Epidemiology of pediatric cardiac injuries: a National Trauma Data Bank analysis

Kaptein, Yvonne E.; Talving, Peep; Konstantinidis, Agathoklis; Lam, Lydia; Inaba, Kenji; Plurad, David; Δημητριάδης, Δημήτριος

doi:10.1016/j.jpedsurg.2011.02.041

Cited by 29 publications

(32 citation statements)

References 19 publications

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“…44,45 These injuries have significant mortality with 30% mortality within 6 hours of arrival at the hospital with blunt aortic trauma and 40% in hospital mortality with cardiac trauma. 3,46 Children with thoracic aortic injury present with first rib and sternal fractures, paraplegia, upper extremity hypertension, or pulse or blood pressure differentials in extremities. 47,48 Aortic injury can be diagnosed with chest X-ray findings of widened mediastinum or loss of the aortic knob, and a CT scan with IV contrast should be performed in anyone with a suspicion of aortic injury.…”

Section: Cardiovascular Injurymentioning

confidence: 99%

Pediatric Blunt Thoracic Trauma

Alemayehu

Aguayo

2015

J Pediatr Intensive Care

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Thoracic injury in children deserves special attention because, although it accounts for less than 10% of traumatic injuries in children, there is a significant associated morbidity and mortality. This review discusses the anatomic and physiologic factors resulting in such injury severity with blunt thoracic trauma in children. Specific organ injuries, including most common chest wall injuries, hemo- and pneumothoraces, and pulmonary parenchymal injuries, are discussed, encompassing epidemiology, presentation, diagnosis, and management. Rare injuries including tracheobronchial tree injuries, cardiovascular injuries, esophageal injuries, and diaphragmatic injuries are also briefly discussed.

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Section: Cardiovascular Injurymentioning

confidence: 99%

Pediatric Blunt Thoracic Trauma

Alemayehu

Aguayo

2015

J Pediatr Intensive Care

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“…In the National Trauma Bank Data analysis by Kaptein et al, among cases with BCT, cardiac contusion is the most common cardiac injury in 87% cases, followed by cardiac laceration in 10%, and other unspecified cardiac injury in only 4.7% (8). There are only a few reports of coronary artery injuries in children and the precise incidence is unknown.…”

Section: Discussionmentioning

confidence: 99%

Left Main Coronary Artery Dissection in Pediatric Sport-Related Chest Trauma

Diaz-Miron

Dillon

Saini

et al. 2014

The Journal of Emergency Medicine

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Background Traumatic coronary artery dissection (CAD) after blunt chest trauma (BCT) is extremely rare, particularly in children. Among coronary dissections, left main coronary artery (LMCA) dissection is the least common, with only two pediatric cases reported previously. Manifestations of coronary dissections can range from ST segment changes to sudden death. However, these manifestations are not specific and can be present with other cardiac injuries. To our knowledge we present the first pediatric case of traumatic LMCA dissection after sport-related BCT that was treated successfully with coronary stenting. Case Report A 14-year-old child sustained BCT during a baseball game. Early in the clinical course, he had episodes of ventricular arrhythmias, diffuse ST changes, rising troponin I, and hemodynamic instability. Emergent cardiac catheterization revealed an LMCA dissection with extension into the proximal left anterior descending artery (LADA). A bare metal stent was placed from the LMCA to the LADA, which improved blood flow through the area of dissection. He has had almost full recovery of myocardial function and has been managed as an outpatient with oral heart failure and antiplatelet medications. Why Should an Emergency Physician Be Aware of This?: Our case highlights that CAD, although rare, can occur after pediatric BCT. Pediatric emergency responders must have a heightened awareness that evidence of ongoing myocardial ischemia, such as evolving and focal myocardial infarction on electrocardiogram, persistent elevation or rising troponin I, and worsening cardiogenic shock, can represent a coronary event and warrant further evaluation. Cardiac catheterization can be both a diagnostic and therapeutic modality in such cases. Early recognition and management is vital for myocardial recovery.

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“…The consequence of this rare occasion, however, is quite high, as a mortality rate of 40% was observed. Out of 626 children who sustained cardiac trauma, the mechanism was blunt in 65% (402 children) [1]. Of these 402 patients, 87% sustained a cardiac contusion.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately one in four patients admitted to a pediatric Level I trauma center has a traumatic injury of the chest, with high-energy blunt trauma accounting for 83% of those injuries [1]. While pulmonary contusions are the most commonly found thoracic injuries in the hospital setting [2], blunt injury to the heart accounts for both a significant number of pre-hospital deaths and an in-hospital mortality of up to 40% [1].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Cardiopulmonary bypass after severe blunt hepatic injury: management of multi-system blunt trauma in an adolescent

Streit¹,

Kavarana²,

Scheurer³

et al. 2013

Journal of Pediatric Surgery

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A 16-year-old adolescent male sustained combined injuries to the tricuspid valve and liver. This injury is exceptional due to the mechanism and the circumstances in which it took place: a flying pumpkin thrown from a sport utility vehicle. An echocardiogram demonstrated a flail chordal apparatus associated with the posterior leaflet of the tricuspid valve, creating substrate for severe tricuspid regurgitation with preserved right heart function. He was treated with non-operative management for the liver injury; he remained hemodynamically stable and was discharged home. He underwent successful repair of the tricuspid valve 17 days following the initial injury necessitating systemic anticoagulation and was discharged home two days later. The patient recovered fully without residual valvular pathology or hepatic sequelae.

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Epidemiology of pediatric cardiac injuries: a National Trauma Data Bank analysis

Cited by 29 publications

References 19 publications

Pediatric Blunt Thoracic Trauma

Pediatric Blunt Thoracic Trauma

Left Main Coronary Artery Dissection in Pediatric Sport-Related Chest Trauma

Cardiopulmonary bypass after severe blunt hepatic injury: management of multi-system blunt trauma in an adolescent

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