractures and BCIs, but more lung contusions. Despite similar ISSs, children have significantly lower mortality than adults. More effort needs to be concentrated on child safety and preventing pedestrian injury.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Severe blunt thoracic trauma: Differences between adults and children in a level 1 trauma centre

et al. 2014

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“…3 -que apresentou 48,4% de toracotomias; e maior incidência do que Balci et al 6 com 8% de toracotomias. Deneuville et al 12 realizou 10 toracotomias em sua amostra, o mesmo número de toracotomias do estudo de Cuba et al 5 , sendo ambas com duas a menos que neste estudo.…”

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Perfil Dos Pacientes Vítimas De Trauma Torácico Atendidos No Hospital Universitário Evangélico De Curitiba (Huec)

2014

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RESUMOIntrodução: O trauma torácico cursa frequentemente com alterações na dinâmica respiratória e circulatória. A maioria dos traumas torácicos é tratada com drenagem pleural e somente 15-30% necessitarão de toracotomia. Objetivo: Analisar o perfil dos pacientes vítimas de trauma torácico. Metodologia: Analisados 98 prontuários entre Janeiro e Dezembro de 2011, com acometimento torácico que necessitou de drenagem pleural para seu tratamento. Resultados: Oitenta e dois pacientes eram homens e 16 mulheres. A idade média de 36,9 ± 16 anos (variando entre 9 e 83 anos). Quarenta e três (43,8%) foram vítimas de trauma penetrante e 55 (56,2%) de trauma fechado. Quinze pacientes apresentaram hemotórax, 23 pneumotórax e 55 hemopneumotórax. Sessenta e oito pacientes (69,4%) sofreram lesões associadas ao trauma torácico. A permanência com dreno foi de 7 ± 6,2 dias. O volume drenado imediatamente foi 401 mL (variando entre 50 e 1050 ml). Em 12 casos foi realizada toracotomia. Setenta (71,4%) pacientes foram submetidos à antibioticoterapia, por 4,6 ± 6,9 dias. Vinte e sete receberam cuidados em unidade de terapia intensiva, por 10,3 ± 7,9 dias. O tempo médio de internamento foi 9,3 ± 8,4 dias (variando entre 1 e 48 dias). Trinta e um (31,6%) pacientes apresentaram complicações e 17 (17,3%) foram a óbito. Conclusão: Homens com idade entre 15 e 29 anos foram os mais acometidos, submetidos à drenagem pleural por trauma fechado, mais frequentemente associado a hemopneumotórax. A baixa incidência de toracotomia neste estudo confirma a drenagem como tratamento preferencial dos traumas torácicos em nosso meio.Palavras-Chave: Traumatismos torácicos/epidemiologia; Traumatismos abdominais; Drenagem; Hemotórax.ABSTRACT Introduction: Thoracic trauma demands special attention because of the changes in respiratory and cardiac dynamics. Most thoracic traumas are treated with chest tubes, only 15-30% require thoracotomy. Objective: To analyze the victims' profiles of thoracic trauma. Materials and methods: Analysis of 98 medical records treated in a trauma service from January to December 2011, with thoracic involvement that required pleural drainage. Results: Eighty two patients were male and 16 were female. The mean age was 36,9 ± 16 years (from 9 to 83 years). Forty three (43,8%) were victims of penetrating trauma e 55 (56,2%) of blunt trauma. Fifteen patients had hemothorax, 23 pneumothorax and 55 hemopneumothorax. Sixty eight patients (69,4%) suffered associated lesions. The average length with the drain was 7 ± 6,2 days. The mean volume drained immediately was 401 mL (from 50 to 1050 mL). In 12 cases thoracotomy was performed. Seventy patients (71,4%) used antibiotic for an average of 4,6 ± 6,9 days. Twenty seven patients remained in intensive care unit, for an average of 10,3 ± 7,9 days. The mean time of hospitalization was 9,3 ± 8,4 days (from 1 to 48 days). Thirty one patients (31,6%) presented complications and 17 (17,3%) died. Conclusions: Thoracic trauma was more incident in men with age between 15 e 29 years, most frequently b...

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“…Proposed mechanisms for TBS in blunt trauma include: (1) decrease of the anteroposterior diameter of the thorax with widening of the transverse diameter leading to traction at the carina, (2) rapid deceleration causing shearing at the cricoid and carina, (3) sudden increase in pressure against a closed glottis, and (4) direct tracheal trauma with rupture [5][6][7][8]. The thoracic cavity is more compressible in children than in adults, which allows forces to be transmitted to the trachea without injury to surrounding tissues [9]. This can result in a delay in diagnosis, which often predisposes to higher mortality rates [3].…”

Section: Introductionmentioning

confidence: 98%

Management of traumatic tracheobronchial separation in a teenager using a fabricated extra-long endotracheal tube

Propst

Lin

Istaphanous

et al. 2009

International Journal of Pediatric Otorhinolaryngology

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Blunt thoracic trauma in children: review of 137 cases

Abstract: Associated injury is the most important mortality factor. Thoracic operations can be performed with minimal morbidity and without mortality in children with blunt thoracic trauma.

Cited by 102 publications

References 22 publications

Severe blunt thoracic trauma: Differences between adults and children in a level 1 trauma centre

Severe blunt thoracic trauma: Differences between adults and children in a level 1 trauma centre

Perfil Dos Pacientes Vítimas De Trauma Torácico Atendidos No Hospital Universitário Evangélico De Curitiba (Huec)

Management of traumatic tracheobronchial separation in a teenager using a fabricated extra-long endotracheal tube

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