Chest Trauma In Children Research Articles

Delayed tension hemothorax after chest trauma in children.

Blunt chest injury is commonly observed in the Pediatric Emergency Department and Intensive Care Unit since up to 30% of children with traumatic injury sustain injury to the thorax. Differently from adults, who present with concomitant rib or sternoclavicular fractures in 70% of cases, more than half of childhood chest injuries occur without any bone fracture, mostly causing lung contusions. This lower rate of rib fractures and near absence of flail chest in children may be due to greater elasticity of the pediatric cartilaginous and bony skeleton. Whenever a rib fracture is present, underlying complications should be evaluated carefully (i.e., air leaks or blood effusions). Depending on the trauma mechanism, even minor injuries should raise the suspicion of pathologic bone fractures.

Chest trauma in children-what an anesthesiologist should know.

Injury is the leading cause of death in children, with chest trauma accounting for 25% of this mortality. In addition, these patients often present with multiple system injuries, which require simultaneous management. These concurrent injuries can lead to challenges when prioritizing tasks in the resuscitation room and during anesthetic management. In addition, changes from spontaneous ventilation to positive pressure ventilation can impact lung physiology. Therefore, a clear communication plan with careful monitoring and vigilance is needed for intubation and ventilation in these children. These injuries also require specific strategies to prevent barotrauma which could lead to complications such as respiratory failure, pneumonia, sepsis, and acute respiratory distress syndrome. This educational review aims to guide clinicians managing pediatric chest trauma through some of the critical decision-making regarding intubation, ventilation, and subsequent management of injuries.

The effect of quantifying pulmonary contusion extent on the treatment management of blunt chest trauma in children

Objective: Post-traumatic pulmonary contusion in children is often asymptomatic at diagnosis and has a good prognosis. The aim of this study was to investigate the clinical significance of the extent of post-traumatic pulmonary contusions and evaluate the timing of complications to determine the safe follow-up period in children with lung contusions. Methods: The study included pediatric patients who presented to the emergency department after blunt chest trauma and had pulmonary contusion detected on chest computed tomography (CT) between January 2017 and January 2020. Based on the percentage of total lung capacity occupied on thorax CT, pulmonary contusions were classified as grade 1: <19% (mild), grade 2: 19%-27% (moderate) and grade 3: ≥28% (severe). The relationship between pulmonary contusion grade and pulmonary functional status; complications and intensive care admission was examined and the mean time to complication development was determined. Results: The mean extent of pulmonary contusion after trauma was 17.8±8.6% (min-max, 5-100%) and mild (grade 1) contusion was significantly associated with spontaneous breathing (p=0.009). Contusion grade was not associated with the development of atelectasis, pneumonia, pleural effusion, pneumothorax (p=0.719) or intensive care admission (p=0.176). The mean time to detection of complications (atelectasis, pneumonia, pleural effusion, pneumothorax) on chest X-ray was 6.33±3.78 days (range, 2-9 days). Conclusion: The results suggest that although no statistically significance between the extent of pulmonary contusion and complications, patients should be hospitalized for at least 48 hours, then followed-up with chest X-ray for 1 week due to possible complications after blunt chest trauma in children.

Management of bronchial rupture after blunt chest trauma in children.

Management of bronchial rupture after blunt chest trauma in children.

Perioperative extracorporeal membrane oxygenation in traumatic bronchial avulsion

Abstract Traumatic bronchial avulsion is standardly treated with emergent lobectomy versus primary repair. We reviewed our experience with peri-operative use of extracorporeal membrane oxygenation (ECMO) to manage respiratory failure in two cases of pediatric chest trauma. ECMO can be an effective intervention to overcome respiratory failure, facilitate surgical repair, and promote healing in bronchial injuries as a result of blunt chest trauma in children.

The Use of Chest Computed Tomographic Angiography in Blunt Trauma Pediatric Population.

Blunt chest trauma in children is common. Although rare, associated major thoracic vascular injuries (TVIs) are lethal potential sequelae of these mechanisms. The preferred study for definitive diagnosis of TVI in stable patients is computed tomographic angiography imaging of the chest. This imaging modality is, however, associated with high doses of ionizing radiation that represent significant carcinogenic risk for pediatric patients. The aim of the present investigation was to define the incidence of TVI among blunt pediatric trauma patients in an effort to better elucidate the usefulness of computed tomographic angiography use in this population. A retrospective cohort study was conducted including all blunt pediatric (age < 14 y) trauma victims registered in Israeli National Trauma Registry maintained by Gertner Institute for Epidemiology and Health Policy Research between the years 1997 and 2015. Data collected included age, sex, mechanism of injury, Glasgow Coma Scale, Injury Severity Score, and incidence of chest named vessel injuries. Statistical analysis was performed using SAS statistical software version 9.2 (SAS Institute Inc, Cary, NC). Among 433,325 blunt trauma victims, 119,821patients were younger than 14 years. Twelve (0.0001%, 12/119821) of these children were diagnosed with TVI. The most common mechanism in this group was pedestrian hit by a car. Mortality was 41.7% (5/12). Thoracic vascular injury is exceptionally rare among pediatric blunt trauma victims but does contribute to the high morbidity and mortality seen with blunt chest trauma. Computed tomographic angiography, with its associated radiation exposure risk, should not be used as a standard tool after trauma in injured children. Clinical protocols are needed in this population to minimize radiation risk while allowing prompt identification of life-threatening injuries.

