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Abstract
Children comprise approximately one-quarter of all visits to most emergency departments. Children are generally healthier than adults, yet there are similar priorities in assessment and management of pediatric patients. The initial approach to airway, breathing, and circulation still applies and is first and foremost in the evaluation of young infants and children. There are certain anatomic, physiologic, developmental, and social considerations that are unique to this population and must be taken into account during their evaluation and treatment. In this review, we present and discuss an evidence-based approach to high-yield procedures necessary for all emergency physicians taking care of children.
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Affiliation(s)
- Fernando Soto
- Pediatric Emergency Medicine Section, University of Puerto Rico School of Medicine, PO Box 29207, San Juan, PR 00929, USA.
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53
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Prat N, Rongieras F, de Freminville H, Magnan P, Debord E, Fusai T, Destombe C, Sarron JC, Voiglio EJ. Comparison of thoracic wall behavior in large animals and human cadavers submitted to an identical ballistic blunt thoracic trauma. Forensic Sci Int 2012; 222:179-85. [DOI: 10.1016/j.forsciint.2012.05.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 05/02/2012] [Accepted: 05/28/2012] [Indexed: 11/28/2022]
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54
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55
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Kamdar G, Santucci K, Emerson BL. Management of Pediatric Cardiac Trauma in the ED. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2011. [DOI: 10.1016/j.cpem.2011.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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56
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57
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Yazgan H, Demirdoven M, Korkmaz AA, Mahmutyazicioglu K, Toraman AR. A Mild Chest Trauma in an Infant who Developed Severe Pulmonary Hemorrhage. Eurasian J Med 2011; 43:119-21. [PMID: 25610176 DOI: 10.5152/eajm.2011.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 06/09/2011] [Indexed: 11/22/2022] Open
Abstract
Chest trauma, an important cause of morbidity and mortality, is the second most common cause of death in children under four years of age. Due to the different anatomy and physiology of the respiratory system in childhood, the injuries and consequences of chest trauma are also dissimilar. A seven-month-old male infant presented to the emergency clinic with cyanosis and respiratory distress. His medical history revealed that he had been found trapped behind his bed in a cyanotic state two hours earlier. Although physical examination revealed no signs of trauma, respiratory distress and hemorrhagic secretions indicated pulmonary hemorrhage or contusion. This preliminary diagnosis was confirmed by thoracic tomography. There was complete recovery following 48-hour oxygen and medical treatment. Even after mild injuries, the fact that severe pulmonary hemorrhages and contusions may develop without a trace of trauma should be kept in mind.
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Affiliation(s)
- Hamza Yazgan
- Clinic of Pediatrics, Private Sema Hospital, Istanbul, Turkey
| | | | - Askin Ali Korkmaz
- Clinic of Cardiovascular Surgery, Private Sema Hospital, Istanbul, Turkey
| | | | - Ahmet Ruhi Toraman
- Clinic of Occupational Physician, Private Sema Hospital, Istanbul, Turkey
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58
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Abstract
This article discusses pneumothorax, pneumomediastinum, and pulmonary embolism in pediatric practice. Although children appear to have better outcomes than adults, the risk factors are substantial. Topics covered include the pathophysiology incidence, presentation, diagnosis, and management of these diseases.
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Affiliation(s)
- Nakia N Johnson
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin, Suite A-210, Houston, TX 77030, USA
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59
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Abstract
Thoracic injuries are very common among trauma victims. This article reviews the current literature on the management of multiple aspects of the care of the patient with severe chest injury. The mechanics of chest injury are complex and varied. Chest wall injuries are the most common and noticeable manifestation of thoracic trauma. Overall morbidity and mortality are primarily determined by associated injuries. New ventilatory strategies permit oxygenation of the severely hypoxic patient. Acute pain management modalities offer the potential of decreasing associated pulmonary complications. Surgical chest wall fixation is clearly indicated in extreme cases of pulmonary herniation and chest wall disruption. There are potential benefits of surgical fixation in other settings, although further trials are needed.
