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Selesner L, Yorkgitis B, Martin M, Ng G, Mukherjee K, Ignacio R, Freeman J, Wong LY, Durbin S, Crandall M, Longshore SW, Gerall C, Flynn-O'Brien KT, Jafri M. Emergency department thoracotomy in children: A Pediatric Trauma Society, Western Trauma Association, and Eastern Association for the Surgery of Trauma systematic review and practice management guideline. J Trauma Acute Care Surg 2023; 95:432-441. [PMID: 37608453 DOI: 10.1097/ta.0000000000003879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Abstract
BACKGROUND The role of emergency department resuscitative thoracotomy (EDT) in traumatically injured children has not been elucidated. We aimed to perform a systematic review and create evidence-based guidelines to answer the following PICO (population, intervention, comparator, and outcome) question: should pediatric patients who present to the emergency department pulseless (with or without signs of life [SOL]) after traumatic injuries (penetrating thoracic, penetrating abdominopelvic, or blunt) undergo EDT (vs. no EDT) to improve survival and neurologically intact survival? METHODS Using Grading of Recommendations Assessment, Development and Evaluation methodology, a group of 12 pediatric trauma experts from the Pediatric Trauma Society, Western Trauma Association, and Eastern Association for the Surgery of Trauma assembled to perform a systematic review. A consensus conference was conducted, a database was queried, abstracts and manuscripts were reviewed, data extraction was performed, and evidence quality was determined. Evidence tables were generated, and the committee voted on guideline recommendations. RESULTS Three hundred three articles were identified. Eleven studies met the inclusion criteria and were used for guideline creation, providing 319 pediatric patients who underwent EDT. No data were available on patients who did not undergo EDT. For each PICO, the quality of evidence was very low based on the serious risk of bias and serious or very serious imprecision. CONCLUSION Based on low-quality data, we make the following recommendations. We conditionally recommend EDT when a child presents pulseless with SOL to the emergency department following penetrating thoracic injury, penetrating abdominopelvic injury and after blunt injury if emergency adjuncts point to a thoracic source. We conditionally recommend against EDT when a pediatric patient presents pulseless without SOL after penetrating thoracic and penetrating abdominopelvic injury. We strongly recommend against EDT in the patient without SOL after blunt injury.
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Affiliation(s)
- Leigh Selesner
- From the Division of General Surgery (L.S., L.-Y.W., S.D.), Oregon Health & Sciences University, Portland, Oregon; Department of Surgery (B.Y., M.C.), University of Florida College of Medicine-Jacksonville, Florida; Department of Surgery (M.M.), Los Angeles County + University of Southern California Medical Center, Los Angeles, California; Department of Surgery (G.N.), Texas Tech University Health Sciences Center El Paso, El Paso, Texas; Division of Acute Care Surgery (K.M.), Loma Linda University Medical Center, Loma Linda, California; Department of Surgery (R.I.), University of California San Diego School of Medicine/Rady Childrens Hospital San Diego, San Diego, California; Department of Surgery (J.F.), Burnett School of Medicine at Fort Worth, Texas; Department of Surgery (S.W.L.), East Carolina University, Greenville, North Carolina; Department of Surgery (C.G.), University of Texas Health San Antonio, San Antonio, Texas; Department of Pediatric Surgery (K.T.F.-B.), Medical College of Wisconsin, Children's Wisconsin, Milwaukee, Wisconsin; and Division of Pediatric Surgery (M.J.), Doernbecher Children's Hospital, Oregon Health & Sciences University; and Randall Children's Hospital (M.J.), Legacy Emanuel Medical Center, Portland, Oregon
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Alaqeel SM, Howsawi AA, Al Namshan MK, Al Maary JO. Patterns of pediatric thoracic penetrating injuries: A single-trauma-center experience in Riyadh, Saudi Arabia. Saudi Med J 2021; 42:280-283. [PMID: 33632906 PMCID: PMC7989254 DOI: 10.15537/smj.2021.42.3.20200693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/14/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To review the patterns and outcomes of pediatric thoracic penetrating injuries in a level one trauma center. METHODS Retrospective chart review of pediatric patients who presented to the King Abdulaziz Medical City Emergency Department (KAMC-ED), Riyadh, Saudi Arabia with thoracic penetrating injury from 2001 to 2016. RESULTS Eighty-nine patients had a penetrating injury to the thorax were identified. The mean age was 15.5 ± 3.6 years. The mean length of hospital stay was 3.87 ± 5 days. The most common cause was stabbing followed by gunshot. Isolated injury to the thorax was seen in 58 patients. The most common injuries sustained were pneumothorax and hemothorax. In the ED, tube thoracostomy was required in 65 patients, endotracheal intubation in 12, blood transfusion in 14, massive blood transfusion in one, pericardiocentesis in one, and ED thoracotomy in 2. Only 15 patients required surgical intervention. The overall mortality rate was 3.4%. Death was mainly caused by associated injuries to the heart, aorta and/or inferior vena cava. CONCLUSION Thoracic injuries represent 25% of the overall penetrating traumas in pediatric age group. Most sustained injuries can be safely managed non-operatively, with a favorable outcome. Prompt resuscitation and intervention are required to identify and manage life-threatening injuries.
