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  • Thoracic injuries occur less frequently in children than in adults, but remain a source of significant morbidity and mortality.
  • Pediatric victims of thoracic trauma require rapid evaluation and management. Knowledge of pediatric-specific anatomy and injury patterns will help expedite the identification of injuries and allow for early surgical referral and treatment of potentially life-threatening chest injuries.
  • Due to the increased compliance of the ribs and supporting structures, children are particularly susceptible to pulmonary contusion with little external signs of trauma.
  • Treatment with needle and then chest tube thoracostomy should occur immediately in hemodynamically unstable or deteriorating victims of thoracic trauma. Uncertainty as to the side of a tension, pneumothorax should not prohibit initiation of this potentially life-saving procedure. Decompression of the alternate side should be done if immediate improvement is not seen with the initial thoracostomy.
  • The most common site for aortic disruption in children is at the level of the ligamentum arteriosum, and it may be associated with aortic dissection. As in adults, morbidity and mortality is high with injuries to the great vessels.
  • Gunshot wounds to the chest are associated with abdominal injuries in 30% to 40% of patients. Be aware of the possibility of concomitant injuries.

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Traumatic injury is the most common cause of morbidity and mortality in children of age 1 to 14 years. While relatively rare in the pediatric trauma victim, it still accounts for approximately 5% to 10% of pediatric hospital admissions. Despite its low incidence, it remains a significant cause of death secondary to trauma. In isolation, thoracic trauma has a 5% mortality rate; however, when combined with head or abdominal trauma, the mortality rate increases dramatically. With multisystem injury, the risk of mortality may be as high as 40% to 50%.1 The highest mortality rates involve injury to the heart and great vessels, hemothorax, and lung laceration.

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The most common cause of thoracic injury is due to blunt trauma, with penetrating trauma accounting for only a small percentage of these injuries. Infants and toddlers are most often victims of passive injury such as motor vehicle crashes, falls, and nonaccidental trauma. School-age children and adolescents also have the 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 is severe and results in cardiopulmonary arrest in the field, survival for both pediatric and adult victims is poor. Review of the trauma registry databases shows an overall mortality rate estimated at 95%, with victims of blunt traumatic arrest faring worse than those with a penetrating injury (97% vs. 89%, respectively).2 A review of the National Pediatric Trauma Registry, however, estimates pediatric victims of traumatic arrest to fare better than their adult counterparts, with up to 25% of children surviving to hospital discharge.3 For trauma patients suffering cardiac arrest, motor vehicle ...

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