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60
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Abstract
Occasionally, individuals accused of inflicting fatal injuries on infants and young children will claim some variant of the "CPR defense," that is, they attribute the cause of injuries found at autopsy to their "untrained" resuscitative efforts. A 10-year (1994-2003) historical fixed cohort study of all pediatric forensic autopsies at the Miami-Dade County Medical Examiner Department was undertaken. To be eligible for inclusion in the study, children had to have died of atraumatic causes, with or without resuscitative efforts (N(atraumatic) = 546). Of these, 382 had a history of cardiopulmonary resuscitation (CPR; average age of 4.17 years); 248 had CPR provided by trained individuals only; 133 had CPR provided by both trained and untrained individuals; 1 had CPR provided by untrained individuals only. There was no overlap between these 3 distinct groups. Twenty-two findings potentially attributable to CPR were identified in 19:15 cases of orofacial injuries compatible with attempted endotracheal intubation; 4 cases with focal pulmonary parenchymal hemorrhage; 1 case with prominent anterior mediastinal emphysema; and 2 cases with anterior chest abrasions. There were no significant hollow or solid thoracoabdominal organ injuries. There were no rib fractures. The estimated relative risk of injury subsequent to resuscitation was not statistically different between the subset of decedents whose resuscitative attempts were made by trained individuals only, and the subset who received CPR from both trained and untrained individuals. In the single case of CPR application by an untrained individual only, no injuries resulted. The remaining 164 children dying from nontraumatic causes and who did not undergo resuscitative efforts served as a control group; no injuries were identified. This study indicates that in the pediatric population, injuries secondary to resuscitative efforts are infrequent or rare, pathophysiologically inconsequential, and predominantly orofacial in location. In our population, CPR did not result in any rib fractures or significant visceral injuries. Participation of nonmedical or untrained individuals in resuscitation did not increase the likelihood of injury.
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61
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Abstract
Caring for pediatric trauma patients requires an understanding of the distinct anatomy and pathophysiology of the pediatric population compared to adult trauma patients. Initial evaluation, management, and resuscitation are performed as a multidisciplinary approach including pediatric physicians, trauma surgeons, and pediatric intensive care physicians. Head injury severity is the principle determinant of outcome and mortality in polytraumatized children. Abdominal injuries rarely require surgery in contrast to adults, but need to be detected. Spine and pelvic injuries as well as injuries of the extremities require age-adapted surgical procedures. However, the degree of recovery in polytraumatized children is often remarkable, even after apparently devastating injuries. Maximal care should, therefore, be rendered under the assumption that a complete recovery will be made.
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62
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Patel RP, Hernanz-Schulman M, Hilmes MA, Yu C, Ray J, Kan JH. Pediatric chest CT after trauma: impact on surgical and clinical management. Pediatr Radiol 2010; 40:1246-53. [PMID: 20180107 DOI: 10.1007/s00247-009-1533-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 12/10/2009] [Accepted: 12/28/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chest CT after pediatric trauma is frequently performed but its clinical impact, particularly with respect to surgical intervention, has not been adequately evaluated. OBJECTIVE To assess the impact of chest CT compared with chest radiography on pediatric trauma management. MATERIALS AND METHODS Two hundred thirty-five consecutive pediatric trauma patients who had both chest CT and radiography were identified. Images were reviewed and findings were categorized and correlated with subsequent chest interventions, blinded to final outcome and management. RESULTS Of the 235 children, 38.3% (90/235) had an abnormal chest radiograph and 63.8% (150/235) had an abnormal chest CT (P < 0.0001). Chest interventions followed in 4.7% (11/235); of these, the findings could be made 1 cm above the dome of the liver in 91% (10/11). Findings requiring chest intervention included pneumothorax (PTX) and vertebral fractures. PTX was found on 2.1% (5/235) of chest radiographs and 20.0% (47/235) of chest CTs (P < 0.0001); 1.7% (4/235) of the children received a chest tube for PTX, 0.85% (2/235) seen on chest CT only. Vertebral fractures were present in 3.8% of the children (9/235) and 66.7% (6/9) of those cases were treated with spinal fusion or brace. There were no instances of mediastinal vascular injury. CONCLUSION Most intrathoracic findings requiring surgical management in our population were identified in the lower chest and would be included in routine abdominopelvic CT exams; this information needs to be taken into consideration in the diagnostic algorithm of pediatric trauma patients.
