Thoracic trauma in children: An indicator of increased mortality

Peclet, Maria H.; Newman, Kurt D.; Eichelberger, Martin R.; Gotschall, Catherine S.; Garcia, Victor F.; Bowman, Leon M.

doi:10.1016/0022-3468(90)90238-5

Cited by 180 publications

(116 citation statements)

References 15 publications

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“…It is important to recognize this pattern because the presence of head or thoracic injury has been shown to be associated with higher mortality. 37,38 We found "Waddell's triad" in 25.5% of all cases of femur fracture with associated injuries. The typical mechanisms that led to associated injuries that emerged from our work were high-impact accidents such as MVC involving teenagers, auto-pedestrian accident in children of any age, and NAT in infants and toddlers.…”

Section: E548 Femur Fractures Associated Injuries Sociodemographic mentioning

confidence: 80%

Childhood Femur Fractures, Associated Injuries, and Sociodemographic Risk Factors: A Population-Based Study

Rewers¹,

et al. 2005

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ABSTRACT. Objective. The objectives of this study were to determine the incidence of femur fractures in Colorado children, to assess underlying causes, to determine the prevalence and predictors of associated injuries, and to identify potentially modifiable risk factors.Methods. The study population included all Colorado residents who were aged 0 to 17 years at the time of injury between January 1, 1998, and December 31, 2001. Cases of femur fracture were ascertained using the population-based Colorado Trauma Registry and International Classification of Diseases, Ninth Revision, Clinical Modification codes 820.0 to 821.39. Associated injuries with an Abbreviated Injury Scale of 2 or higher were classified into 5 categories. Poisson regression, small area analysis, and multivariate logistic regression were used to identify predictors of femur fractures and associated injuries, respectively.Results. During the study period, 1139 Colorado children (795 boys, 344 girls) sustained femur fractures, resulting in the incidence of 26.0 per 100 000 person-years. Rates were higher in boys than in girls in all age groups (overall risk ratio: 2.19; 95% confidence interval: 1.92-2.47) but did not differ by race/ethnicity. Femur fractures that were caused by nonaccidental trauma showed more distal and combined shaft ؉ distal pattern; their incidence did not differ by gender or race but was higher in census tracts with more single mothers and less crowded households. Associated injuries were present in 28.6% of the cases, more often in older children. Fatalities occurred only among children with associated injuries. Children who were involved in nonaccidental trauma, motor vehicle crashes, or auto-pedestrian accidents were 16 to 20 times more likely to have associated injuries than those with femur fractures as a result of a fall. In smallarea analysis, the incidence of femur fractures in infants and toddlers was higher in census tracts characterized by higher proportion of Hispanics, single mothers, and more crowded households. Among children 4 to 12 years of age, the incidence was higher in census tracts with fewer single-family houses and more crowded households. Finally, the incidence of femur fractures among teenagers was higher in rural tracts and those with a higher proportion of Hispanics. Conclusions

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Section: E548 Femur Fractures Associated Injuries Sociodemographic mentioning

confidence: 80%

Childhood Femur Fractures, Associated Injuries, and Sociodemographic Risk Factors: A Population-Based Study

Rewers¹,

et al. 2005

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“…[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.…”

mentioning

confidence: 99%

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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“…In adults, traumatic diaphragmatic hernia forms about 3%-8% of those with severe blunt trauma. 22 In a large series of 2086 injured children, none had diaphragmatic injury, 23 and Cywes et al 24 reported only four diaphragmatic injuries studying 587 children with 732 organ injuries over an 11-year period. Over a shorter period and in a smaller number of injured children, we saw five cases of traumatic diaphragmatic injuries.…”

Section: Discussionmentioning

confidence: 99%