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Eur J Pediatr Surg 2013; 23(06): 434-443
DOI: 10.1055/s-0033-1363160
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Treatment of Thoracic Trauma in Children: Literature Review, Red Cross War Memorial Children's Hospital Data Analysis, and Guidelines for Management

Arjan Bastiaan van As
1   Department of Paediatric Surgery, University of Cape Town, Red Cross Children's Hospital, Rondebosch, Cape Town, Western Cape, South Africa
,
Rodgers Manganyi
2   Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa
,
Andre Brooks
2   Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa
› Author Affiliations
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Publication History

11 October 2013

18 October 2013

Publication Date:
10 December 2013 (online)

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Abstract

Introduction 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.

Conclusion 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.

Keywords

thoracic trauma - management - trauma
 

  • References

  • 1 Lema MK, Chalya PL, Mabula JB, Mahalu W. Pattern and outcome of chest injuries at Bugando Medical Centre in Northwestern Tanzania. J Cardiothorac Surg 2011; 6: 7
    CrossrefPubMedGoogle Scholar
  • 2 Oikonomou A, Prassopoulos P. CT imaging of blunt chest trauma. Insights Imaging 2011; 2 (3) 281-295
    CrossrefPubMedGoogle Scholar
  • 3 Hewitson J. Chest injuries. In: Naidoo S, Van As S, , eds. Paediatric Trauma and Child Abuse.1st ed. Cape Town: Oxford University Press SA; 2006: 240-247
    Google Scholar
  • 4 Peden M, Hyder AA. Time to keep African Kids safer. S Afr Med J 2009; 1 (99) 36-37
    PubMedGoogle Scholar
  • 5 Paden M, Oyegbite K, Ozanne-Smith J et al , eds. World Report on Child Injury Prevention. Geneva: World Health Organization and United Nations Children's Fund; . Retrieved August 19, 2010 from http://www.who.int/violence_injury_prevention/child/en/
    Google Scholar
  • 6 Campbell NM, Colville JG, van der Heyde Y, van As AB. Firearm injuries to children in Cape Town, South Africa: impact of the 2004 Firearms Control Act. S Afr J Surg 2013; 51 (3) 92-96
    CrossrefPubMedGoogle Scholar
  • 7 Alterman DM, Daley BJ, Kennedy AP , et al. Considerations in pediatric trauma. Available at: http://emedicine.medscape.com/article/435031-overview . Last accessed November 28, 2013
    PubMedGoogle Scholar
  • 8 Buschmann C, Kühne CA, Lösch C, Nast-Kolb D, Ruchholtz S. Major trauma with multiple injuries in German children: a retrospective review. J Pediatr Orthop 2008; 28 (1) 1-5
    CrossrefPubMedGoogle Scholar
  • 9 Ademuyiwa AO, Usang UE, Oluwadiya KS , et al. Pediatric trauma in sub-Saharan Africa: Challenges in overcoming the scourge. J Emerg Trauma Shock 2012; 5 (1) 55-61
    CrossrefPubMedGoogle Scholar
  • 10 Tovar JA, Vazquez JJ. Management of chest trauma in children. Paediatr Respir Rev 2013; 14 (2) 86-91
    CrossrefPubMedGoogle Scholar
  • 11 Samarasekera SP, Mikocka-Walus A, Butt W, Cameron P. Epidemiology of major paediatric chest trauma. J Paediatr Child Health 2009; 45 (11) 676-680
    CrossrefPubMedGoogle Scholar
  • 12 Ismail MF, Al-Refaie RI. Chest trauma in children, single center experience. Arch Bronconeumol 2012; 48 (10) 362-366
    PubMedGoogle Scholar
  • 13 Newbury C, Hsiao K, Dansey R, Hamill J. Paediatric pedestrian trauma: the danger after school. J Paediatr Child Health 2008; 44 (9) 488-491
    CrossrefPubMedGoogle Scholar
  • 14 Kendrick D, Coupland C, Mulvaney C , et al. Home safety education and provision of safety equipment for injury prevention. Cochrane Database Syst Rev 2012; 9: CD005014 . Available at: http://www.ncbi.nlm.nih.gov/pubmed/17253536 . Last accessed November 28, 2013
    PubMedGoogle Scholar
  • 15 Moore MA, Wallace EC, Westra SJ. The imaging of paediatric thoracic trauma. Pediatr Radiol 2009; 39 (5) 485-496
