title: Treatment of thoracic trauma in children: literature review, Red Cross War Memorial Children's Hospital data analysis, and guidelines for management.
abstract: BACKGROUND
  Thoracic injuries continue to be a leading cause of childhood trauma, despite the government's efforts to curb the scourge of this problem. Our review focuses on the incidence, etiology, and management of thoracic trauma in the pediatric population with reference to the recent experience at our institution in a developing country.
  
  
  METHODS
  For the literature review, the National Library of Medicine's PubMed database was searched for the following terms: "pediatric," "chest trauma," "hemothorax," "hemopneumothorax," "pneumothorax," "diaphragmatic," "esophageal," and "mediastinal injury." For the hospital data analysis, data of all 378 pediatric patients treated with thoracic injuries under the age of 13 years from 2008 to 2012 (a 5-year period), at the Red Cross War Memorial Children's Hospital, were retrospectively analyzed.
  
  
  RESULTS
  The male to female ratio was 2.1:1 (255 males and 123 females). The mean age was 6.9 ± 2.3 years. Blunt chest trauma was responsible for chest injuries in 90.5%, while penetrating trauma caused 9.5% of the injuries. Road traffic crashes were the mean cause (48.9%) with pedestrian injuries in 72.4% and passenger injuries in 27.6%, respectively. Sports injuries were the cause in 4% and falls from a height in 22%. Most injuries occurred at home: inside one's own home (5%), outside one's own home (52%); inside someone else's home (44%); outside someone else's home (2%). Public space injuries occurred at schools or crèches in 77%, pavement or roads in 6%, and were not specified in 17%. Overall 74% presented with injuries of the thoracic cage; rib fractures occurred in 13%, chest wall contusions in 40%, and abrasions in 31%. Respiratory system injuries occurred in 22%; hemothoraces in 23%, pneumothoraces in 45%, and hemopneumothoraces in 29%. Cardiovascular injuries occurred in 16% of cases with vascular injuries in five patients (two firearms injuries and three motor vehicle crashes). Management was nonoperative in 79.4%, tube thoracotomy in 17.2%, and open surgery in 3.4%. The mortality rate was 1.3%, all contributed by firearm-related injuries and polytrauma.
  
  
  CONCLUSIONS
  Thoracic trauma has remained a significant cause of morbidity and mortality in the pediatric population. Concerted effort from governments, civil societies, and the medical profession are needed to address this challenge.
authors: Department of Paediatric Surgery, University of Cape Town, Red Cross Children's Hospital, Rondebosch, Cape Town, Western Cape, South Africa.
authors: Arjan Bastiaan
authors: AB
authors: van As
authors: Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa.
authors: Rodgers
authors: R
authors: Manganyi
authors: Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa.
authors: Andre
authors: A
authors: Brooks
mesh_terms: D002648:Child; D002675:Child, Preschool; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D017410:Practice Guidelines as Topic; D012042:Registries; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D013898:Thoracic Injuries / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D014193:Trauma Centers