Critical Care of Chest Trauma in Children

Critical Care of Chest Trauma in Children

Traumatic chest injury in children: A single thoracic surgeon's experience in two Nigerian tertiary hospitals.

Background:This study was to determine the extent and outcome of childhood chest injury in Nigeria, and to compare results with that of other literatures.Patients and Methods:A Prospective study of all children under 18 years of age with chest trauma in two tertiary hospitals in Southern Nigeria from January 2012 to December 2014 was reviewed. The aetiology, type, associated injury, mechanism, treatment and outcome were evaluated. The patients were followed up in the clinic. The data were analysed using SPSS version 20.0 with a significant P < 0.05.Results:Thirty-one patients (12.1%) under 18 years of age of 256 chest trauma patients were managed in the thoracic units. The mean age was 9.78 ± 6.77 years and 27 (87.1%) were male. The aetiology in 13 was from falls, 10 from automobile crashes, 3 from gunshots, 4 from stabbing and 1 from abuse. The highest peak of chest injury was on Saturday of the week and April of the year. The pleural collections are as follows: 15 (71.4%) was haemothorax, 4 (19.1%) pneumothorax, 2 (9.5%) haemopneumothorax and 18 patients had lung contusion in combination or alone with the pleural collections. Seven patients who presented >12-h versus 2 who presented <12-h and 6 of children between 0 and 9 years versus 3 at 10-18 years of age had empyema thoracis (P value not significant). One death was recorded.Conclusion:Chest trauma in children is still not common, and blunt chest injury from falls and automobile accidents are more common than penetrating chest injury. Treatment with tube thoracostomy is the major management modality with empyema thoracis as the most common complication.

Management of Chest Trauma in Children

Chest trauma in children is caused by high-energy blows, due in general to traffic accidents, that involve several other body regions. They occur mainly in the first decade of life and can be penetrating but are more often non-penetrating. Rib fractures and lung contusions, sometimes associated with pneumothorax or haemothorax, are the more usual injuries, but tracheobronchial rupture, cardiac, oesophageal or diaphragmatic injuries may also occur. These injuries are treated with supportive respiratory and haemodynamic measures, drainage of air or blood from the pleural space and, at times, surgical repair of the injured organ(s). Ruptures of the airway may be difficult to treat and occasionally require suture, anastomosis or resection. Oesophageal injuries can be treated conservatively with antibiotics, drainage and parenteral nutrition. Diaphragmatic tears should be repaired operatively. Overall mortality ranges from 6 to 20%. Mortality is high but this is mainly due to the associated presence of extra-thoracic trauma, and particularly to head injuries.

Large Traumatic Pneumatocele in a 2-Year-Old Child

Traumatic pneumatoceles are a rare complication of blunt chest trauma in children. Although they characteristically present as small, regular shaped lesions which can be safely treated nonoperatively, larger traumatic pneumatoceles pose diagnostic and management difficulties for clinicians. This case study reports one of the largest traumatic pneumatoceles reported to date in the paediatric population, which resulted in aggressive surgical intervention for both diagnostic and treatment reasons. This case adds further evidence to the current literature that significantly large traumatic pneumatoceles with failure of initial conservative management warrant surgical exploration and management to optimise recovery and prevent complications.

Chest Trauma in Children, Single Center Experience

Trauma is the leading cause of mortality in children over one year of age in industrialized countries. In this retrospective study we reviewed all chest trauma in pediatric patients admitted to Mansoura University Emergency Hospital from January 1997 to January 2007. Our hospital received 472 patients under the age of 18. Male patients were 374 with a mean age of 9.2±4.9 years. Causes were penetrating trauma (2.1%) and blunt trauma (97.9%). The trauma was pedestrian injuries (38.3%), motor vehicle (28.1%), motorcycle crash (19.9%), falling from height (6.7%), animal trauma (2.9%), and sports injury (1.2%). Types of injuries were pulmonary contusions (27.1%), lacerations (6.9%), rib fractures (23.9%), flail chest (2.5%), hemothorax (18%), hemopneumothorax (11.8%), pneumothorax (23.7%), surgical emphysema (6.1%), tracheobronchial injury (5.3%), and diaphragm injury (2.1%). Associated lesions were head injuries (38.9%), bone fractures (33.5%), and abdominal injuries (16.7%). Management was conservative (29.9%), tube thoracostomy (58.1%), or thoracotomy (12.1%). Mortality rate was 7.2% and multiple trauma was the main cause of death (82.3%) (P<.001). We concluded that blunt trauma is the most common cause of pediatric chest trauma and often due to pedestrian injuries. Rib fractures and pulmonary contusions are the most frequent injuries. Delay in diagnosis and multiple trauma are associated with high incidence of mortality.