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Affiliation(s)
- Suliaman M. Alaqeel
- From the Department of Pediatric Surgery (Alaqeel, Al Namshan, Al Maary), King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City and from the Department of Family Medicine (Howsawi), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Suliaman M. Alaqeel, Department of Pediatric Surgery, King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0003-2778-9710
| | - Abdulaziz A. Howsawi
- From the Department of Pediatric Surgery (Alaqeel, Al Namshan, Al Maary), King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City and from the Department of Family Medicine (Howsawi), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammad K. Al Namshan
- From the Department of Pediatric Surgery (Alaqeel, Al Namshan, Al Maary), King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City and from the Department of Family Medicine (Howsawi), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Jamila O. Al Maary
- From the Department of Pediatric Surgery (Alaqeel, Al Namshan, Al Maary), King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City and from the Department of Family Medicine (Howsawi), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
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Elkbuli A, Meneses E, Kinslow K, McKenney M, Boneva D. Successful management of gunshot wound to the chest resulting in multiple intra-abdominal and thoracic injuries in a pediatric trauma patient: A case report and literature review. Int J Surg Case Rep 2020; 76:372-376. [PMID: 33080529 PMCID: PMC7575832 DOI: 10.1016/j.ijscr.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Trauma remains the leading cause of mortality in the pediatric population. Penetrating thoracic injuries can result in devastating trauma to multiple organ systems. When these injuries occur, prompt diagnosis and swift treatment of internal organ injury are of utmost importance. CASE PRESENTATION A 13-year-old male presented to our Trauma Center after sustaining a gunshot wound (GSW) to the left chest. Despite his hemodynamic stability on presentation, CT scan revealed multiple injuries including splenic and renal lacerations. Exploratory laparotomy resulted in splenectomy, but no intervention was performed for the renal laceration. Instead, clinical monitoring alone was sought. Patient was discharged on hospital day 13 in stable condition. DISCUSSION Pediatric penetrating injuries secondary to GSWs can impact multiple organ systems. Despite hemodynamic stability on presentation, adequate staging of internal damage with CT allowed a targeted approach. In our case, non-operative management of the renal injury was implemented after hemorrhage control of his additional injuries. Failure to have done so would have inevitably complicated his overall management and made kidney salvage not feasible. CONCLUSION Prompt diagnosis and treatment are required in order to prevent significant morbidity and mortality in the pediatric patient from GSW-mediated penetrating thoracic injuries. Despite hemodynamic stability on presentation, patients should be emergently assessed for severe injury, with immediate surgical management as needed. Failure to do so could lead to rapid clinical deterioration, and inability to enact other conservative measures that lead to positive outcomes.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.
| | - Evander Meneses
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Kyle Kinslow
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Dessy Boneva
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; Department of Surgery, University of South Florida, Tampa, FL, USA
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Evaluation of factors affecting prognosis in penetrating thoracic injuries. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:598-605. [PMID: 32082802 DOI: 10.5606/tgkdc.dergisi.2018.15734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/23/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to investigate the prognostic factors affecting survival and clinical outcomes in patients exposed to pediatric penetrating thoracic injury. Methods A t otal o f 2 67 p ediatric p enetrating t horacic injury patients (217 males, 50 females; mean age 10.8 years; range, 3 to 17 years) who were treated at our hospital during the recent 20 years were analyzed retrospectively. Penetrating thoracic injuries were divided into three groups: incisive/stabbing injuries, gunshot injuries, explosive injuries. Patients" age, gender, New Injury Severity Score, injury type, injuries accompanying thoracic trauma, types of treatment applied, length of hospital stay, and morbidity and mortality outcomes were examined. Their prognostic characteristics were compared to their injury types, New Injury Severity Scores, lengths of hospital stay and complications. Results Of the patients, 103 were exposed to gunshot injuries, 128 to incisive/stabbing injuries, and 36 to explosive injuries. Of the penetrating thoracic injuries, while 211 (79%) were isolated injuries, 56 (21%) were accompanying non-thoracic injuries. Mean New Injury Severity Score was 13±10. Of the patients, 50 (18.6%) were treated with medical therapy alone, 199 (74.5%) with tube thoracostomy, and 18 (6.7%) with thoracotomy. Fiftyone patients (19%) developed complications. Length of hospital was 9±2.7 days. Twenty-one patients (7.9%) died. New Injury Severity Scores, rates of combined injuries, complications, length of hospital stay, and mortality were higher in explosive injuries (p<0.05). Conclusion Pediatric penetrating thoracic injuries may be observed in all age groups in children, the most severe type being explosive injuries. Prognostic factors may vary according to injury type, complications, treatment approach, and presence of accompanying non-thoracic injuries.