    CrossrefPubMedGoogle Scholar
  • 16 Rattan KN, Narang R, Rohilla S, Maggu S, Dhaulakhandi DB. Thirteen Years' Experience of Diaphragmatic Injury in Children from the Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, India. Malays J Med Sci 2011; 18 (1) 45-51
    PubMedGoogle Scholar
  • 17 Bastos R, Baisden CE, Harker L, Calhoon JH. Penetrating thoracic trauma. Semin Thorac Cardiovasc Surg 2008; 20 (1) 19-25
    CrossrefPubMedGoogle Scholar
  • 18 Pabon-Ramos WM, Williams DM, Strouse PJ. Radiologic evaluation of blunt thoracic aortic injury in pediatric patients. AJR Am J Roentgenol 2010; 194 (5) 1197-1203
    CrossrefPubMedGoogle Scholar
  • 19 Anderson SA, Day M, Chen MK , et al. Traumatic aortic injuries in the pediatric population. J Pediatr Surg 2008; 43 (6) 1077-1081
    CrossrefPubMedGoogle Scholar
  • 20 Kim YM, Yoo BW, Choi JY, Sul JH, Park YH. Traumatic ventricular septal defect in a 4-year-old boy after blunt chest injury. Korean J Pediatr 2011; 54 (2) 86-89
    CrossrefPubMedGoogle Scholar
  • 21 Pracht EE, Tepas III JJ, Langland-Orban B, Simpson L, Pieper P, Flint LM. Do pediatric patients with trauma in Florida have reduced mortality rates when treated in designated trauma centers?. J Pediatr Surg 2008; 43 (1) 212-221
    CrossrefPubMedGoogle Scholar
  • 22 Pitcher RD, van As AB, Sanders V , et al. A pilot study evaluating the “STATSCAN” digital X-ray machine in paediatric polytrauma. Emerg Radiol 2008; 15 (1) 35-42
    CrossrefPubMedGoogle Scholar
  • 23 Carpenter AJ. Diagnostic techniques in thoracic trauma. Semin Thorac Cardiovasc Surg 2008; 20 (1) 2-5
    CrossrefPubMedGoogle Scholar
  • 24 Roudsari BS, Psoter KJ, Vavilala MS, Mack CD, Jarvik JG. CT use in hospitalized pediatric trauma patients: 15-year trends in a level I pediatric and adult trauma center. Radiology 2013; 267 (2) 479-486
    CrossrefPubMedGoogle Scholar
  • 25 Rippey JCR, Royse AG. Ultrasound in trauma. Best Pract Res Clin Anaesthesiol 2009; 23 (3) 343-362
    CrossrefPubMedGoogle Scholar
  • 26 Cheung NK, James A, Kumar R. Large traumatic pneumatocele in a 2-year-old child. Case Rep Pediatr 2013; 2013: 940189
    PubMedGoogle Scholar
  • 27 Voutsas V, Giakamozis A, Lazaridis T, Bitzani M. Post-traumatic lung pseudocysts: two case reports in ICU patients. J Thorac Dis 2012; 4 (1) (Suppl. 01) 74-78
    PubMedGoogle Scholar
  • 28 Coley E, Roach P, Macmillan AI, West AT, Johnston AM. Penetrating paediatric thoracic injury. J R Army Med Corps 2011; 157 (3) 243-245
    CrossrefPubMedGoogle Scholar
  • 29 Tovar JA. The lung and pediatric trauma. Semin Pediatr Surg 2008; 17 (1) 53-59
    CrossrefPubMedGoogle Scholar
  • 30 Pryor SD, Lee LK. Clinical outcomes and diagnostic imaging of pediatric patients with pneumomediastinum secondary to blunt trauma to the chest. J Trauma 2011; 71 (4) 904-908
    CrossrefPubMedGoogle Scholar
  • 31 Hauri-Hohl A, Baenziger O, Frey B. Pneumomediastinum in the neonatal and paediatric intensive care unit. Eur J Pediatr 2008; 167 (4) 415-418
    CrossrefPubMedGoogle Scholar
  • 32 Choi J-S, Kim E-J. Simultaneous rupture of the mitral and tricuspid valves with left ventricular rupture caused by blunt trauma. Ann Thorac Surg 2008; 86 (4) 1371-1373
    CrossrefPubMedGoogle Scholar
  • 33 Khan TR, Rawat J, Maletha M , et al. Traumatic diaphragmatic injuries in children: do they really mark the severity of injury? Our experience. Pediatr Surg Int 2009; 25 (7) 595-599
    CrossrefPubMedGoogle Scholar
  • 34 Mammadov E, Alim A, Elicevik M, Celayir S. Traumatic upper cervical esophageal perforation in childhood with door handle. Ann Pediatr Surg 2011; 7: 23-24
    PubMedGoogle Scholar
  • 35 Garey CL, Laituri CA, Kaye AJ , et al. Esophageal perforation in children: a review of one institution's experience. J Surg Res 2010; 164 (1) 13-17
    CrossrefPubMedGoogle Scholar