Trauma profile at a tertiary intensive care unit in Saudi Arabia

BACKGROUND AND OBJECTIVESTrauma is a leading cause of death worldwide and in Saudi Arabia. This study describes the injury profiles and ICU outcomes of patients in a tertiary trauma care referral center in Riyadh, Saudi Arabia.DESIGN AND SETTINGA retrospective analysis of ICU data collected prospectively over 5 years in a 21-bed medical and surgical intensive care unit (ICU) in a tertiary care teaching hospital.PATIENTS AND METHODSWe collected ICU data on all patients admitted secondary to motor vehicle accidents (MVAs), excluding patients younger than 18 years, brain dead patients and readmissions. We collected data on age, gender, and Glasgow coma scale score at admission, injury severity scores, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and other data. Multivariate logistic regression was used to identify predictors of mortality.RESULTSDuring the study period, of 1659 patients, MVA was the most common cause of injury (78.4%), followed by pedestrian accident (12.7%). ICU mortality included 221 patients (13.3%) during the study period. Severe head injury, age > 60 years, Glascow coma scale score, injury severity scores, APACHE II and international normalized ratio were independent predictors of mortality.CONCLUSIONMVA is very common in our country and leads to significant mortality and morbidity. Public education and strict law enforcement are needed to reduce these adverse events.

Ventricular septal defect, developed due to the coronary artery injury after blunt chest trauma in childhood

In the literature, cardiac response associated with blunt chest trauma in children has been reported generally as case reports, and interventricular septal rupture due to trauma is quite rare. Interventricular septal rupture can develop even in the absence of visible signs of a trauma because of the flexibility of the chest structure in children. In the present case, a seven-year-old boy with interventricular septal rupture at the mid-muscular region and left ventricle pseudoaneurysm developed due to injury to the left anterior descending coronary artery after a traffic accident is reported. Patients with cardiac murmur detected on physical examination after a blunt chest trauma must be considered as cardiac injury, and in those with signs of ischemia detected on electrocardiography, it should not be forgotten that the coronary artery may be affected.

Rupture of main bronchus due to blunt chest trauma in children: a report of two cases

Trakeobronsiyal yaralanma kunt ya da penetran gogus travmasindan kaynaklanir ve nadir ancak potansiyel olarak olumcul bir durumdur. Ana bronsun ya da karinanin kunt travma nedeniyle rupture olmasi nadir bir durumdur ve cocuklarda en ciddi yaralanmalardan biridir. Bu tip yaralanmanin tanisi guctur ve yuksek seviyeli klinik suphe gerektirir. Burada iki total ana brons rupturu olgusu sunmaktayiz. Bronsiyal rupturun primer onarimi ilk olguda yaralanmadan iki hafta sonra, ikinci olguda ise yaralanmadan hemen sonra gerceklestirildi. Anah tar soz cuk ler: Bronslar; karina; cocuk; ruptur; travma. Tracheobronchial injury results from blunt or penetrating chest trauma and is a rare, but potentially fatal condition. Rupture of the main bronchus or carina by blunt trauma is unusual, and it is one of the most severe injuries in children. The diagnosis of this kind of injury is challenging and requires a high degree of clinical suspicion. Here, we report two cases of total rupture of the main bronchus. Primary repair of the bronchial rupture was performed two weeks after the injury in the first case, and immediately after the injury in the second case.

Pediatric traumatic bronchial rupture; results of early and late presentation.

The aim of this study is to evaluate our results in management of bronchial rupture after blunt chest trauma in children either presented early or late and their prognosis. Between January 2000 and December 2007, 25 cases <18 years presented early with blunt chest trauma and underwent surgical treatment of bronchial rupture, and 9 cases presented late. This study included 34 cases with age ranging from 6 to 18 years (mean 11.58+/-2.51 years). Twenty-one of them were males (61.76%) and 13 (38.24%) were females. In early cases, we approached 21 patients (84%) through right thoracotomy and 4 cases (16%) via left thoracotomy, direct sutures of the all early cases (except 3 cases needed lobectomies) were done. Reimplantation after debridment of the edges was done in 4 cases (44.44%) in the late cases, while pulmonary resections were done in 5 cases (55.56%). Mortalities from perioperative cardiac arrest and cerebral hypoxia with failure of resuscitation occurred in 4 patients (11.76%) from all cases. We conclude that early diagnosis and repair of the bronchial rupture gives good results before suppuration of the parenchyma, which leads to pulmonary resection. Meticulous coordination between the surgeon and anaesthiologist is important to prevent mortalities. Keywords: Bronchial rupture; Children; Blunt chest trauma.