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Affiliation(s)
- Rina P Patel
- Vanderbilt University School of Medicine, Nashville, TN, USA
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63
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Samarasekera SP, Mikocka-Walus A, Butt W, Cameron P. Epidemiology of major paediatric chest trauma. J Paediatr Child Health 2009; 45:676-80. [PMID: 19845838 DOI: 10.1111/j.1440-1754.2009.01594.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIM Paediatric chest trauma is a marker of severe injury and a significant cause of morbidity and mortality. However, current trends in the Australian population are unknown. This study aims to outline the profile and management of major paediatric chest trauma in Victoria. METHODS Prospectively collected data of patients from the Victorian State Trauma Registry from July 2001 to June 2007 were retrospectively reviewed. Data on fatalities were obtained from the National Coroners Information System. Descriptive statistics were used to summarise the profiles of major trauma cases and coroners' cases. RESULTS Overall, 204 cases with serious paediatric chest injuries were reported by the Victorian State Trauma Registry (n = 158) and National Coroners Information System (n = 46) (excluding overlapping cases) in 2001-2007. Paediatric chest trauma was more common in males. The Injury Severity Score ranged from 16 to 25 in most patients. Blunt trauma was responsible for 96% of cases, of which motor vehicle collisions accounted for 75%. Median hospitalisation was 9 days, and 64% of patients were admitted to intensive care. Common injuries included lung contusion (66%), haemo/pneumothorax (32%) and rib fracture (23%). Multiple organ injury occurred in 99% of cases, with head (62%) and abdominal (50%) injury common. Management was conservative, with only 11 cases (7%) treated surgically. The highest mortality was in the 10-15-year age group. In 52 (79%) fatalities, injury was transport related. CONCLUSION Australian paediatric chest trauma trends are similar to international patterns. Serious injury requiring surgical intervention is rare. This limited exposure may lead to difficulty in maintaining surgical expertise in this highly specialised area.
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Affiliation(s)
- Sumudu P Samarasekera
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria 3004, Australia
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64
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Kelley WE, Januzzi JL, Christenson RH. Increases of cardiac troponin in conditions other than acute coronary syndrome and heart failure. Clin Chem 2009; 55:2098-112. [PMID: 19815610 DOI: 10.1373/clinchem.2009.130799] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although cardiac troponin (cTn) is a cornerstone marker in the assessment and management of patients with acute coronary syndrome (ACS) and heart failure (HF), cTn is not diagnostically specific for any single myocardial disease process. This narrative review discusses increases in cTn that result from acute and chronic diseases, iatrogenic causes, and myocardial injury other than ACS and HF. CONTENT Increased cTn concentrations have been reported in cardiac, vascular, and respiratory disease and in association with infectious processes. In cases involving acute aortic dissection, cerebrovascular accident, treatment in an intensive care unit, and upper gastrointestinal bleeding, increased cTn predicts a longer time to diagnosis and treatment, increased length of hospital stay, and increased mortality. cTn increases are diagnostically and prognostically useful in patients with cardiac inflammatory diseases and in patients with respiratory disease; in respiratory disease cTn can help identify patients who would benefit from aggressive management. In chronic renal failure patients the diagnostic sensitivity of cTn for ACS is decreased, but cTn is prognostic for the development of cardiovascular disease. cTn also provides useful information when increases are attributable to various iatrogenic causes and blunt chest trauma. SUMMARY Information on the diagnostic and prognostic uses of cTn in conditions other than ACS and heart failure is accumulating. Although increased cTn in settings other than ACS or heart failure is frequently considered a clinical confounder, the astute physician must be able to interpret cTn as a dynamic marker of myocardial damage, using clinical acumen to determine the source and significance of any reported cTn increase.
