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Thoracic Trauma 183

supervision, particularly of small children; a single caregiver; a home Evidence-Based Research
with multiple siblings; and substance abuse by the caregiver and in Table 28.1 presents a retrospective review of paediatric blunt chest trauma.
large families. Although these risk factors are located within particular Table 28.1: Evidence-based research.
households, the larger context in which they operate cannot be ignored;
child safety is ultimately a matter of crucial concern for all societies. Title Blunt chest trauma in childhood
Some studies have demonstrated the feasibility of interventions to Authors Inan M, Ayvaz S, Sut N, et al.
reduce child mortality and morbidity from unintentional injury. Institution Departments of Pediatric Surgery and Biostatistics, Faculty
Risk factors for child abuse include the demographic characteristics of Medicine, Trakya University, Edirne, Turkey
of the child (e.g., younger age); caregiver characteristics (e.g., prior Reference ANZ J Surg 2007; 77:682–685
history of abuse); family structure and resources; and community Problem Evaluate the clinical features of children with blunt chest
factors (e.g., increased poverty, decreased social capital). 8–9 injury and investigate the predictive accuracy of their paedi-
atric trauma scores.
Methods Retrospective review evaluating children with blunt thoracic
trauma.
Outcomes Forty-four patients were identified, of which 27 were male
and 17 were female. The mean paediatric trauma score was
7.6 ± 2.4. Causes of injury consisted of motor vehicle/pedes-
trian collisions, 19 cases; motor vehicle collisions, 11; falls, 8;
and motor vehicle/bicycle or motorbike accidents, 6. Injuries
included pulmonary contusions, 28; pneumothoraxes, 12;
haemothoraxes, 10; rib fractures, 9; haemopneumothoraxes,
7; clavicle fractures, 5; flail chest, 2; diaphragmatic rupture,
1; and pneumatocele, 1. In this cohort, 27 patients were
managed nonoperatively, 17 were treated with tube thora-
costomy, and 2 required thoracotomy. Four patients (9.09%)
had concomitant abdominal injuries.
Comments Thoracic injuries are rare in children and are a predictor of
severe and multiple—frequently fatal—injuries.
Historical This well-written article takes the reader through the his-
significance/ torical development of some trauma scoring systems and
comments provides a very good overview of frequently used systems.
The authors even inform readers about an ideal scoring
system: it should correlate well with the desired outcome
(e.g., death, disability, costs, etc.); it should be reasonable
to clinicians and correlate with their judgement; it should use
available data; it should be reliable among different users;
and it should be simple. This is, in fact, what all scoring
systems should be.

Key Summary Points

1. The majority of thoracic injuries can be diagnosed by a good 4. Optimum treatment and outcomes can be achieved only by
clinical exam and a plain chest x-ray. having a thorough understanding of the unique anatomy and
physiology of children.
2. The majority of chest trauma in children can be treated
nonoperatively, often with a well-placed chest tube. 5. Even the most severe of injuries requiring operative therapy
can, if recognised early, be managed successfully.
3. Life-threatening injuries from thoracic trauma are relatively
uncommon in children, and when they occur, they are related
to associated head and abdominal injuries.

References

1. Buntain WL, ed. Management of pediatric trauma. Saunders, 6. Abdessalam SF, Keller A, Groner JI, Kable K, Krishnaswami S,
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2. Eichelberger MR, ed. Pediatric trauma: prevention, acute care,
rehabilitation. Mosby, 1993. Am Coll Surg 2004; 199(3S):S53(abstract).
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3. Mayer TA, ed. Emergency management of pediatric trauma. on Child Injury Prevention. WHO and UNICEF, 2008.
Saunders, 1985.
8. Peden M, Hyder AA. Time to keep African kids safer. South Afr
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Nwomeh BC, eds. Paediatric Trauma Care in Africa: A Practical Med J 2009; 99:36–37.
Guide. Spectrum Books, 2006, Pp 12-24. 9. van As S and Naidoo S, eds. Paediatric Trauma and Child Abuse.
Oxford University Press, 2006.
5. American College of Surgeons Committee on Trauma. Advanced
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Surgeons, 2008.