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

Abstract

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.

Pediatric Trauma Care in Low Resource Settings: Challenges, Opportunities, and Solutions

“…Again, where available the value and use of ultrasound should be capitalized on, and the FAST exam taught. They are also a strain on resources for both patients and healthcare facilities and increase radiation exposure to children ( 57 , 60 ). Initial resuscitation should follow the usual trauma protocol attention to airway, breathing, and circulation (ABCs) while ensuring C-spine immobilization for polytrauma patients.…”

Pediatric Trauma Care in Low- and Middle-Income Countries: A Brief Review of the Current State and Recommendations for Management and a Way Forward

“…32 Thoracic injuries are often associated with TBI and abdominal trauma because of the disproportionately smaller size of the chest compared with the head and abdomen. 34 It is imperative to assess the whole patient when they have chest trauma to rule out other injuries. Pediatric trauma scores may be of value in triaging and initiation of care.…”

“…CT scan imaging and other advanced imaging techniques can be useful adjuncts but may not be readily available in LMICs, and are a strain on resources for both patients and health care facilities. 34 At a minimum, a chest radiograph should be obtained.…”

Pulmonary Contusion in Mechanically Ventilated Subjects After Severe Trauma

“…Rib fractures and their degree of displacement, as well as flail chest and penetrating mechanisms, all contribute to severity of the underlying lung injury. [1][2][3] Shear forces associated with the development of pulmonary contusions cause several local and systemic effects. Mucus production is increased.…”