The Routine Use of Radiography and Arterial Blood Gases in the Evaluation of Blunt Trauma in Children

Kharasch, Sigmund; Vinci, Robert J.; Hirsch, Erwin F.; Cranley, William R.; Coates, Ellen

doi:10.1016/s0196-0644(94)70033-8

Cited by 5 publications

(6 citation statements)

References 8 publications

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“…Chest x-rays in these children may not correlate with the clinical condition of respiratory distress, but abnormal arterial blood gases should point towards the seriousness of this condition. 17,18 Similar observation were made in our series. CT scan remains the best available tool, besides physical examination and direct peritoneal lavage, for the diagnosis of abdominal trauma, as it precisely defines the parenchymal organ injury, 13 and is helpful in some instances where a non-operative approach is to be followed, such as with splenic injury.…”

Section: Discussionsupporting

confidence: 90%

“…4 In children with pulmonary contusion, respiratory distress may not be recognized until blood gas measurements are made, thereby suggesting the importance of performing blood gas analysis routinely for all children admitted with thoracic trauma. 4,16,17 Many extensive injuries with normal arterial blood gases can be managed conservatively without ventilatory support initially. It is only after 24-48 hours that signs of respiratory distress are manifested, due to late occurrence of atelectasis, as the injured child is unable to perform deep breathing exercises and cough out retained secretions as a result of painful rib fractures.…”

Section: Discussionmentioning

confidence: 99%

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Chest Trauma in Children: A Local Experience

1999

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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.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Chest Trauma in Children: A Local Experience

1999

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“…[4][5][6][7][8][9] Many authors, however, believe laboratory tests do little to alter the management of the pediatric trauma patient. [10][11][12][13] Regardless of laboratory test results, pediatric trauma patients with abdominal tenderness, a decreased mental status, or gross hematuria routinely undergo radiologic evaluation of the abdomen because of high risk for IAI. In patients without these findings (abdominal tenderness, decreased mental status, or gross hematuria), the utility of ED laboratory tests is also unclear.…”

mentioning

confidence: 99%

Identification of Intra‐abdominal Injuries in Children Hospitalized Following Blunt Torso Trauma

Holmes¹,

Sokolove²,

Land³

et al. 1999

Academic Emergency Medicine

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Abstract. Objective: To determine the utility of the ED physical examination and laboratory analysis in screening hospitalized pediatric blunt trauma patients for intra-abdominal injuries (IAIs). Methods: The authors reviewed the records of all patients aged <15 years who sustained blunt traumatic injury and were admitted to a Level 1 trauma center over a fouryear period. Patients were considered high-risk for IAI if they had any of the following at ED presentation: decreased level of consciousness (GCS < 15), abdominal pain, tenderness on abdominal examination, or gross hematuria. Patients without any of these findings were considered moderate risk for IAI. The authors compared moderate-risk patients with and without IAIs with regard to physical examination and laboratory findings obtained in the ED. Results: Of 1,040 children with blunt trauma, 559 (54%) were high-risk and 481 (46%) were moderate-risk for IAI. 126 (23%) of the high-risk and 22 (4.6%) of the moderate-risk patients had IAIs. Among moderate-risk patients with and without IAIs, those with IAIs were more likely to have abdominal abrasions (5/22 vs 34/459, p = 0.008), an abnormal chest examination (11/22 vs 86/457, p = 0.01), higher mean serum concentrations of aspartate aminotransferase (AST) (604 U/L vs 77 U/L, p < 0.001) and alanine aminotransferase (ALT) (276 U/L vs 39 U/L, p = 0.002), higher mean white blood cell (WBC) counts (16.3 K/mm 3 vs 12.8 K/mm 3 , p < 0.001), and a higher prevalence of >5 RBCs/hpf on urinalysis (7/22 vs 54/427, p = 0.02). There was no significant difference (p > 0.05) between moderate-risk patients with and without IAIs in initial serum concentrations of amylase, initial hematocrit, drop in hematocrit >5 percentage points in the ED, or initial serum bicarbonate concentrations. Conclusion: In children hospitalized for blunt torso trauma who are at moderate risk for IAI, ED findings of abdominal abrasions, an abnormal chest examination, and microscopic hematuria as well as elevated levels of AST and ALT, and elevated WBC count are associated with IAI.

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“…Obvious clinical findings such as altered mental status, intoxication and obvious pelvic trauma warrant radiographic evaluation for pelvic fracture [14][15][16][17][18][19][25][26][27]. It is less clear what historical and examination findings lower the risk for a pelvic fracture enough to change current practice.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. A growing amount of evidence has repeatedly shown that the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children [14][15][16][17][18][19][20][21][22][23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%