Controversies in pediatric thoracic and abdominal trauma

El uso de las imágenes en el trauma de tórax

El  trauma  de  tórax  produce  un  desenlace  fatal  en aproximadamente un 25% de los traumatismos en general. Constituye  la  principal  causa  de  morbilidad  y  mortalidad después  del  trauma  craneoencefálico  y  las  lesiones  de  la médula ósea; puede afectar cualquiera o la totalidad de las estructuras del  tórax, desde los tejidos blandos, la pleura, los pulmones y el diafragma hasta las estructuras mediastinales incluyendo el corazón. Constituye una urgencia médica que requiere de un rápido y oportuno manejo. Su diagnóstico temprano  y  un  adecuado  tratamiento  en  los  servicios  de urgencias  evitarán  una  resolución  fatal  en  la  mayoría  de pacientes  que  ha  sufrido  un  trauma  de  tórax  teniendo  en cuenta que aproximadamente solo de un 10 a 15 % requiere manejo  quirúrgico.  Es  de  vital  importancia  establecer  un diagnóstico, por  lo cual  las  imágenes diagnósticas, entre ellas la  radiografía  convencional  y  la  tomografía  computarizada multidetector juegan un papel fundamental ya que cada vez se están  utilizando  con  mayor  frecuencia  porque  brindan información rápida y precisa en  la variedad de  lesiones de  los pacientes que han sufrido trauma; además las imágenes de tomografía  computada  multiplanar  y  volumétricas proporcionan una mejor visualización de las lesiones con un aumento en la comprensión de estas para así poder ofrecer un tratamiento a  las  lesiones  secundarias a un  trauma de tórax. Por  lo  tanto, el profesional de  la medicina debe  tener un conocimiento claro acerca de la ayuda diagnóstica de mejor elección y de  la  interpretación de  la misma. Para la realización del presente artículo se hizo una búsqueda sistemática de la literatura en relación al trauma de tórax, su epidemiología, fisiopatología,  clasificación  y  los  métodos  de  ayudas diagnósticas por  imagen que se utilizan para su adecuado diagnóstico y manejo. 

The mechanics of the in vivo infant and toddler trunk during respiratory physiotherapy

BACKGROUND

The purpose of this study is to quantify the in vivo mechanical response of the child trunk under loading during physiotherapy treatments.

METHODS

Twenty-six children aged 45 days to 7 years (14 girls and 12 boys) took part in this study. The forces applied by the physiotherapist were recorded using a force-plate embedded in the manipulation table supporting the child. Two synchronized cameras filmed the scene in a calibrated environment. The displacement of reflective targets glued on the physiotherapist's hands was calculated using an automatic tracking procedure and the 3D reconstruction "Direct Linear Transformation" algorithm. The progression of physical parameters was evaluated according to the age of the child. They included force, displacement, normalized displacement, loading speed, displacement and normalized displacement at the maximum force, force at the maximum displacement, viscous criterion and effective stiffness.

FINDINGS

For all patients, the mean maximum displacement and load were 22 mm (SD 9 mm) and 240 N (SD 46 N) respectively. The force-displacement curves had shown the complexity of the in vivo behavior: four phases have been distinguished with cycles in respect with the respiratory phases. The increase in force always occurred before the increase in displacement.

INTERPRETATION

This study helps to understand the in vivo behavior of the child trunk subjected to repetitive non-injurious mechanical loading. Further analysis in other populations and with different therapeutic maneuvers would refine the results.

Paediatric chest trauma (part 1) — Initial Lethal Injuries

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.

Paediatric chest trauma (part 2) — Hidden Injuries

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.

Imaging Evaluation of Pediatric Chest Trauma

Following a discussion of the various imaging manifestations of pediatric chest trauma by anatomic location, the authors discuss their diagnostic approach to the pediatric multitrauma patient with an emphasis on chest imaging.