Initial evaluation and stabilization of children with thoracic trauma
- Donna Reyes Mendez, MD
Donna Reyes Mendez, MD
- Associate Professor of Emergency Medicine
- University of Texas Health Science Center (UTHSC) Medical School Houston
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The initial evaluation and stabilization of children with thoracic trauma will be reviewed here. Thoracic trauma in adults and specific thoracic injuries in children are discussed separately. (See "Initial evaluation and management of blunt thoracic trauma in adults" and "Overview of intrathoracic injuries in children" and "Chest wall injuries in children" and "Pulmonary contusion in children".)
Among injured children, thoracic trauma occurs infrequently. In several observational series describing pediatric trauma victims, between 4 and 8 percent of children sustained thoracic injury [1-4].
Blunt mechanisms are involved in 85 percent or more of cases [1-4]. Most patients are injured as passengers or pedestrians in motor vehicle crashes. Other mechanisms include falls (8 to 10 percent) and abuse (7 to 8 percent). Children with inflicted injuries usually have rib fractures and are young (typically less than three years of age) [5,6]. (See "Orthopedic aspects of child abuse", section on 'Rib fractures'.)
Penetrating thoracic trauma may be caused by a gunshot wound or from stabbing/impalement:
●In the United States, gunshot wounds are the major cause of penetrating thoracic injury among children. A retrospective study describing reports to the National Pediatric Trauma Registry noted that 60 percent of penetrating thoracic injuries were the result of gunshot wounds, while 33 percent were from stab wounds .
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- TYPES OF THORACIC INJURY
- ASSOCIATED INJURIES
- Initial rapid assessment
- - Airway
- - Breathing
- - Circulation
- - Emergency department thoracotomy
- Physical examination
- Diagnostic studies
- - Laboratory studies
- - Electrocardiography
- - Imaging
- Supportive care
- Chest decompression
- Emergency thoracotomy
- SUMMARY AND RECOMMENDATIONS