Chest Trauma in Children: A Local Experience

Abstract

Background: Chest trauma in childhood is relatively uncommon in clinical practice, and has been the subject of few reports in the literature. This study was undertaken to examine our experience in dealing with chest trauma in children. Patients and Methods:This was a retrospective study of 74 children who sustained chest trauma, and were referred to King Fahad Hospital in Medina over a two-year period. The age, cause of injury, severity of injury, associated extrathoracic injuries, treatment and outcome were analyzed. Results: The median age of the patients was nine years. Fifty-nine of them (80%) sustained blunt trauma, and 15 (20%) were victims of penetrating injuries. Road traffic accident was the cause of chest trauma in 62% of the children, gun shot wounds were seen in five, and stab wounds in 10 children. Head injury was the most common injury associated with thoracic trauma, and was seen in 14 patients (19%), and associated intraabdominal injuries were seen in nine patients. Chest x-ray of the blunt trauma patients revealed fractured ribs in 24 children, pneumothorax in six, hemothorax in four, hemopneumothorax in three, and pulmonary contusions in 22 patients. Fifty-one percent of children were managed conservatively, 37% required tube thoracostomy, 8% were mechanically ventilated, and 4% underwent thoracotomy. Conclusion:The prevalence of chest trauma in children due to road traffic accidents is high in Saudi Arabia. Head injury is thought to be the most common associated extrathoracic injuries, however, most of these patients can be managed conservatively.

Isolated Hemothorax Following Thoracic Trauma: Analysis of 57 Cases

“…Mortality arising from injury to the chest alone has been estimated at 4-12% and increases with injury to other organ systems. The lung is the most commonly injured intrathoracic structure [6]. Isolated thoracic trauma is not common in blunt traumas.…”

“…The most common etiology of hemothorax in children is trauma [8]. Blunt trauma is the most frequent cause of chest injuries in children [6,8,10]. In children, hemothorax usually occurs as a consequence of blunt or penetrating trauma, with penetrating trauma being more severe than blunt trauma [8].…”

“…Therefore, very little bleeding may lead to hypovolemia and shock [12]. The pericardial sac of a child has a small volume, and a volume of 200 ml of blood is necessary to cause significant tamponade in young children [6]. The majority of chest injuries can be managed by immediate drainage with a wide calibrated chest tube in an unstable child and can be life-saving [10,12].…”

Traumatic Hemothorax: Analysis of 282 Patients

“…Özellikle sistemik dolaşıma ait arter ve ven sistemindeki hasara bağlı olarak hemotoraks gelişmesi durumunda, mortalite artmaktadır. Toraks içi organlardan akciğer yaralanmaya en çok maruz kalan organdır [8]. Akciğer parenkiminden olan kanamalarda mortalite daha az görülmektedir.…”

“…Çocuklarda hemotoraksın en yoğun sebeplerinden biri travmadır. Künt travma, çocuklarda göğüs yaralanmalarının en sık nedenlerindendir [8,13] Ceran ve ark. 'nın [14] 1653 olguluk serilerinde, %13.6 olguda; Melek ve ark.…”