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Thoracic Trauma

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Pediatric Surgery

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Abstract

Pediatric thoracic trauma is a significant source of morbidity and mortality in children older than 1 year of age. This chapter introduces the key elements involved in the evaluation and treatment of children who have sustained thoracic traumatic injuries. Areas of focus include initial assessment, airway management, imaging modalities, pneumothorax, hemothorax, pulmonary contusion, chest wall injury, airway injury, vascular injury, cardiac injury, diaphragmatic injury, esophageal rupture, spinal cord injury, and minimally invasive surgery in acute management of thoracic trauma.

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References

  • Alterman DM. Considerations in pediatric trauma. Medscape. [Cited 30 Dec 2013]. Available from: http://emedicine.medscape.com/article/435031-overview

  • American College of Surgeons Committee on Trauma. Chapter 10, Pediatric surgery. In: Fildes J, et al., editors. ATLS student course manual. 8th ed. Chicago: American College of Surgeons; 2008.

    Google Scholar 

  • Balci AE, Kazez A, Eren S, Ayan E, Ozalp K, Eren MN. Blunt thoracic trauma in children: review of 137 cases. Eur J Cardiothorac Surg. 2004;26(2):387–92.

    Article  PubMed  Google Scholar 

  • Ball CG, Hameed M, Evans D, Kortbeek JB, Kirkpatrick AW, for the Canadian Trauma Trials Collaborative. Occult pneumothorax in the mechanically ventilated trauma patient. Can J Surg. 2003;46(5):373–9.

    PubMed  PubMed Central  Google Scholar 

  • Ball CG, Kirkpatrick AW, Feliciano DV. The occult pneumothorax: what have we learned? Can J Surg. 2009;52(5):E173–9.

    PubMed  PubMed Central  Google Scholar 

  • Billeter AT, Druen D, Franklin GA, Smith JW, Wrightson W, Richardson JD. Video-assisted thoracoscopy as an important tool for trauma surgeons: a systematic review. Langenbeck’s Arch Surg. 2013;398(4):515–23.

    Article  Google Scholar 

  • Casós SR, Richardson JD. Role of thoracoscopy in acute management of chest injury. Curr Opin Crit Care. 2006;12(6):584–9.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. Injury prevention and control: traumatic brain injury. Spinal Cord Injury: fact sheet. 2010. Available from: http://www.cdc.gov/traumaticbraininjury/scifacts.html

  • Cirak B, Ziegfeld S, Knight VM, Chang D, Avellino AM, Paidas CN. Spinal injuries in children. J Pediatr Surg. 2004;39(4):607–12.

    Article  PubMed  Google Scholar 

  • Coleman GM, Fischer R, Fuentes F. Blunt chest trauma. Extrapericardial cardiac tamponade by a mediastinal hematoma. Chest. 1989;95(4):922–4.

    Article  CAS  PubMed  Google Scholar 

  • Collopy KT, Kivlehan SM, Snyder SR. Pediatric spinal cord injuries: anatomical differences bring different challenges with kids. EMS World. 2012;41(8):52–7.

    PubMed  Google Scholar 

  • Dowd MD, Keenan HT, Bartton SL. Epidemiology and prevention of childhood injuries. Crit Care Med. 2002;30(11S):S385–92.

    Article  PubMed  Google Scholar 

  • Easter JS, Vinton DT, Haukoos JS. Emergent pediatric thoracotomy following traumatic arrest. Resuscitation. 2012;83(12):1521–4.

    Article  PubMed  Google Scholar 

  • Ferguson LP, Wilkinson AG, Beattie TF. Fracture of the sternum in children. Emerg Med J. 2003;20(6):518–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Freeman RK, Al-Dossari G, Hutcheson KA, Huber L, Jessen ME, Meyer DM, Wait MA, DiMaio JM. Indications for using video-assisted thoracoscopic surgery to diagnose diaphragmatic injuries after penetrating chest trauma. Ann Thorac Surg. 2001;72(2):342–7.

    Article  CAS  PubMed  Google Scholar 

  • Garcia VF, Gotschall CS, Eichelberger MR, Bowman LM. Rib fractures in children: a marker for severe trauma. J Trauma. 1990;30(6):695–700.

    Article  CAS  PubMed  Google Scholar 

  • Goodman M1, Lewis J, Guitron J, Reed M, Pritts T, Starnes S. Video-assisted thoracoscopic surgery for acute thoracic trauma. J Emerg Trauma Shock. 2013;6(2):106–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Grushka J, Ginzburg E. Through the 10-mm looking glass: advances in minimally invasive surgery in trauma. Scand J Surg. 2014;103(2):143–8.

