Excerpt from Thoracic Trauma

Synonyms, Key Words, and Related Terms: thoracic trauma, multisystem injury, blunt injury, airway obstruction, airway injury, lung injury, chest wall injuries, open pneumothorax, tension pneumothorax, hemopneumothorax, flail chest, widened mediastinum, aortic dissection, cardiac tamponade, pulmonary contusion, ruptured tracheobronchial tree, ruptured diaphragm, esophageal perforation, myocardial contusion, chest injury, motor vehicle accident, hypovolemia, shock, foreign body aspiration, subcutaneous emphysema, video-assisted thoracic surgery, VATS, seizures, cardiac arrest

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Trauma is the leading cause of mortality in patients younger than 18 years, accounting for more than 5000 deaths annually. Although thoracic trauma accounts for only 5-12% of admissions to a trauma center, it is second only to head injury as the most common cause of death. Multisystem involvement is reported in more than 50% of children with thoracic trauma and portends a worse prognosis. The mortality for isolated thoracic trauma is 5% and approaches 20-35% with concomitant abdominal or head injuries, respectively (see Media file 1).

Analysis of the National Pediatric Trauma Registry reveals that blunt trauma accounts for approximately 85% of chest injuries serious enough to warrant treatment.¹ Almost three fourths of these chest injuries were caused by motor vehicle accidents, with the remainder attributable to motorcycle-related trauma, falls, and bicycle accidents. Penetrating trauma comprises 15% of chest injuries in children, with most due to gunshots, knife wounds, and injury from other sharp objects. Regardless of the mechanism of thoracic trauma, 15% of children do not survive. According to the analysis of the National Pediatric Trauma Registry, almost half of the deaths in those with blunt injury were due to associated neurological injury, compared with children who had penetrating chest trauma, in whom all fatalities are due to the chest injury itself.¹

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