Pediatric thoracic trauma

OBJECTIVE: A retrospective analysis of the medical records of children up to 12 years of age inclusive, who sustained thoracic injuries during a 6-year period.

METHODS: Ninety-one children were treated at King Fahad National Guard Hospital, Riyadh from January 1993 through December 1998. The clinical data included age, sex, mechanism of injury, associated injuries, pediatric trauma score, treatment and mortality.

RESULTS: Eighty-seven children (96%) had injuries from blunt trauma and 4 from penetrating injuries. Of the blunt trauma cases, 82 children sustained motor vehicle accident related injuries, 62 as pedestrians and 20 as passengers. Penetrating thoracic injuries occurred in 4 children: 1 stab wound and 3 gunshots. The most frequent thoracic injuries were pulmonary contusion (70), pneumothorax (32), fractured rib (20) and fractured clavicle (18). Extrathoracic injuries included head (45), abdominal (41) and skeletal (26). Thoracotomy was required in only 1 child, laparotomy being necessary in 9 children for intraabdominal injuries. Tube thoracostomy was required in 33 children. Nine children died from motor vehicle accident related fatal head and neck injuries, 8 as pedestrians all with a pediatric trauma score <= 6.

CONCLUSION: Thoracic injuries in children below 12 years of age are usually from motor vehicle accident related blunt trauma. Pulmonary contusion and pneumothorax are the most common thoracic injuries. Most thoracic injuries can be managed either conservatively or by tube thoracostomy. Thoracic trauma in children is an indicator of multisystem injury with head injury being the most common cause of mortality.