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Culyba AJ, Guo W, Branas CC, Miller E, Wiebe DJ. Comparing residence-based to actual path-based methods for defining adolescents' environmental exposures using granular spatial data. Health Place 2017; 49:39-49. [PMID: 29190517 DOI: 10.1016/j.healthplace.2017.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 10/23/2017] [Accepted: 11/20/2017] [Indexed: 11/27/2022]
Abstract
This paper uses data from a population-based case control study of daily activities and assault injury to examine residence-based versus actual path-based approaches to measuring environmental exposures that pose risks for violence among adolescents. Defining environmental exposures based on participant home address resulted in significant misclassification compared to gold standard daily travel path measures. Dividing participant daily travel paths into origin-destination segments, we explore a method for defining spatial counterfactuals by comparing actual trip path exposures to shortest potential trip path exposures. Spatial methods explored herein can be utilized in future research to more accurately quantify environmental exposures and associations with health outcomes.
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Affiliation(s)
- Alison J Culyba
- Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States.
| | - Wensheng Guo
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States.
| | - Charles C Branas
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States.
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh, Oakland Medical Building, 3420 Fifth Avenue, Pittsburgh, PA 15213, United States.
| | - Douglas J Wiebe
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, United States.
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Abstract
Thoracic trauma in children is the second most frequent cause of death in the pediatric population. The majority of these children will have multisystem injuries. Management of these patients starts with the primary survey, resuscitation, and secondary survey as described in Advanced Trauma Life Support training. Most children with thoracic injuries can be observed or treated nonoperatively. The majority of children who do need surgery will need exploratory laparotomy and may have significant blood loss. The anesthesiologist needs to be prepared to manage a patient with severe underlying respiratory derangements, ongoing blood loss, and /or cardiac dysfunction. Moreover, one-lung ventilation may be necessary for optimal surgical exposure, which will present considerable challenges.
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Affiliation(s)
- Rita Agarwal
- Department of Anesthesiology, Associate, The Childrens' Hospital, 1056 E 19th Ave, Denver, CO 80218
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The early management of gunshot wounds Part II: the abdomen, extremities and special situations. TRAUMA-ENGLAND 2016. [DOI: 10.1177/1460408607084151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The management of gunshot wounds of the abdomen and extremities is evolving with centres who treat large volumes of such injuries tending to the application of a policy of selective non-operative management. This article discusses the management of gunshot wounds to the abdomen and extremities and reviews the evidence supporting these changing practices. Special situations such as wounding by shotguns or air rifles are also examined as are the special considerations needed when dealing with the gunshot injured pregnant women or in a child.
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Okonta KE. Traumatic chest injury in children: A single thoracic surgeon's experience in two Nigerian tertiary hospitals. Afr J Paediatr Surg 2015; 12:181-6. [PMID: 26612123 PMCID: PMC4955435 DOI: 10.4103/0189-6725.170193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND This study was to determine the extent and outcome of childhood chest injury in Nigeria, and to compare results with that of other literatures. PATIENTS AND METHODS A Prospective study of all children under 18 years of age with chest trauma in two tertiary hospitals in Southern Nigeria from January 2012 to December 2014 was reviewed. The aetiology, type, associated injury, mechanism, treatment and outcome were evaluated. The patients were followed up in the clinic. The data were analysed using SPSS version 20.0 with a significant P < 0.05. RESULTS Thirty-one patients (12.1%) under 18 years of age of 256 chest trauma patients were managed in the thoracic units. The mean age was 9.78 ± 6.77 years and 27 (87.1%) were male. The aetiology in 13 was from falls, 10 from automobile crashes, 3 from gunshots, 4 from stabbing and 1 from abuse. The highest peak of chest injury was on Saturday of the week and April of the year. The pleural collections are as follows: 15 (71.4%) was haemothorax, 4 (19.1%) pneumothorax, 2 (9.5%) haemopneumothorax and 18 patients had lung contusion in combination or alone with the pleural collections. Seven patients who presented >12-h versus 2 who presented <12-h and 6 of children between 0 and 9 years versus 3 at 10-18 years of age had empyema thoracis (P value not significant). One death was recorded. CONCLUSION Chest trauma in children is still not common, and blunt chest injury from falls and automobile accidents are more common than penetrating chest injury. Treatment with tube thoracostomy is the major management modality with empyema thoracis as the most common complication.
