title: Mortality after emergency department thoracotomy for pediatric blunt trauma: Analysis of the National Trauma Data Bank 2007-2012.
abstract: OBJECTIVE
  The purpose of this study was to determine the proportion of children who survived after emergency department thoracotomy (EDT) for blunt trauma using a national database.
  
  
  METHODS
  A review of the National Trauma Data Bank was performed for years 2007-2012 to identify children <18 years of age who underwent EDT for blunt trauma.
  
  
  RESULTS
  Eighty-four children <18 years of age underwent EDT after blunt trauma. Every child died during their hospitalization. The median age was 15 (IQR 6-17) years. Mean injury severity score (ISS) was 34.2 (SD 20.8), and 56% had an ISS of 26-75. Data for "signs of life" were available for 21 children. Fifteen (71%) had signs of life upon ED arrival. Sixty percent of children died in the ED. Of those who survived to the operating room (OR), 66% died in the OR. Four children (5%) survived more than 24 hours in the intensive care unit, three of whom had a maximum head abbreviated injury score of 5.
  
  
  CONCLUSIONS
  There were no survivors after EDT for blunt trauma in the pediatric population in this national dataset. Usual indicators for EDT after blunt trauma in adults may not apply in children, and use should be discouraged without compelling evidence of a reversible cause of extremis.
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, Seattle, WA. Electronic address: flynnobr@uw.edu.
authors.forename: Katherine T
authors.initials: KT
authors.lastname: Flynn-O'Brien
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA.
authors.forename: Barclay T
authors.initials: BT
authors.lastname: Stewart
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Kosair Children's Hospital and University of Louisville, Louisville, KY.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Fallat
authors.affiliation: Harborview Injury Prevention and Research Center, Seattle, WA; Department of Surgery, Harborview Medical Center and University of Washington, Seattle, WA.
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
authors.affiliation: Harborview Injury Prevention and Research Center, Seattle, WA; Department of Surgery, Harborview Medical Center and University of Washington, Seattle, WA.
authors.forename: Saman
authors.initials: S
authors.lastname: Arbabi
authors.affiliation: Harborview Injury Prevention and Research Center, Seattle, WA; Department of Pediatrics, Harborview Medical Center and University of Washington, Seattle, WA.
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.affiliation: Department of Surgery, Harborview Medical Center and University of Washington, Seattle, WA.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: McIntyre
mesh_terms: D000293:Adolescent; D002648:Child; D006259:Craniocerebral Trauma / Q000150:complications; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D013908:Thoracotomy; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality* / Q000601:surgery*
keywords: Critical care; Pediatrics; Resuscitation; Thoracotomy; Trauma