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Affiliation(s)
- Walter E Kelley
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA.
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65
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Pediatric Wartime Admissions to US Military Combat Support Hospitals in Afghanistan and Iraq: Learning from the First 2,000 Admissions. ACTA ACUST UNITED AC 2009; 67:762-8. [DOI: 10.1097/ta.0b013e31818b1e15] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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66
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Complete bilateral tracheobronchial disruption in a child with blunt chest trauma. ACTA ACUST UNITED AC 2009; 66:1478-81. [PMID: 18815578 DOI: 10.1097/ta.0b013e3180340e4e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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67
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Moore MA, Wallace EC, Westra SJ. The imaging of paediatric thoracic trauma. Pediatr Radiol 2009; 39:485-96. [PMID: 19151969 DOI: 10.1007/s00247-008-1093-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 10/23/2008] [Accepted: 11/25/2008] [Indexed: 12/30/2022]
Abstract
Major chest trauma in a child is associated with significant morbidity and mortality. It is most frequently encountered within the context of multisystem injury following high-energy trauma such as a motor vehicle accident. The anatomic-physiologic make-up of children is such that the pattern of ensuing injuries differs from that in their adult counterparts. Pulmonary contusion, pneumothorax, haemothorax and rib fractures are most commonly encountered. Although clinically more serious and potentially life threatening, tracheobronchial tear, aortic rupture and cardiac injuries are seldom observed. The most appropriate imaging algorithm is one tailored to the individual child and is guided by the nature of the traumatic event as well as clinical parameters. Chest radiography remains the first and most important imaging tool in paediatric chest trauma and should be supplemented with US and CT as indicated. Multidetector CT allows for the accurate diagnosis of most traumatic injuries, but should be only used in selected cases as its routine use in all paediatric patients would result in an unacceptably high radiation exposure to a large number of patients without proven clinical benefit. When CT is used, appropriate modifications should be incorporated so as to minimize the radiation dose to the patient whilst preserving diagnostic integrity.
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Affiliation(s)
- Michael A Moore
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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68
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Abstract
Chest trauma is the second greatest cause of mortality from trauma, a leading cause of death in children over the age of one. Prompt diagnosis can be difficult as the underlying thoracic injuries are often disproportionately severe compared to the visible surface injury and symptoms may not appear for several hours. Diagnosis is easily underestimated, delayed or missed. This is a two part article reviewing paediatric chest trauma and its current management. The injuries are usefully classified into six lethal injuries that need excluding in the primary survey and six hidden injuries that must be considered in the secondary survey. The first article reviews paediatric anatomy and biomechanics, and mechanisms of injury with a view to improving the awareness and understanding of the unique response of children to thoracic trauma. This is followed by an in depth review of each of the six lethal injuries. The subsequent article reviews the six hidden injuries as well as the role of chest trauma in non-accidental injury.
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Affiliation(s)
- Maya Kerr
- Paediatric A&E SpR, St Mary's Hospital,
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69
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Abstract
Chest trauma is the second greatest cause of mortality from trauma, a leading cause of death in children over the age of one. Prompt diagnosis can be difficult as the underlying thoracic injuries are often disproportionately severe compared to the visible surface injury and symptoms may not appear for several hours. Diagnosis are easily underestimated, delayed or missed. This is the second of a 2 part article reviewing Paediatric chest trauma and its current management. The injuries are usefully classified into 6 lethal injuries that need excluding in the primary survey and 6 hidden injuries that must be considered in the secondary survey. The 6 lethal injuries are covered in the first part of this article along with biomechanics and mechanisms of injury. This article looks in depth at the 6 hidden injuries, along with a review of chest trauma in non-accidental injury.
