Burhan APİLİOĞULLARI, Sami CERAN, Murat KURU, Tamer ALTINOK

Thoracic trauma in children; A retrospective study for causes, diagnosis and treatments

Aim: To evaluate pediatric patients subjected to thoracic trauma in terms of prognosis, diagnosis and treatment. Although studieson trauma in adults are aplenty, those on the pediatric population are rarely available.Material and Methods: 261 patients who were exposed to thoracic trauma for any reason in the last 24 hours of hospital admissionwere included. The patients’ demographic data, etiology, treatments and results were retrospectively evaluated.Results: Our sample consisted of 85 girls and 176 boys with a mean age of 9.73±5.71 (range: 1-18 years). 228 of the patients (87%)had blunt trauma, 26 (10%) had penetrating trauma, and 7 (3%) had both penetrating and blunt trauma. Rate of penetrating traumawas about 4 times higher in boys. Traffic accidents were the most common reason for traumas. The most commonly fracturedribs were the 6th-9th ribs. 75 patients (28.7%) required tube thoracostomy, and 12 required open surgery. Rigid bronchoscopy wasperformed in 12 patients.Conclusion: None of the 33 patients with penetrating trauma died, contrary to the information in the literature. We found boysto be exposed to trauma more than girls (B/G: 2.07/1), albeit at different rates compared to the findings of other research. Thedevelopment of rib fractures was found to be a predisposing factor for hemothorax. Hemothorax was observed in the 6th-9th ribsand in ≥4 rib fractures.

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1. Meredith JV, Hoth JJ. Thoracic trauma: when and how to intervene. Surg Clin North Am 2007;87:95-118.
2. Çevik M, Çavuş UY, Yılmaz MS, et al. Acil serviste göğüs travmalı çocuk hastaların geriye dönük incelenmesi. Kocatepe Tıp Derg 2012;13:63-8.
3. Eichelberger M. Thoracic trauma. In: Ashcraft KW, Holder TM, eds. Pediatric Surgery. Philadelphia, London: WB Saunders 1993:122-32.
4. Turan C, Okur H, Bekercioğlu A, et al. Çocuklarda toraks travmaları. T Klin Pediatri 1994;3:48-51.
5. Ceran S, Sunam GS, Arıbaş OK, et al. Chest trauma in children. Eur J Cardiothorac Surg 2002;21:57-9.
6. Çevik M, Boleken ME, Balcıoğlu ME, et al. Çocuklarda penetran göğüs ve karın travmaları: otuz sekiz olguluk seri. Çocuk Cerrahisi Dergisi 2011;25:23-8.
7. Alisha C, Gajanan G, Jyothi H. Risk Factors Affecting the Prognosis in Patients with Pulmonary Contusion Following Chest Trauma. J Clin Diagn Res 2015;9:OC17–9.
8. Jöres AP, Heverhagen JT, Bonel H, et al. Diagnostic Accuracy of Full-Body Linear X-Ray Scanning in Multipl Trauma Patients in Comparison to Computed Tomography. Rofo 2016;188:163-71.
9. Pearson EG, Fitzgerald CA, Santore MT. Pediatric thoracic trauma: current trends. Semin Pediatr Surg 2017;26:36–42.
10. Holmes JF, Sokolove PE, Brant WE, et al. A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma. Ann Emerg Med. 2002;39:492-9.
11. Kadish H. Thoracic trauma. In: Fleisher GR, Ludwig S, Henretig FM. Textbook of Pediatric Emergency Medicine 5th ed. Philadelphia:Williams and Wilkins; 2006. p.1433.
12. Tsai FC, Chang YS, Lin PJ, et al. Blunt trauma with flail chest and penetrating aortic injury. Eur J Cardiothorac Surg 1999;16:374–7.
13. Tovar JA. The lung and pediatric trauma. Semin Pediatr Surg 2008;17:53-9.
14. Al-Hassani A, Abdulrahman H, Afifi I, et al. Rib fracture patterns predict thoracic chest wall and abdominal solid organ injury. Am Surg 2010;76:888-91.
15. Logan PM. Is there an association between fractures of the cervical spine and first- and second-rib fractures? Can Assoc Radiol J 1999;50:41-3.
16. Harris GJ, Soper RT. Pediatric first rib fractures. J Trauma 1990;30:343-5.
17. Ozel SK, Kazez A. Horner syndrome due to first rib fracture after major thoracic trauma. J Pediatr Surg 2005;40:e17.
18. Borman JB, Aharonson-Daniel L, Savitsky B, et al. Unilateral flail chest is seldom a lethal injury. Emerg Med J 2006;23:903-5.
19. Fowler TT, Taylor BC, Bellino MJ, et al. Surgical Treatment of flail chest and rib fractures. J Am Acad Orthop Surg 2014;22:751–60.
20. Webb PA, Suchey JM. Epiphyseal union of the anterior iliac crest and medial clavicle in a modern multiracial sample of American males and females. Am J Phys Anthropol 1985;68:457-66.
21. Masudi T, McMahon HC, Scott JL, et al. Seat beltrelated injuries: a surgical perspective. J Emerg Trauma Shock 2017;10:70–73.
22. Bowen TR, Miller F. Greenstick fracture of the scapula: a cause of scapular winging. J Orthop Trauma 2006;20:147-9.
23. Abd El-Shafy I, Rosen LM, Prince JM, et al. Blunt trumatic scapular fractures are associated with great vessel injuries in children. J Trauma Acute Care Surg 2018;85:932-5.
24. Al-Saigh A, Fazili FM, Allam AR. Chest Trauma in children: A local experience. Ann Saudi Med 1999;19:106-9.
25. Moskowitz EE, Burlew CC, Kulungowski AM, et al. Survival after emergency department thoracotomy in the pediatric trauma population: A review of published data. Pediatr Surg Int 2018;34:857-60.
26. Shafi S, Barnes SA, Rayan N, et al. Compliance with recommended care at trauma centers: association with patient outcomes. J Am Coll Surg 2014;219:189– 98.
27. Bellone A, Bossi I, Etteri M, et al. Factors associated with ICU admission following blunt chest trauma. Can Respir J 2016;3257846.