Chest injuries in children: an analysis of 100 cases of blunt chest trauma from motor vehicle accidents.
One hundred twenty-eight cases of chest injury were seen in a Paediatric Trauma Unit over a 5 1/2-year period. One hundred patients sustained motor vehicle accident (MVA)-related blunt chest injuries, 91 of them as pedestrians. Nine children had blunt chest injuries from falls, 10 had stab wounds (3 assault, 7 accidental), and 9 had gunshot injuries (6 from birdshot used by police during civil disturbance). MVA-related injuries were studied separately, as an etiologically homogeneous group. Sixty-five of these patients were under the age of 6. All but 3 also had serious extrathoracic injuries. The mean injury severity score (ISS) in MVA-related injuries was 25. Eight patients died, all with an ISS of 34 or more, 7 of whom had fatal head injuries. In MVA-related injuries, pulmonary contusion (n = 73) was the most frequent lesion seen, followed by rib fracture (n = 62), posttraumatic effusion (n = 58), pneumothorax (n = 38), and pneumatocele (n = 5). In MVA-related injuries, 18 children required ventilation. Thirty-nine (69%) of 56 children with radiologically evident posttraumatic pleural effusion had intercostal chest drainage. Analysis suggests that lung injury is a central event in MVA-related blunt chest trauma. Primary lung injury, radiologically visible as contusion, is complicated by hematoma, posttraumatic effusion, and pneumothorax.
Roux
P
P
Department of Paediatrics, University of Cape Town, South Africa.
Fisher
R M
RM
D000063:Accidents, Traffic; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003288:Contusions / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D055370:Lung Injury; D008297:Male; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D011859:Radiography; D012253:Rib Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D013019:South Africa; D013898:Thoracic Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D014505:Urban Population; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy