title: Clinical considerations for blunt laryngotracheal trauma in children.
abstract: OBJECTIVE
  Systematic review of blunt pediatric laryngeal and tracheal trauma and development of proposed evaluation and management strategy.
  
  
  METHODS
  Systematic review and proposed clinical consideration algorithm.
  
  
  METHODS
  PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials.
  
  
  METHODS
  A medical librarian was utilized.
  
  
  RESULTS
  329 titles and abstracts were identified, and 50 reports were included. A total of 66 children were identified, with a majority of males (76.1%). Average age was 9.5±4.4years [range 2-17]. CT was employed in 66.7% of cases. False negative CT occurred in 29.5% of cases. Treatment consisted of observation (9.1%), endoscopy alone (31.8%), endoscopic repair (7.6%), and open neck exploration with repair/open reduction internal fixation (ORIF) (51.5%). Tracheotomy was utilized in 33.3% of the cases. Mortality was rare, with only one (1.5%) reported and occurred within one hour after presentation.
  
  
  CONCLUSIONS
  Significant deviation and variation from recommended previously proposed management algorithms exists in reported cases. Awareness of the natural clinical history, potential for severe morbidity or mortality, and associated complications are extremely important. CT and fiberoptic, bedside laryngoscopy may not play a significant role but may add to clinical evaluation prior to operative intervention. If employed, care must be taken to not create an unstable clinical scenario. Operative endoscopy is recommended in cases with positive physical examination findings, and treatment tailored to extent of injury.
  
  
  METHODS
  IV.
  
  
  METHODS
  Systematic review.
authors.affiliation: Pediatric Otolaryngology, Department of Surgery, Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC 27710, United States. Electronic address: jeffrey.cheng@duke.edu.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Department of Surgery, Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC 27710, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cooper
authors.affiliation: Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Tracy
mesh_terms: D000465:Algorithms; D002648:Child; D000066491:Clinical Decision-Making / Q000379:methods; D006801:Humans; D007830:Larynx / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014132:Trachea / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000628:therapy*
keywords: Blunt; Bronchoscopy; Laryngoscopy; Larynx; Pediatric; Trachea; Trauma