    Article  CAS  PubMed  Google Scholar 

  • Hamrick MC, Duhn RD, Carney DE, Boswell WC, Ochsner MG. Pulmonary contusion in the pediatric population. Am Surg. 2010;76(7):721–4.

    PubMed  Google Scholar 

  • Herrera P, Langer JC. Thoracic trauma in children. The hospital for sick children manual of pediatric trauma. Philadelphia: Lippincott, Williams and Wilkins; 2008.

    Google Scholar 

  • Hsu LW, Chong CF, Wang TL, Wu BH. Traumatic mediastinal hematoma: a potentially fatal condition that may be overlooked by traditional focused assessment with sonography for trauma. Am J Emerg Med. 2013;31(1):262.

    Article  PubMed  Google Scholar 

  • Kaptein YE, Talving P, Konstantinidis A, Lam L, Inaba K, Plurad D, Demetriades D. Epidemiology of pediatric cardiac injuries: a National Trauma Data Bank analysis. J Pediatr Surg. 2011;46(8):1564–71.

    Article  PubMed  Google Scholar 

  • Karmy-Jones R, Hoeffer E, Meissner M, Bloch RD. Management of traumatic rupture of the thoracic aorta in pediatric patients. Ann Thorac Surg. 2003;75(5):1513–7.

    Article  PubMed  Google Scholar 

  • König TT, Wittenmeier E, Muensterer OJ. Emergency repair of an isolated traumatic avulsion of the right main stem bronchus in a 7-year-old girl. European J Pediatr Surg Rep. 2019;7(1):e1–4.

    Article  PubMed  PubMed Central  Google Scholar 

  • Love JC, Derrick SM, Wiersema JM, Pinto DC, Greeley C, Donaruma-Kwoh M, Bista B. Novel classification system of rib fractures observed in infants. J Forensic Sci. 2013;58(2):330–5.

    Article  PubMed  Google Scholar 

  • Manlulu AV, Lee TW, Thung KH, Wong R, Yim AP. Current indications and results of VATS in the evaluation and management of hemodynamically stable thoracic injuries. Eur J Cardiothorac Surg. 2004;25(6):1048–53.

    Article  CAS  PubMed  Google Scholar 

  • Martin MA, Barnatan M, Cole F, Long W, Hill J, Karmy-Jones R. A case report of traumatic aortic rupture: a possible role for endovascular management as a bridge to definitive repair. J Trauma. 2009;67(5):E 136–9.

    Article  Google Scholar 

  • Miglioretti DL, Johnson E, Williams A, Greenlee RT, Weinmann S, Solberg LI, Feigelson HS, Roblin D, Flynn MJ, Vanneman N, Smith-Bindman R. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr. 2013;167(8):700–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Moore MA, Wallace EC, Westra SJ. The imaging of paediatric thoracic trauma. Pediatr Radiol. 2009;39(5):485–96.

    Article  PubMed  Google Scholar 

  • Neal MD, Sippey M, Gaines BA, Hackman DJ. Presence of pneumomediastinum after blunt trauma in children: what does it really mean? J Pediatr Surg. 2009;44(7):1322–7.

    Article  PubMed  Google Scholar 

  • Notrica DM, Garcia-Filion P, Moore FO, Goslar PW, Coimbra R, Velmahos G, Stevens LR, Petersen SR, Brown CVR, Foulkrod KH, Coopwood TB Jr, Lottenberg L, Phelan HA, Bruns B, Sherck JP, Norwood SH, Barnes SL, Matthews MR, Hoff WS, deMoya MA, Bansal V, Hu CKC, Riyad K-JRC, Vinces F, Hill J, Pembaur K, Haan JM. Management of pediatric occult pneumothorax in blunt trauma: a subgroup analysis of the American Association for the Surgery of Trauma multicenter prospective observational study. J Pediatr Surg. 2012;47:467–72.

    Article  PubMed  Google Scholar 

  • Pabon-Ramos WM, Williams DM, Strouse PJ. Radiologic evaluation of blunt thoracic aortic injury in pediatric patients. AJR Am J Roentgenol. 2010;194(5):1197–203.

    Article  PubMed  Google Scholar 

  • Pang D. Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery. 2004;55(6):1325–42.

    Article  PubMed  Google Scholar 

  • Piccolo CL, Ianniello S, Trinci M, et al. Diagnostic imaging in pediatric thoracic trauma. Radiol Med. 2017;122(11):850–65.

    Article  PubMed  Google Scholar 

  • Pons F, Lang-Lazdunski L, de Kerangal X, Chapuis O, Bonnet PM, Jancovici R. The role of videothoracoscopy in management of precordial thoracic penetrating injuries. Eur J Cardiothorac Surg. 2002;22(1):7–12.

    Article  CAS  PubMed  Google Scholar 

  • Pryor HI 2nd, Vaziri K. Diagnostic Laparoscopy. In: Murayama KM, Chand B, Kothari SN, Mikami D, Nagle A, editors. An evidence-based approach to minimally invasive surgery. Woodbury: Cine-Med; 2012.

    Google Scholar 

  • Puapong D.P., Tuggle D.W. Thoracic trauma. Holcomb III G.W., Murphy J.P.. Ashcraft’s pediatric surgery. 5th. Philadelphia, Elsevier; 2010.

    Google Scholar 

  • Roach JO. Injuries kill 20.000 children in a year in developed countries. BMJ. 2001;322(7282):317.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rosenfeld EH, Lau P, Shah SR, et al. Sternal fractures in children: an analysis of the National Trauma Data Bank. J Pediatr Surg. 2019;54(5):980–3.

    Article  PubMed  Google Scholar 

  • Rozycki GS, Ballard R, Feliciano DV, Schmidt JA, Pennington SD. Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg. 1998;228(4):557–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sartorelli KH, Vane DW. The diagnosis and management of children with blunt injury of the chest. Semin Pediatr Surg. 2004;13(2):98–105.

    Article  PubMed  Google Scholar 

  • Sartorelli KH, McBride WJ, Vane DW. Perforation of the intrathoracic esophagus from blunt trauma in a child: case report and review of the literature. J Pediatr Surg. 1999;34(3):495–7.

    Article  CAS  PubMed  Google Scholar 

  • Shehata SMK, Shabaan BS. Diaphragmatic injuries in children after blunt abdominal trauma. J Pediatr Surg. 2006;41(10):1727–31.

    Article  PubMed  Google Scholar 

  • Teague WJ, Amarakone KV, Quinn N. Rule of 4’s: safe and effective pleural decompression and chest drain insertion in severely injured children. Emerg Med Australas. 2019;31(4):683–7.

    Article  PubMed  Google Scholar 

  • Tiao GM, Griffith PM, Szmuszkovicz JR, Hossein Mahour G. Cardiac and great vessel injuries in children after blunt trauma: an institutional review. J Pediatr Surg. 2000;35(11):1656–60.

    Article  CAS  PubMed  Google Scholar 

  • Tovar JA, Vazquez JJ. Management of chest trauma in children. Paediatr Respir Rev. 2013;14(2):86–91.

    Article  PubMed  Google Scholar 

  • Trachiotis GD, Sell JE, Pearson GD, Martin GR, Midgley FM. Traumatic thoracic aortic rupture in the pediatric patient. Ann Thorac Surg. 1996;62(3):724–31.

    Article  CAS  PubMed  Google Scholar 

  • Trinavarat P, Riccabona M. Potential of ultrasound in the pediatric chest. Eur J Radiol. 2014;83(9):1507–18.

    Article  PubMed  Google Scholar 

  • Weissberg D, Rafaeli Y. Pneumothorax. Experience with 1199 patients. Chest. 2000;117(5):1279–85.

    Article  CAS  PubMed  Google Scholar 

  • Wesson DE, Cox CS Jr. Thoracic injuries. In: Coran AG, Adzick NS, et al., editors. Pediatric surgery. 7th ed. Philadelphia: Elsevier; 2012.

    Google Scholar 

  • Working Group Ad Hoc Subcommittee on Outcomes, American College of Surgeons – Committee on Trauma. Practice management guidelines for emergency department thoracotomy. J Am Coll Surg. 2001;193:303–9.

    Article  Google Scholar 

  • Wylie J, Morrison GC, Nalk K, Kornecki A, Kotylak TB, Fraser DD, Kornecki A. Lung contusion in children – early computed tomography versus radiography. Pediatr Crit Care Med. 2009;10(6):643–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Howard I. Pryor II, Chiara Croce & Paul M. Colombani

Authors
  1. Howard I. Pryor II
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  2. Chiara Croce
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  3. Paul M. Colombani
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Correspondence to Howard I. Pryor II .

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Editors and Affiliations

  1. Our Lady’s Children's Hospital, National Children’s Research Centre, Dublin, Ireland

    Prem Puri

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Pryor, H.I., Croce, C., Colombani, P.M. (2020). Thoracic Trauma. In: Puri, P. (eds) Pediatric Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38482-0_139-1

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  • DOI: https://doi.org/10.1007/978-3-642-38482-0_139-1

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  • Print ISBN: 978-3-642-38482-0

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