Traumatic asphyxia: an indicator of potentially severe injury in trauma

A retrospective study of 51 pediatric cases of traumatic asphyxia

Background

Traumatic asphyxia (TA) is a rarely reported disease characterized as thoraco-cervico-facial petechiae, facial edema and cyanosis, subconjunctival hemorrhage and neurological symptoms. This study aimed to report 51 children of TA at the pediatric medical center of west China.

Methods

Scanned medical reports were reviewed and specific variables as age, sex, cause of injury, clinical manifestations and associated injuries were analyzed using SPSS 25.0.

Results

The average age of patients was 5.3 ± 2.9 (1.3–13.2) year-old. Thirty (58.8%) were boys and 21 (41.2%) were girls. Most TAs occurred during vehicle accident, object compression and stampede. All patients showed facial petechiae (100.0%, CI 93.0–100.0%), 25 (49.0%, CI 34.8–63.2%) out of 51 presented with facial edema, 29 (56.9%, CI 42.8–70.9%) presented with subconjunctival hemorrhage, including bilateral 27 and unilateral 2. Six patients had facial cyanosis (11.8%, CI 2.6–20.9%). Other symptoms were also presented as epileptic seizure, vomiting, incontinence, paraplegia, etc. The most frequent companion injury was pulmonary contusion (76.5%, CI 64.4–88.5%). Other companion injuries included mediastinal emphysema, fracture, cerebral contusion and hemorrhage, hypoxic-ischemic brain injury, abdominal organ contusion, mastoid hemorrhage, hematocele of paranasal sinuses, spinal cord injury, hepatic insufficiency, myocardial injury and retinal hemorrhage and edema. Treatment was mainly supportive. No death occurred in our study. The prognosis is rather good if without damage of central nervous system.

Conclusion

TA could bring out multiple symptoms, among which retinal hemorrhage and edema, spinal cord injury and viscera impairment have been less observed. Comprehensive physical and auxiliary examination should be performed considering TA. Its prognosis is rather good with focus on life-threatening complications.

[Perthes Syndrome after Roll-Over Trauma]

Roll-over trauma and associated traumatic entrapments frequently result in serious polytraumatisation. In rare cases, severe extrathoracic compressions and a protracted entrapment period can lead to Perthes syndrome, also known as traumatic asphyxia. The Perthes syndrome manifests itself by a triad of craniocervical cyanosis, facial petechiae and subconjunctival haemorrhages, enabling a rapid diagnosis based on these typical clinical features. In addition, a contusion of the heart, lungs or even the liver may occur as well as neurological and other ophthalmological complications. An early identification of this condition, the elevation of the upper body to allow adequate venous drainage in addition to ensuring sufficient oxygenation are essential for optimal therapy. In general, no long-term complications are to be expected for Perthes syndrome. The stasis usually disappears completely within a few months.

Comparison of autopsy findings and injury severity scores in deaths due to traumatic asphyxia (perthes syndrome)

Traumatic asphyxia is a rare clinical syndrome usually caused by sudden and severe thoracic and/or thoracoabdominal compression. It presents with craniofacial cyanosis, petechiae, and subconjunctival haemorrhages. The present study employed a postmortem retrospective methodology to analyse autopsy findings and accompanying injuries in cases of death due to traumatic asphyxia. Four years of case files from a morgue department at a forensic medicine institute were searched and 53 cases of lethal traumatic asphyxia were found. These cases were then classified into groups and compared using the Injury Severity Score (ISS) and New Injury Severity Score (NISS) indices to measure trauma.

RESULTS

The individuals had died due to occupational (n = 28; 52.8%), farm (n = 10; 18.9%), traffic (n = 9; 17.0%) or household (n = 6; 11.3%) accidents. At the external examination, conjunctival petechiae (60.4%) and petechiae on the face/neck (52.8%); at the autopsy, subpleural petechiae (58.5%) and petrous ridge hemorrgahe (without skull base fracture) (56.6%) were the most common findings. A finding of petrous ridge hemorrgahe was very common in the cases without any accompanying injuries (Group A in which mean Injury Severity Score was 0.83 ± 0.98). Traumatic asphyxia is usually suspected from the given circumstances before an autosopy is performed. In cases without hospitalisation, any of the following signs may lead the physician to diagnose traumatic asphyxia as the cause of death: petechiae on the upper parts of the body and conjunctiva, petechiae on serous membranes (including subpleural regions), signs of petrous ridge haemorrhage without skull base fracture.

Asphyxiation: a review

Asphyxia may be broadly defined as any condition that leads to tissue oxygen deprivation. This article reviews traumatic causes of asphyxia, including the syn drome known as traumatic asphyxia, where a crush injury to the thoracoabdominal area gives the striking clinical triad of cervicofacial cyanosis and oedema, subcon junctival haemorrhage and cutaneous petechial haemorrhages of the face, neck and upper chest. Other traumatic causes of asphyxia reviewed are strangulation due to hanging and autoerotic asphyxiation. However bleak the initial prognosis may appear, any patient who presents with a history of asphyxiation should initially be resuscitated according to the prioritized approach: airway with cervical spine control, oxygenation and ventilation, and circulation. The clinical appearance of the patient is not an indicator of outcome. The identification and treatment of associated compli cations and injuries is vital, since these are a major cause of morbidity and mortality if the patient survives the initial asphyxiation insult.

A Rare and Serious Syndrome That Requires Attention in Emergency Service: Traumatic Asphyxia

Traumatic asphyxia is a rare syndrome caused by blunt thoracoabdominal trauma and characterized by cyanosis, edema, and subconjunctival and petechial hemorrhage on the face, neck, upper extremities, and the upper parts of the thorax. Traumatic asphyxia is usually diagnosed by history and inspection; however, the patient should be monitored more closely due to probable complications of thoracoabdominal injuries. Treatment is conservative, but the prognosis depends on the severity of the associated injuries. Herein we present a traumatic asphyxia due to an elevator accident in a 32-year-old male patient and discuss the diagnosis, treatment, and prognosis by reviewing the relevant literature.

Traumatic asphyxia

Traumatic asphyxia is a rare condition in children that usually occurs after severe compression to the chest or abdomen. We report 3 cases in patients 18, 20, and 36 months of age who presented signs and symptoms of traumatic asphyxia after car accidents. Two clinical features were consistent in all 3 patients: multiple petechiae on the face and bulbar conjunctival hemorrhage; 2 patients had facial cyanosis, and 1 had facial edema.In children, the number of clinical manifestations that should be evident to diagnose traumatic asphyxia has not been ascertained. However, in any history of trauma with compression of the chest or abdomen and signs of increased intravenous craniocervical pressure, traumatic asphyxia should be suspected.