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Eur J Cardiothorac Surg 2004;26:387-392
© 2004 Elsevier Science NL

Blunt thoracic trauma in children: review of 137 cases

Akn Eraslan Balc^a*, Ahmet Kazez^b, evval Eren^c, Erhan Ayan^a, Koray Özalp^a, Mehmet Nesimi Eren^d

^a Department of Thoracic Surgery, Firat University School of Medicine, Elazig 23100, Turkey
^b Department of Pediatric Surgery, Firat University School of Medicine, Elazig 23100, Turkey
^c Department of Thoracic Surgery, Dicle University School of Medicine, 21280 Diyarbakir, Turkey
^d Department of Cardiovascular Surgery, Dicle University School of Medicine, 21280 Diyarbakir, Turkey

Received 24 September 2003; received in revised form 11 April 2004; accepted 21 April 2004.

^* Corresponding author. Tel.: +90-424-2388080x139, +90-535-7719008 (Mobile); fax: +90-424-2335038
e-mail: abalci{at}firat.edu.tr

Objective: Thoracic injuries are uncommon in children and few report present on blunt ones. Methods: Between 1994 and 2003, 137 children with blunt thoracic injury were reviewed. Results: The mean age of children was 6.9±7.3 (1–16) years. Etiology was falls in 46.7%, traffical accidents in 51% and abuse in 2.2%. Average height in fallen-down cases was 6.4±2 (range: 3–11) m. Calculated mean kinetic energy transfer to body was 1923±1056 J. When first seen, 70% (82/117) of the patients had vital signs that were within normal limits. Forty-two (35.9%) children had isolated thoracic injury. Associated injuries were present in 75 (64.1%) children. Head injury was the most common associated injury present in 33 (28.2%). Pulmonary contusion was the most common thoracic injury with 68 (49.6%). Seventeen (12.4%) required surgery, 11 (8%) of them were thoracic (4 for diaphragmatic tear, 2 for flail chest, 2 for tracheobronchial injuries, 2 for laceration, 1 for esophageal rupture). Surgical group had higher ISS (26.8 vs 36.2, P=0.001). Fifteen were lost (10.9%): There were lethal injuries in 7; chest tube treatment in 3; intensive care unit management in 2; mechanical support in 2 and observation in 1 patient. No death occurred for operations. Mortality rate was the lowest at injuries to chest alone and the highest for multi-system injuries (P<0.05). The hospital length of stay for averaged 13.4±8.8 (range: 4–49) days. Conclusion: Associated injury is the most important mortality factor. Thoracic operations can be performed with minimal morbidity and without mortality in children with blunt thoracic trauma.

Key Words: Blunt thoracic truma • Children • Fall

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