Purpose: While accounting for less than 10% of trauma affecting children, chest trauma is associated with a considerable associated morbidity and mortality. We aimed to identify nationwide trends in circumstances and clinical outcomes resulting from pediatric non-cardiac thoracic accidents.
Methods: The National Trauma Database (2010-2012) was reviewed for patients ≤19 years of age admitted with diagnosis of non-cardiac thoracic trauma. Patients were stratified into 3 age groups, with demographics, patterns of injury, and outcomes evaluated.
Results: 59,027 children (67.4% male, 59.0% white) were admitted with thoracic injuries, with mean age of 14.2±5.5 years. 68.4% of the children were injured in motor vehicle accidents, 17.2% in assaults, and 6.6% in falls. 43.1% of the accidents resulted in lung contusions, 16.7% pneumo- or hemothorax, 9.0% rib fractures, 7.4% open chest wounds. Mean hospital stay was 6.7 days, with 45.4% of the patients admitted to the ICU, and 23% requiring ventilator support. Patients 17-19 years-old presented most commonly with thoracic trauma, but the youngest group had highest rate of ICU admissions (48.7%,p=0.007), ventilator requirements (24.6%,p=0.011) and associated mortality (8.3%, p=0.001). Despite no difference in Injury Severity Score, the youngest group was also associated with higher rates of concurrent head trauma (18.6,p<0.001) and higher mean head AIS (3.32,p=0.002).
Conclusion: Thoracic trauma results in a significant number of pediatric injuries and trauma-related admissions, especially in the 17-19 year-old age-group. However, children below age 9 were most likely to suffer from associated morbidities and mortality, possibly due to a higher rate of concurrent head traumas.