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Affiliation(s)
- Maya Kerr
- Paediatric A&E SpR, St Mary's Hospital,
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70
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Woosley CR, Mayes TC. The Pediatric Patient and Thoracic Trauma. Semin Thorac Cardiovasc Surg 2008; 20:58-63. [DOI: 10.1053/j.semtcvs.2008.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2008] [Indexed: 11/11/2022]
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71
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Abstract
Thoracic trauma is relatively frequent in children and causes considerable mortality. This is mainly due to the multiorganic nature of the trauma. The lung is more often affected even in the absence of rib fractures because of the considerable pliability of the chest wall that allows direct transfer of energy to this organ. Injuries to the heart, the aorta, the esophagus, and the diaphragm are rare. Lung contusion and laceration cause parenchymal hemorrhage and consolidation sometimes accompanied by pneumothorax and/or hemothorax. Tracheobronchial disruption is rare but life-threatening. Most traumatic lung injuries may be treated with rest, respiratory support, and eventually intercostal drainage. Large hemorrhage may require thoracotomy, and persistent pneumothorax (indicative of tracheobronchial disruption) may require intubation with fiberoptic bronchoscopic assistance and eventually reparative or ablative surgery. Adult respiratory distress syndrome is very rarely seen in children with thoracic trauma, but it remains highly lethal.
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72
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Buffo-Sequeira I, Fraser DD. Widened mediastinum in a child with severe trauma. CMAJ 2007; 177:1181-2. [PMID: 17984469 DOI: 10.1503/cmaj.070936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ilan Buffo-Sequeira
- Division of Cardiology, Department of Paediatrics, University of Western Ontario, Children's Health Research Institute, London, Ont
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73
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Carreras González E, Carreras González G, Álvarez Pérez R. Traumatismos torácicos graves. Revisión de 39 casos. An Pediatr (Barc) 2007; 67:553-8. [DOI: 10.1016/s1695-4033(07)70803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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74
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Youngster I, Eshel G, Abu-kishak I, Heyman E, Baram S. Left Ventricular Thrombus. Chest 2007; 132:1659-61. [DOI: 10.1378/chest.07-0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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75
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Abstract
BACKGROUND Although thoracic injuries are uncommon in children, their rate of morbidity and mortality is high. The aim of this study was to evaluate the clinical features of children with blunt chest injury and to investigate the predictive accuracy of their paediatric trauma scores (PTS). METHODS Between September 1996 and September 2006, children with blunt thoracic trauma were evaluated retrospectively. Clinical features and PTS of the patients were recorded. RESULTS There were 27 male and 17 female patients. The mean age was 7.1 +/- 3.4 years, and the mean PTS was 7.6 +/- 2.4. Nineteen cases were injuries caused by motor vehicle/pedestrian accidents, 11 motor vehicle accidents, 8 falls and 6 motor vehicle/bicycle or motorbike accidents. The following were noted: 28 pulmonary contusions, 12 pneumothoraxes, 10 haemothoraxes, 9 rib fractures, 7 haemopneumothoraxes, 5 clavicle fractures and 2 flail chests, 1 diaphragmatic rupture and 1 pneumatocele case. The cut-off value of PTS to discriminate mortality was found to be < or = 4, at which point sensitivity was 75.0% and specificity was 92.5%. Twenty-seven patients were treated non-operatively, 17 were treated with a tube thoracostomy and two were treated with a thoracotomy. Four patients who suffered head and abdominal injuries died (9.09%). CONCLUSION Thoracic injuries in children expose a high mortality rate as a consequence of head or abdominal injuries. PTS may be helpful to identify mortality in children with blunt chest trauma. Blunt thoracic injuries in children can be treated with a non-operative approach and a tube thoracostomy.
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Affiliation(s)
- Mustafa Inan
- Department of Pediatric Surgery, Faculty of Medicine, Trakya University, Edirne, Turkey.