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Affiliation(s)
- Kelechi Emmanuel Okonta
- Thoracic Unit,Department of Surgery, University of Port-Harcourt Teaching Hospital, Port-Harcourt, Rivers State; Federal Medical Center, Owerri, Imo State, Nigeria
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Age-associated impact on presentation and outcome for penetrating thoracic trauma in the adult and pediatric patient populations. J Trauma Acute Care Surg 2014; 76:273-7; discussion 277-8. [DOI: 10.1097/ta.0000000000000090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Chest trauma in children is caused by high-energy blows, due in general to traffic accidents, that involve several other body regions. They occur mainly in the first decade of life and can be penetrating but are more often non-penetrating. Rib fractures and lung contusions, sometimes associated with pneumothorax or haemothorax, are the more usual injuries, but tracheobronchial rupture, cardiac, oesophageal or diaphragmatic injuries may also occur. These injuries are treated with supportive respiratory and haemodynamic measures, drainage of air or blood from the pleural space and, at times, surgical repair of the injured organ(s). Ruptures of the airway may be difficult to treat and occasionally require suture, anastomosis or resection. Oesophageal injuries can be treated conservatively with antibiotics, drainage and parenteral nutrition. Diaphragmatic tears should be repaired operatively. Overall mortality ranges from 6 to 20%. Mortality is high but this is mainly due to the associated presence of extra-thoracic trauma, and particularly to head injuries.
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Affiliation(s)
- Juan A Tovar
- Department of Paediatric Surgery, Hospital Universitario La Paz and Department of Paediatrics, Universidad Autonoma de Madrid, Madrid, Spain.
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Abstract
Penetrating injuries account for 10% to 20% of all pediatric trauma admissions at most centers. Gunshot wounds are responsible for the overwhelming majority of penetrating traumatic injuries and have a significantly higher mortality rate than do blunt injury mechanisms. The management of penetrating injuries can be quite challenging and often requires rapid assessment and intervention. Specific management principles are guided by the anatomic location of injury, the determination of trajectory, and the suspected organs injured. Management approaches have been adopted in large part from the more robust adult experience. However, application of these strategies to similar life-threatening injuries in the pediatric population appears appropriate.
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Affiliation(s)
- Bryan A Cotton
- From the Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Clemence B. Emergency department thoracotomy: nursing implications for pediatric cases. INTERNATIONAL JOURNAL OF TRAUMA NURSING 2000; 6:123-7; quiz 128. [PMID: 11035855 DOI: 10.1067/mtn.2000.110826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiac arrest in the pediatric patient is an infrequent event. Although an emergency department thoracotomy is a potentially lifesaving procedure, it should be used in only a small, select group of patients. A literature review was conducted to determine the indications, surgical techniques, emergency procedures, and nursing responsibilities associated with an emergency department thoracotomy.
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Affiliation(s)
- B Clemence
- Pennsylvania Trauma Systems Foundation, 5070 Ritter Rd, Suite 100, Mechanicsburg, PA 17055-4879, USA
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Abstract
Given the magnitude of childhood injuries that occur yearly in the United States, physicians need integrated echelons of care that include regional pediatric trauma centers, trauma centers with pediatric commitment, and EDs appropriate for children. Head injury is the most significant cause of morbidity and mortality among children, but physicians are far from effectively evaluating the dynamics of cerebral metabolism and oxygen delivery in the acute resuscitation of injured children. Critically injured children must be kept normothermic, and attention to the signs of hypovolemic shock must be monitored. Secondary brain ischemia frequently occurs because the details of resuscitation are not carefully monitored. A "leader" must be designated, and this should be someone experienced in childhood trauma. The younger the child and the more severe the injury, the more important is the notion of "experience." The ultimate goal, now and in the new millennium, should not be who, where, or when to administer care to critically ill or injured children but rather the quality of the treatment of these children.
