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High-Yield Facts

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  • Pediatric victims of thoracic trauma require rapid evaluation and management. Knowledge of pediatric-specific anatomy and injury patterns will expedite identification of injuries.

  • Children are particularly susceptible to pulmonary contusion with little external signs of trauma due to increased compliance of the ribs and supporting structures.

  • Treatment with needle and then chest tube thoracostomy should occur immediately in hemodynamically unstable or deteriorating victims of thoracic trauma.

  • Most common site for aortic disruption in children is at level of ligamentum arteriosum.

  • Gunshot wounds to chest are associated with abdominal injuries in 30% to 40% of patients.

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Epidemiology and Significance

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Traumatic injury is the most common cause of morbidity and mortality in children of age 1 to 14 years.1,2 Thoracic trauma is relatively rare in children but still accounts for approximately 5% to 10% of pediatric injuries and is a significant cause of deaths secondary to trauma.35 The highest mortality rates involve injury to the heart and great vessels, hemothorax, and lung laceration.

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Blunt trauma is the most common cause of thoracic injury; however, penetrating trauma continues to rise in the adolescent population. Infants and toddlers are most often victims of passive injury such as motor vehicle crashes, falls, and nonaccidental trauma. School-age children and adolescents have an additional risk of sports-related chest injuries. Adolescents are particularly at risk for high-energy injuries related to motor vehicle crashes, extreme sports, violence, and suicide. The most common injuries sustained include pulmonary contusion, pneumothorax, hemothorax, pneumohemothorax, and rib fractures.

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When trauma results in cardiopulmonary arrest in the field, survival for both pediatric and adult victims is poor. The trauma registry databases show an overall mortality rate estimated at 95%.6 The National Pediatric Trauma Registry, however, estimates pediatric traumatic arrest far better than their adult counterparts, with up to 25% of children surviving to hospital discharge.7

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The impact of designated trauma centers on pediatric outcomes continues to be researched. Several studies show improved survival and overall improved functional outcomes for injured children when initial evaluation and resuscitation occur at designated pediatric trauma centers.814 Other studies show no difference in survival for children cared for at adult trauma centers.15,16 Despite the differences in findings, most pediatric trauma patients must be initially evaluated and stabilized in nonspecialty centers until arrangements for transport to an appropriate facility is made for definitive care. Because of anatomic reasons, even seemingly benign mechanisms of trauma have the potential of producing severe injuries in infants and young children.

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Mechanism of Injury

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Blunt Thoracic Trauma
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The National Pediatric Trauma Registry and trauma research show that approximately 80% to 90% of pediatric chest injuries are due to blunt forces compared with 10% to 20% from penetrating trauma.7,10,17,18 Most blunt ...

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