Predictors of Intrathoracic Injury after Blunt Torso Trauma in Children Presenting to an Emergency Department as Trauma Activations

• Published in: The Journal of emergency medicine Vol. 52; no. 6; pp. 793 - 800
• Main Authors: McNamara, Caitlin, BS, Mironova, Irina, BA, Lehman, Erik, MS, Olympia, Robert P., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2017
• Subjects: Abdominal Pain - epidemiology; Abdominal Pain - etiology; Adolescent; blunt; chest; chest x-ray; Child; Child, Preschool; CT scan; Emergency; Emergency Service, Hospital - organization & administration; Female; Glasgow Coma Scale - statistics & numerical data; Humans; imaging; Male; Neck Injuries - epidemiology; Neck Injuries - etiology; Pennsylvania - epidemiology; Prognosis; Retrospective Studies; thoracic; Thoracic Injuries - complications; Thoracic Injuries - epidemiology; torso; trauma; Unconsciousness - epidemiology; Unconsciousness - etiology; Wounds and Injuries - complications; Wounds and Injuries - epidemiology; Wounds and Injuries - physiopathology; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - epidemiology; Wounds, Nonpenetrating - physiopathology; trauma; chest; torso; blunt; chest x-ray; thoracic; imaging; CT scan
• DOI: 10.1016/j.jemermed.2016.11.031
• EISSN: 2352-5029
• ISSN: 0736-4679

Abstract Background Thoracic injuries are a major cause of death associated with blunt trauma in children. Screening for injury with chest x-ray study, compared with chest computed tomography (CT) scan, has been controversial, weighing the benefits of specificity with the detriment of radiation exposure. Objective To identify predictors of thoracic injury in children presenting as trauma activations to a Level I trauma center after blunt torso trauma, and to compare these predictors with those previously reported in the literature. Methods We performed a retrospective chart review of pediatric patients (<18 years of age) who presented to the Emergency Department of a Level I trauma center between June 2010 and June 2013 as a trauma activation after sustaining a blunt torso trauma and who received diagnostic imaging of the chest as part of their initial evaluation. Results Data analysis was performed on 166 patients. There were 33 patients (20%) with 45 abnormalities detected on diagnostic imaging of the chest, with the most common abnormalities being lung contusion (36%), pneumothorax (22%), and rib fracture (13%). Statistically significant predictors of abnormal diagnostic imaging of the chest included Glasgow Coma Scale score (GCS) < 15 (27% with abnormality vs. 13% without abnormality), hypoxia (22% vs. 5%), syncope/loss of consciousness (55% vs. 35%), cervical spine tenderness (12% vs. 3%), thoraco-lumbar-sacral spine tenderness (41% vs. 17%), and abdominal/pelvic tenderness (12% vs. 3%). Conclusions Based on our data, predictors of thoracic injury in children after blunt torso trauma include GCS < 15, hypoxia, syncope/dizziness, cervical spine tenderness, thoraco-lumbar-sacral spine tenderness, and abdominal/pelvic tenderness.