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Affiliation(s)
- J I Sanchez
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Abstract
BACKGROUND Chest trauma in childhood is relatively uncommon in clinical practice, and has been the subject of few reports in the literature. This study was undertaken to examine our experience in dealing with chest trauma in children. PATIENTS AND METHODS This was a retrospective study of 74 children who sustained chest trauma, and were referred to King Fahad Hospital in Medina over a two-year period. The age, cause of injury, severity of injury, associated extrathoracic injuries, treatment and outcome were analyzed. RESULTS The median age of the patients was nine years. Fifty-nine of them (80%) sustained blunt trauma, and 15 (20%) were victims of penetrating injuries. Road traffic accident was the cause of chest trauma in 62% of the children, gun shot wounds were seen in five, and stab wounds in 10 children. Head injury was the most common injury associated with thoracic trauma, and was seen in 14 patients (19%), and associated intraabdominal injuries were seen in nine patients. Chest x-ray of the blunt trauma patients revealed fractured ribs in 24 children, pneumothorax in six, hemothorax in four, hemopneumothorax in three, and pulmonary contusions in 22 patients. Fifty-one percent of children were managed conservatively, 37% required tube thoracostomy, 8% were mechanically ventilated, and 4% underwent thoracotomy. CONCLUSION The prevalence of chest trauma in children due to road traffic accidents is high in Saudi Arabia. Head injury is thought to be the most common associated extrathoracic injuries, however, most of these patients can be managed conservatively.
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Affiliation(s)
- A Al-Saigh
- Department of Surgery, King Khalid University Hospital, Riyadh, and Thoracic Unit, King Fahad Hospital, Medina, Saudi Arabia
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Carrillo EH, Gonzalez JK, Carrillo LE, Chacon PM, Namias N, Kirton OC, Byers PM. Spinal cord injuries in adolescents after gunshot wounds: an increasing phenomenon in urban North America. Injury 1998; 29:503-7. [PMID: 10193491 DOI: 10.1016/s0020-1383(98)00110-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
While much attention is focused on firearm fatalities, the purpose of this study was to determine the expense of acute medical care and the rehabilitation experience of surviving adolescent patients in the USA with spinal cord injury secondary to gunshot wounds. We analyzed a cohort of 19 patients, 18 of whom survived 12 months after spinal cord injury. The need for primary medical care related to the injury, current work and scholastic status, and satisfaction with the quality of rehabilitation were determined. Ten were not involved in any type of academic or meaningful activity, five had returned to school, three were undergoing rehabilitation, and one patient died. Major complications were present in 14 of the 18 patients. Thus, despite a high survival rate after spinal cord injury in this USA population, considerable long-term disability persists, and survivors report a low level of satisfaction with life.
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Affiliation(s)
- E H Carrillo
- Department of Surgery, University of Miami School of Medicine, FL, USA
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Bratton SL, Dowd MD, Brogan TV, Hegenbarth MA. Serious and fatal air gun injuries: more than meets the eye. Pediatrics 1997; 100:609-12. [PMID: 9310513 DOI: 10.1542/peds.100.4.609] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To describe the epidemiology of air gun injuries to children that required hospitalization. DESIGN A consecutive series of children with air gun injuries. SETTING Urban pediatric teaching hospitals in Cincinnati, OH; Kansas City, MO; and Seattle, WA. METHODS A retrospective chart review. RESULTS A total of 101 children were studied: 81% were male; 80% were white, 18% were black, and 2% were other races. The median age was 10.9 years (range, 0.5 to 18.8). Victims were most commonly shot by a friend (30%) or sibling (21%). A total of 34% occurred at the victim's home, and 36% occurred at the home of a friend or relative. Although 71% of shootings were unintentional, 5% were assaults, and 1% were suicides. The median hospital stay was 3 days (range, 1 to 17 days). Fifteen children (15%) required treatment in intensive care. A total of 56% required at least one surgical procedure. Forty-nine had injuries to the head, including 38 with injuries to the eye, 10 with intracranial injuries, and 1 with a skull injury. Fourteen children were shot in the neck; 15 were shot in the chest, with 2 patients sustaining lacerations of the pericardium and 1 having a right ventricular foreign body. Another child had a laceration of the innominate artery. Nineteen had abdominal injuries, including laceration of the stomach (N = 3), small bowel (N = 4), colon (N = 2), and liver (N = 3). Three of 10 children with intracranial injuries died. Two had long-term neurologic deficits. Of children with eye injuries, 25 (66%) had permanent visual loss and 15 (39%) of these were blind. CONCLUSION Air guns are associated with serious and fatal injuries. Families should be counseled that air guns may cause serious injuries and even death. Furthermore, pediatric care givers should advocate for increased regulation of air guns and expansion of safety standards.
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Affiliation(s)
- S L Bratton
- Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington, USA
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