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76
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Gschwentner M, Gruber G, Oberladstätter J, Kralinger F, Rieger M. Mediastinal Widening After Blunt Chest Trauma in a Child: A Very Rare Case of Thymic Bleeding in a Child and Possible Differential Diagnosis. ACTA ACUST UNITED AC 2007; 63:E51-4. [PMID: 17693818 DOI: 10.1097/01.ta.0000265308.54551.be] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Martin Gschwentner
- Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria.
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77
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Lee C, Revell M, Porter K, Steyn R. The prehospital management of chest injuries: a consensus statement. Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh. Emerg Med J 2007; 24:220-4. [PMID: 17351237 PMCID: PMC2660039 DOI: 10.1136/emj.2006.043687] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2006] [Indexed: 12/21/2022]
Abstract
This paper provides a guideline for the management of prehospital chest injuries after a consensus meeting held by the Faculty of Prehospital Care, Royal College of Surgeons of Edinburgh, Edinburgh, UK, in January 2005. An overview of the prehospital assessment, diagnosis and interventions for life threatening chest injury are discussed, with the application of skills depending on the training, experience and competence of the individual practitioner.
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Affiliation(s)
- Caroline Lee
- Academic Department of Traumatology, Institute of Research and Development, West Midlands, UK.
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78
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Abstract
Despite improved education and prevention initiatives, trauma remains the leading cause of death in children. A variety of preventative measures have been developed to decrease the morbidity and mortality, and the financial burden on the health care system. This article discusses injury prevention strategies, issues in prehospital care, and key points of initial resuscitation. In addition, the major injury patterns are described with attention paid to the diagnosis and management of patients with multiple traumatic injuries.
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Affiliation(s)
- Kim G Mendelson
- Division of Pediatric Surgery, Department of Surgery, University of Louisville, 233 East Gray Street, Suite 708, Louisville, KY 40202, USA
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79
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Abstract
Appropriate care of pediatric polytrauma patients requires the knowledge and expertise of a variety of subspecialists. Though most of pediatric polytrauma patients survive, long-term sequelae are common. The most common causes of long-term functional deficits after pediatric polytrauma involve injuries to the central nervous and musculoskeletal systems. Orthopaedic care of polytrauma patients is important to facilitate early mobilization and care of these children, as well as to minimize late impairment.
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Affiliation(s)
- Robert M Kay
- University of Southern California Keck School of Medicine, Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA
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80
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Javouhey E, Guérin AC, Gadegbeku B, Chiron M, Floret D. Are restrained children under 15 years of age in cars as effectively protected as adults? Arch Dis Child 2006; 91:304-8. [PMID: 16407436 PMCID: PMC2065966 DOI: 10.1136/adc.2005.084756] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To compare the injury distribution between children and adults, injured as restrained car passengers. METHODS Population based study of data from a French road trauma registry in 1996-2002. Children under 15 years old were compared with adult casualties according to the distribution of serious injuries in three distinct body regions (head, chest, and abdomen) when they were restrained car passengers. A multivariate logistic regression was performed to quantify the risk of AIS2+ injury (Abbreviated Injury Scale of 2 or more). RESULTS Among the 7568 casualties who were injured as restrained car passengers in car accidents, 1033 were less than 15 years old. Overall, 35.4% of children and 25.2% of adults were unrestrained. For children and adults, the risk of fatality was significantly reduced when they were restrained, but the percentages of children with Injury Severity Score (ISS) > or =16, were not significantly different between restrained and not restrained casualties. Compared to adults, restrained children aged 5-9 were 2.7 times (OR 2.74; 95% CI 1.17 to 6.43) as likely to sustain an AIS2+ abdominal injury, and tended to be more at risk of AIS2+ head injuries, but were less at risk of AIS2+ chest injuries. CONCLUSIONS Children aged 5-9 years injured in road accidents as restrained car passengers were more likely to sustain an AIS2+ abdominal injury than adults. This emphasises the need to reinforce educational campaigns aimed not only at getting children into restraint systems, but also insisting on their correct use.
