I. I. Maizlin1, R. T. Russell1 1University Of Alabama at Birmingham,Pediatric Surgery,Birmingham, Alabama, USA
Introduction: Trauma is the single greatest cause of mortality in the pediatric population. While chest trauma accounts for less than 10% of trauma affecting children, it is relevant because of the considerable mortality associated with it. We aim to identify nationwide trends in circumstances and clinical outcomes resulting from pediatric non-cardiac thoracic accidents.
Methods: The National Trauma Database (2010-2012) was reviewed for patients ≤19 years of age admitted with diagnosis of non-cardiac thoracic trauma. Patients were stratified into 3 age groups: 1-9 years, 10-16 years, 17-19 years. Demographics, patterns of injury, and outcomes were evaluated, with chi-square and ANOVA tests used for analysis.
Results: 59,027 children (67.4% male, 59.0% white) were admitted with thoracic injuries, with mean age of 14.2 ± 5.5 years. 68.4% of the children were injured in motor vehicle accidents, 17.2% in assaults, and 6.6% in falls. 43.1% of the accidents resulted in lung contusions, 16.7% pneumo- or hemothorax, 9.0% rib fractures, 7.4% open chest wounds. Mean hospital stay was 6.7 days (compared to 5.0 days in the overall pediatric trauma population), with 45.4% of the patients admitted to the ICU, and 23% requiring ventilator support. As compared to the overall national trauma mortality rate in this population of 2.7%, children experiencing thoracic trauma had a much higher mortality rates of 7.3%. When evaluating etiologies by age group (Table 1), youngest patients were more likely to suffer thoracic trauma as a result of accidents and falls, while trauma in the oldest patients was more likely to be caused by assaults and self-inflicted injuries. Compared to younger age groups, patients 17-19 years old were most common group to present with thoracic trauma, with the highest mean thoracic Abbreviated Injury Score (AIS) and the longest mean hospital stay (7.22 days, p<0.001). However, the youngest group had the highest rate of ICU admissions (48.7%, p=0.007), greatest rate of ventilator requirements (24.6%, p=0.011) and highest associated mortality (8.3%, p=0.001). Despite no difference in Injury Severity Score (16.03 vs. 16.10 vs. 16.77, p=0.280), the youngest group was also associated with higher rates of concurrent head trauma (18.6% vs. 13.8% vs. 12.2%, p<0.001) and higher mean head AIS (3.32 vs. 3.17 vs. 3.14, p=0.002).
Conclusion: Thoracic trauma results in a significant number of pediatric injuries and trauma-related admissions, especially in the 17-19 year old age-group. However, children below age 9 were most likely to suffer from associated morbidities and mortality, possibly due to a higher rate of concurrent head traumas.
