Limiting chest computed tomography in the evaluation of pediatric thoracic trauma

Golden, Jamie; Isani, Mubina; Bowling, Jordan; Zagory, Jessica A.; Goodhue, Catherine J.; Burke, Rita V.; Upperman, Jeffrey S.; Gayer, Christopher P.

doi:10.1097/ta.0000000000001110

Cited by 42 publications

(21 citation statements)

References 43 publications

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“…7 Therefore, some authors argue that CT of the thorax should be considered only in patients with pathological findings on plain film X-ray. 6 In our particular case, a primary CT was obtained after stabilization of the patient, which was helpful in locating the injury preoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Even though CT scan might have a higher sensitivity for pathologies like lung contusion or a small pneumothorax, these additional findings rarely lead to a change in management. 1 6 The cancer risk after thoracic CT in childhood is estimated as 25/10,000 for girls and 7.5/10, 000 for boys. 7 Therefore, some authors argue that CT of the thorax should be considered only in patients with pathological findings on plain film X-ray.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Emergency Repair of an Isolated Traumatic Avulsion of the Right Main Stem Bronchus in a 7-Year-Old Girl

König¹,

Wittenmeier

Muensterer³

2019

European J Pediatr Surg Rep

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Introduction Isolated tracheobronchial injury after blunt trauma of the chest is rare. Because of the high elasticity of the chest in children, they occur mainly in the pediatric population. Case Report We report a case of a 7-year-old girl who experienced complete avulsion of the right main bronchus at the level of the carina after a horse-riding accident. The patient presented with extensive emphysema of the upper chest, neck, and face and severe respiratory distress. Endotracheal intubation led to tension pneumothorax. After insertion of two 17-mm thoracostomy tubes, pneumothorax and a massive air leak persisted. Isolated central bronchial injury was confirmed by computed tomography of the chest. Bronchoscopically guided selective intubation of the left main stem bronchus failed and the patient desaturated, requiring immediate salvage right posterolateral thoracotomy. Simultaneous occlusion of the defect, stabilization, and subsequent selective left lung intubation was possible only after placing a suture at the tracheal rim of the defect for retraction allowing compression of the defect and keeping the lumen open at the same time. Conclusion A cluster of clinical signs with subcutaneous emphysema and refractory pneumothorax with air leak of the thoracotomy tube is indicative of bronchial injury. Endotracheal intubation should be postponed in these cases until after thoracostomy tube placement, if possible. Placing a retraction suture during repair is a maneuver that helps to occlude the defect and keep the remaining tracheobronchial lumen open at the same time to establish crucial ventilation of the contralateral lung.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Emergency Repair of an Isolated Traumatic Avulsion of the Right Main Stem Bronchus in a 7-Year-Old Girl

König¹,

Wittenmeier

Muensterer³

2019

European J Pediatr Surg Rep

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“…But some suggest that tomography is overused in blunt pediatric chest trauma, often improving diagnosis without impacting treatment [ 11 ]. In 2016, Golden et al stated that chest tomography should be limited to the identification of intrathoracic vascular injuries when confronted to an abnormal mediastinal silhouette on chest X-ray [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary contusion after bumper car collision: Case report and review of the literature

Berland¹,

Oger

Cauchois

et al. 2018

Respiratory Medicine Case Reports

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Thoracic trauma is a major source of morbi-mortality in injured children. Their pliable chest wall makes pulmonary contusion the most common chest injury. It is most often secondary to blunt trauma caused by traffic accidents. We report a case of severe chest trauma caused by a bumper car collision in an 8-years old girl. She sustained right lung contusion that led to complete atelectasis. After a week of supportive therapy, bronchoscopy removed a mucous plug from the main bronchus, resulting in significant clinical improvement. We aim to raise awareness of the risk of severe chest injuries during bumper car collisions.

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“…In addition to a lower exposure to radiation, the X-ray imaging has much lower costs compared to CT scans. However, CT should be considered when there are abnormalities in the initial diagnosis (145,146). This decision should be combined with a clinical evaluation and careful examination.…”

Section: Markers For Lung Injurymentioning

confidence: 99%

Laboratory Markers in the Management of Pediatric Polytrauma: Current Role and Areas of Future Research

et al. 2021

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Severe trauma is the most common cause of mortality in children and is associated with a high socioeconomic burden. The most frequently injured organs in children are the head and thorax, followed by the extremities and by abdominal injuries. The efficient and early assessment and management of these injuries is essential to improve patients' outcome. Physical examination as well as imaging techniques like ultrasound, X-ray and computer tomography are crucial for a valid early diagnosis. Furthermore, laboratory analyses constitute additional helpful tools for the detection and monitoring of pediatric injuries. Specific inflammatory markers correlate with post-traumatic complications, including the development of multiple organ failure. Other laboratory parameters, including lactate concentration, coagulation parameters and markers of organ injury, represent further clinical tools to identify trauma-induced disorders. In this review, we outline and evaluate specific biomarkers for inflammation, acid-base balance, blood coagulation and organ damage following pediatric polytrauma. The early use of relevant laboratory markers may assist decision making on imaging tools, thus contributing to minimize radiation-induced long-term consequences, while improving the outcome of children with multiple trauma.

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Limiting chest computed tomography in the evaluation of pediatric thoracic trauma

Abstract: Therapeutic study, level IV; diagnostic study, level III.

Cited by 42 publications

References 43 publications

Emergency Repair of an Isolated Traumatic Avulsion of the Right Main Stem Bronchus in a 7-Year-Old Girl

Emergency Repair of an Isolated Traumatic Avulsion of the Right Main Stem Bronchus in a 7-Year-Old Girl

Pulmonary contusion after bumper car collision: Case report and review of the literature

Laboratory Markers in the Management of Pediatric Polytrauma: Current Role and Areas of Future Research

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