S. Kumar1, A. Elkbuli1 1Orlando Regional Medical Center, Orlando, FL, USA
Introduction: This study aims to answer the following PICO (population, intervention, comparator, and outcome) questions: In pediatric trauma patients who undergo an emergency department (ED) thoracotomy secondary to blunt and/or penetrating injuries, is there a difference in mortality outcomes based on the type of injury? What factors can be utilized to predict mortality following ED thoracotomies? Is there a difference in mortality outcomes based on the type of trauma center?
Methods: This review was conducted in accordance with the Grading of Recommendations Assessment, Development and Evaluation methodology. The 6 primary authors queried 5 databases for studies evaluating outcomes of interest. Data extraction and evidence quality evaluation were performed in accordance with the Joanna Briggs Institute (JBI) critical appraisal checklist for observational studies.
Results: This review included 15 studies with 76,341 patients. Pediatric trauma patients undergoing ED thoracotomies revealed a higher mortality rate in blunt injuries (81.4%-100%) compared to penetrating injuries (22%-100%). A lower mortality rate was found in pediatric-only trauma centers (78%) than in adults (90%) or combined adult and pediatric trauma centers (22%-100%) (p=1.00). Predictors of poor outcomes included hemodynamic instability (survival rate of 5% in patients with initial SBP ≤50 mmHg or HR ≤70 bpm), absence of HR or BP (mortality rate =100%), and age, with pediatric patients under 15 exhibiting a higher mortality rate.
Conclusion: Pediatric patients undergoing ED thoracotomies secondary to blunt injuries were found to have a higher mortality rate when compared to those with penetrating injuries. Hemodynamic instability, lack of initial vital signs, and younger age were associated with poorer outcomes. These results emphasize the need to develop pediatric-focused ED thoracotomy guidelines to optimize outcomes.