Management of traumatic tracheobronchial separation in a teenager using a fabricated extra-long endotracheal tube

Tracheobronchial separation (TBS) due to blunt chest trauma in children is extremely rare. We report the case of a 14-year-old boy who fell 20 feet and developed respiratory distress, bilateral pneumothoraces, pneumomediastinum, and subcutaneous emphysema. Computed tomography imaging at the initial institution failed to detect tracheobronchial disruption, and the patient was managed conservatively. The patient's worsening condition prompted bronchoscopic examination which revealed complete separation of the right main bronchus from the trachea. Single-lung ventilation was instituted using a fabricated extra-long nasotracheal tube due to the patient's large size and mandibular fracture, and the airway was primarily anastamosed with an open thoracotomy approach. The clinical features of tracheobronchial separation as well as anesthetic, clinical and surgical management of this rare but life-threatening injury are described.

Experiences in severe chest trauma of children in 20 years

Though chest trauma in children is not so common as it is in adults, it may be life-threatening and suggest a high mortality. Herein we retrospected 59 cases of severe chest trauma of children out of 1506 chest trauma cases during 1986-2006 in our department. Features including demographic characteristics, causes, injury types, associated wound had been collected. There were 42 males (71.18%), 17 females (28.82%), 30 cases (50.84%) in the former 10 years and 29 cases (49.16%) in the latter 10 years. The incidence of children's severe chest trauma was 4.9% and 3.2%, respectively, averagely 3.9%. In these 59 cases, 46 cases were treated conservatively, 13 cases were treated by surgery. Four patients died, two in operations, the others attributed to ARDS and cardiac arrest, respectively. The cure rate was 93.22%. Statistic method was used to compare between two groups and with published results in the literature. Children's severe chest trauma is characteristic and different from adults. In our experience, accurate diagnoses and intensive care are very important to save their lives.

Successful Repair of a Subtotal Rupture of Distal Tracheobronchial Tree With Complete Abridgment of the Right Bronchus in a 4-Year-Old Child

Accurate diagnosis of tracheobronchial injuries in children is difficult due to the paucity of clinical presentation and the variety of clinical symptoms. They are potentially life threatening in blunt chest trauma. We report here on a clinical case of a boy who was injured during outdoor activity. We describe intraoperative findings of the massive tracheobronchial lesion and its successful repair using a pericardial patch technique and postoperative recovery. Such a serious tracheobronchial injury with a positive outcome has not been reported so far. Clinical and technical steps are described and discussed.

Delayed Bronchostenosis After Blunt Chest Trauma in Children: CT and Pathologic Findings

Tracheobronchial disruption is an uncommon injury associated with blunt chest trauma. We report CT features and pathologic findings of two pediatric cases in which a bronchial injury was unnoticed initially but was diagnosed later by appearance of delayed bronchostenosis with distal atelectasis after blunt chest trauma in recent motor vehicle accidents. Pathologically, obliteration of the bronchial lumen was caused by dense fibrous overgrowth and granulation tissue.

Lung contusion-lacerations after blunt thoracic trauma in children.

Chest trauma in children is an indicator of injury severity and is associated with a high mortality rate. The aim of this study was to investigate the impact of pulmonary contusion-laceration on short and long-term outcome of pediatric patients after blunt thoracic trauma. A retrospective analysis of records of 41 children aged 10 months to 17 years who were treated for pulmonary and associated injuries between 1986 and 2000 was done concerning mode of injury, types of injuries, management and outcome. In addition, a follow-up investigation was performed 4.5+/-1 years after injury. Of the patients 27 were involved in motor vehicle accidents (MVA group) and 14 patients suffered other types of accidents (others group). The mean injury severity score (ISS) was 30+/-2 (range 9-75) with no significant difference between the groups. Patients from the MVA group suffered more frequently bilateral pulmonary lesions and needed more often chest tube placement ( p<0.05), 5 patients died (12%) all from the MVA group. The follow-up investigation of 34 patients showed unremarkable chest x-rays and normal lung function in all but 1 patient with bronchial asthma. In conclusion, children who recover after a pulmonary contusion-laceration trauma do not suffer from significant late respiratory problems.