Pediatric emergency department thoracotomy: A large case series and systematic review

Allen, Casey J.; Valle, Evan J.; Thorson, Chad M.; Hogan, Anthony R.; Pérez, Eduardo A.; Namias, Nicholas; Zakrison, Tanya L.; Neville, Holly L.; Sola, Juan E.

doi:10.1016/j.jpedsurg.2014.10.042

Cited by 35 publications

(41 citation statements)

References 23 publications

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“…This is in agreement of the indications for EDT in adult patients, return of circulatory arrest following penetrating trauma is more favorable then blunt[13]. EDT performed in pediatric patients is infrequent [6] and as a result EDT case series are often small and some includes patients up to 18 years of age. Non-adult patients in the age range of 15-18 (adolescents) are arguably not pediatric patients[14] and add confusion to interpreting previously reported outcomes.…”

Section: Introductionsupporting

confidence: 72%

“…The prevalence of adolescent/pediatric EDT in our study is comparable to the Ryder trauma center in Miami which has a similarly high acuity of adult and pediatric trauma patients[6]. However, the minority (30%) of these non-adult patients are less than 15 years old.…”

Section: Discussionsupporting

confidence: 51%

“…A recent meta analysis has compiled these studies and reported a significant survival advantage in patients who sustain penetrating versus blunt injury [6]. This is in agreement of the indications for EDT in adult patients, return of circulatory arrest following penetrating trauma is more favorable then blunt[13].…”

Section: Introductionmentioning

confidence: 53%

“…Patients were dichotomized into pediatric (age <15) versus adolescent based on the American College of Surgeons criteria for pediatric patients. The categorization of adolescent patients was based off previously reported pediatric EDT series where patients up to the age of 18 were included in the analysis[6]…”

Section: Methodsmentioning

confidence: 99%

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Pediatric emergency department thoracotomy: A 40-year review

Moore

Bensard

2016

Journal of Pediatric Surgery

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Background/purpose Emergency department thoracotomy (EDT) has been proposed to be futile in the pediatric patient population. This extreme procedure has survival rates of 0 to 26% in the non-adult population. When taking into consideration that the mechanism of injury is one of the strongest predictors of survival, we hypothesize that the low survival rate in pediatric patients is attributable to a higher rate of blunt trauma compared to their adolescent counterparts. Methods Prospective data collected from our level 1 trauma center from 1974 - 2014 on all patients undergoing EDT at our institution was evaluated for age 18 or younger. Patient predictor variables included injury mechanism, injury pattern, and detected cardiac activity in the field. Outcomes included successful resuscitation (re-establish of blood pressure and taken to operating room) and overall survival. Patients were dichotomized by age into pediatric (age ≤ 15 yrs) and adolescent (16-18yrs) categories. Results 1691 patients who underwent EDT were evaluated for age of 18 or less, which included 179 patents (11%). Overall survival in the adult population was 6.1%, compared to 3.4% in the non-adult population (p=0.157). Pediatric patients were more likely to sustain blunt injury than adolescents (72% vs 32% p<0.001). This also corresponded to differences in anatomic injury patterns and more multisystem trauma (52% vs 44% p=0.001). Adolescents had significantly higher survival rates than pediatric patients (5% vs 0% p=0.036). Conclusion In non-adult patients undergoing EDT, adolescents have a higher survival rate than pediatric patients. The pediatric population had a significantly lower incidence of penetrating trauma and higher incidence of head injury. The discrepancy in survival between adolescent and pediatric patients appears to be attributable due to differences in mechanism. Therefore, those pediatric patients with penetrating thoracic injuries may still benefit from EDT.

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Section: Introductionsupporting

confidence: 72%

Section: Discussionsupporting

confidence: 51%

Section: Introductionmentioning

confidence: 53%

Section: Methodsmentioning

confidence: 99%

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Pediatric emergency department thoracotomy: A 40-year review

Moore

Bensard

2016

Journal of Pediatric Surgery

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“…Hypotension does not develop until 25%e30% blood loss [26]. Although vital signs may not be as predictive of hemorrhage as other indicators of shock, when vitals are lost, children are often unsalveagable [27,28]. Once diagnosed with shock, these patients should receive IV fluids, inotrope therapy, and proper airway management as long as transport is not delayed [29].…”

Section: Discussionmentioning

confidence: 99%