Thoracic trauma in children: an indicator of increased mortality.
This study was undertaken to assess the significance of thoracic trauma as a marker of morbidity and mortality in children. During a 34-month period, 2,086 children younger than 15 years old were consecutively admitted to a Level I pediatric trauma center with blunt or penetrating trauma. For each child we prospectively recorded Trauma Score (TS), Injury Severity Score, (ISS), medical, and etiologic data. One hundred four children (4.4%) presented with thoracic trauma. The most common mechanisms of injury were pedestrian injury (36%), motor vehicle crashes (32%), and armed assault (12%). The most common injuries were pulmonary contusion (48%), pneumothorax, hemothorax, or pneumohemothorax (39%), and rib fractures (32%). Multisystem injury was present in 82% of the children. The mean TS and ISS were 11 and 27, respectively, significantly worse than scores for children without thoracic injury (15 and 7; P less than .0001). Seventy-one percent of the children were admitted to the intensive care unit, where they stayed an average of 6 days; 20% required surgery. The mortality rate was 26%. Injuries to the heart or great vessels had the highest mortality rate (75%), followed by hemothorax (53%), lung laceration (43%), and rib fracture (42%). Mortality for children with isolated chest injury was 5%, compared with rates of 20% for abdominal and chest trauma, 35% for head and chest trauma, and 39% for trauma to the head, chest, and abdomen. Less than 5% of the admissions to a pediatric trauma center incurred thoracic injury.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Surgery, George Washington University School of Medicine, Washington, DC.
M H
MH
Peclet
K D
KD
Newman
M R
MR
Eichelberger
C S
CS
Gotschall
V F
VF
Garcia
L M
LM
Bowman
D000063:Accidents, Traffic; D002648:Child; D003415:Crime; D004219:District of Columbia / Q000453:epidemiology; D006801:Humans; D008396:Maryland / Q000453:epidemiology; D009104:Multiple Trauma / Q000401:mortality; D013898:Thoracic Injuries / Q000401:mortality*; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014768:Virginia / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000401:mortality; D014950:Wounds, Penetrating / Q000401:mortality