title: Pediatric emergency department thoracotomy: a large case series and systematic review.
abstract: OBJECTIVE
  The emergency department thoracotomy (EDT) is rarely utilized in children, and is thus difficult to identify survival factors. We reviewed our experience and performed a systematic review of reports of EDT in pediatric patients.
  
  
  METHODS
  Patients age ≤18 years who received an EDT from 1991 to 2012 at our institution and all published case series were reviewed. Data analyzed include age, sex, mechanism of injury (MOI), injury patterns, presence of vital signs (VS) or signs of life (SOL) in the field/ED, return of spontaneous circulation (ROSC), and survival.
  
  
  RESULTS
  A total of 252 patients were analyzed. 84% were male. 51% sustained penetrating injuries, and median age was 15 years. Upon arrival, 17% had VS, and 35% had SOL. After EDT, 30% experienced ROSC. The survival rate was 1.6% for blunt trauma, 10.2% for penetrating injuries, and 6.0% overall.
  
  
  CONCLUSIONS
  Survival of pediatric patients following EDT is comparable to recent analyses in adults. Children who sustain blunt injury and are without SOL have been uniformly unsalvageable. Children who sustain penetrating trauma and have SOL or are without SOL for a short time prior to arrival have been salvageable. There are no reported EDT survivors less than 14 years of age following blunt injury.
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Casey J
authors.initials: CJ
authors.lastname: Allen
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Valle
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Thorson
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Hogan
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Perez
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Tanya L
authors.initials: TL
authors.lastname: Zakrison
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Holly L
authors.initials: HL
authors.lastname: Neville
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. Electronic address: jsola@med.miami.edu.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Sola
mesh_terms: D002648:Child; D004636:Emergency Service, Hospital; D006801:Humans; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013898:Thoracic Injuries / Q000401:mortality / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods* / Q000401:mortality; D014481:United States / Q000453:epidemiology
keywords: Adolescents; Children; Kids; Resuscitative thoracotomy