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Affiliation(s)
- E Javouhey
- Epidemiological Research and Surveillance Unit in Transport, Occupation and Environment, French National Institute for Transport and Safety Research, University Claude Bernard Lyon 1, Bron, France.
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81
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82
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Abstract
OBJECTIVE The purpose of this review is to review how pediatric trauma may predispose children to sepsis. DESIGN The information discussed in this report is derived from a recent literature review of pediatric trauma and related topics and discussion at an international consensus conference on pediatric sepsis. MEASUREMENTS AND MAIN RESULTS There is a paucity of evidence on sepsis-related complications in pediatric trauma patients. Severe traumatic brain injury is a leading predisposing factor for sepsis complications. Excluding burn trauma, traumatically injured children without severe head injury rarely succumb to overwhelming sepsis. CONCLUSIONS Patients with multiple traumatic injuries are frequently admitted to the intensive care unit, and because head injury is the most common ailment, unconscious patients with a combination of injuries that include head injury will regularly require mechanical ventilation and central venous access and are at risk for life-threatening nosocomial infections. Outside of pulmonary contusions, organ-specific causes of infection are infrequent.
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Affiliation(s)
- Jeffrey S Upperman
- Division of Pediatric Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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83
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Abstract
Thoracic injury is a serious cause of morbidity and mortality in paediatric patients. This review will present cases to assist the clinician in the epidemiology, assessment and management of airway injury, pulmonary contusion, rib fracture, musculoskeletal injury and pneumothorax.
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Affiliation(s)
- Richard M Ruddy
- University of Cincinnati College of Medicine and Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, USA.
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84
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85
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Abstract
Thoracic trauma remains a major source of morbidity and mortality in injured children, and is second only to brain injuries as a cause of death. The presence of a chest injury increases an injured child's mortality by 20-fold. Greater than 80% of chest injuries in children are secondary to blunt trauma. The compliant chest wall in children makes pulmonary contusions and rib fractures the most common chest injuries in children. Injuries to the great vessels, esophagus, and diaphragm are rare. Failure to promptly diagnose and treat these injuries results in increased morbidity and mortality.
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Affiliation(s)
- Kennith H Sartorelli
- From the Department of Surgery, Division of Pediatric Surgery, University of Vermont, Burlington, VT 05401, USA
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86
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Abstract
BACKGROUND/PURPOSE Traumatic spinal injury (TSI) is an uncommon source of morbidity and mortality in children. The aim of this study was to describe childhood TSI in a single level 1 urban pediatric trauma center. METHODS The authors retrospectively analyzed all children younger than 14 years with TSI, treated at a level I pediatric trauma center between 1991 and 2002 (n = 406, 4% total registry). All children were stratified according to demographics, mechanisms, type and level of injury, radiologic evaluations, associated injuries, and mortality. RESULTS The mean age was 9.48 +/- 3.81 years. The most common overall mechanism of injury was motor vehicle crash (MVC; 29%) and ranked highest for infants. Falls ranked highest for ages 2 to 9 years. Sports ranked highest in the 10 to 14 year age group. Paravertebral soft tissue injuries were 68%. The most common injury level was the high cervical spine (O-C4). The incidence of spinal cord injury without radiologic abnormality (SCIWORA) was 6%. Traumatic brain injury (37%) was the most common associated injury. Overall mortality rate was 4% in this urban catchment. CONCLUSIONS TSI in children requires a different preventive and therapeutic logarithm compared with that of adults. The potential devastating nature of TSI warrants that the health care team always maintains a high index of suspicion for injury. Future prospective studies are needed to further elucidate injury patterns.
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Affiliation(s)
- Bayram Cirak
- Pediatric Division, Department of Neurosurgery; Johns Hopkins Medical Institutions, Baltimore, MD, USA
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