Eren Sevval, Balci Akin Eraslan, Ulku Refik, Cakir Omer, Eren M Nesimi
Department of Thoracic and Cardiovascular Surgery, Dicle University School of Medicine, 21280, Diyarbakir, Turkey.
Eur J Cardiothorac Surg. 2003 Jun;23(6):888-93. doi: 10.1016/s1010-7940(03)00143-x.
Thoracic firearm injuries (TFI) have become increasingly prevalent in children. Our purpose is to assess the injury pattern, Injury Severity Score (ISS), length of hospital stay (LOS), management and outcome of children with TFI with respect to the type of injury and to evaluate the value of ISS for predicting injury severity and the eventual need for thoracotomy, as well as the rate of morbidity and mortality.
Between January 1987 and June 2002, 110 children (88 boys and 22 girls) </=16 years of age with firearm injuries to the chest were evaluated. The children were divided in four groups according to cause of injury. An ISS was calculated for each child. Those children who died before admission were excluded from the study. The relationship between ISS and prognostic factors was analyzed in all four groups.
The mean age was 11.1+/-3.0 (range 3-16) years. Eighty-eight (80%) were male and 22 (20%) were female. The causes of firearm injuries were high-velocity gunshot wounds (HVGSW) in 52 (47.2%), low-velocity gunshot wounds (LVGSW) in 23 (20.9%), shotgun wounds (SGW) in 18 (16.3%), and explosives wounds (EW) in 17 (15.4%). Lung injury occurred in 72 (65.5%) patients. Tube thoracostomy was sufficient in 76.3% (84 of 110) for thoracic injury. The morbidity rate was 16.3% (18/110) and the mortality rate was 4.5% (5/110). Mean ISS was 16.62+/-8.2 (range 4-48). Fifty-eight patients (52.7%) had an ISS </=16, while 31 (28.2%) had a score between 17 and 25, and 21 (19.1%) had a score greater than 25. The need for thoracotomy, as well as the rate of morbidity and mortality were significantly higher in children for those with an ISS >25. SGW and EW groups had a significantly higher ISS. The mean LOS was 10.84+/-4.7 days (range 4-42). The value of LOS was significantly higher in children with SGW and EW.
The majority of TFI in children can be treated successfully by tube thoracostomy if there are no gross pulmonary lacerations and airway injuries. SGW and EW were commonly associated with higher ISS and LOS. The ISS was found to be an independent predictor of the need for thoracotomy, as well as for rates of morbidity and mortality.
儿童胸部火器伤（TFI）日益常见。我们的目的是评估儿童TFI的损伤模式、损伤严重程度评分（ISS）、住院时间（LOS）、治疗方法及预后，并根据损伤类型进行分析，同时评估ISS对预测损伤严重程度、最终开胸需求以及发病率和死亡率的价值。
1987年1月至2002年6月，对110名16岁及以下胸部火器伤儿童（88名男孩和22名女孩）进行评估。根据损伤原因将儿童分为四组。计算每名儿童的ISS。将入院前死亡的儿童排除在研究之外。对所有四组儿童分析ISS与预后因素之间的关系。
平均年龄为11.1±3.0岁（范围3 - 16岁）。88名（80%）为男性，22名（20%）为女性。火器伤原因包括高速枪伤（HVGSW）52例（47.2%）、低速枪伤（LVGSW）23例（20.9%）、霰弹枪伤（SGW）18例（16.3%）和爆炸伤（EW）17例（15.4%）。72例（65.5%）患者发生肺损伤。76.3%（110例中的84例）的胸部损伤通过胸腔闭式引流术即可治愈。发病率为16.3%（110例中的18例），死亡率为4.5%（110例中的5例）。平均ISS为16.62±8.2（范围4 - 48）。58例患者（52.7%）的ISS≤16，而31例（28.2%）的评分在17至25之间，21例（19.1%）的评分大于25。ISS>25的儿童开胸需求以及发病率和死亡率显著更高。SGW和EW组的ISS显著更高。平均住院时间为10.84±4.7天（范围4 - 42天）。SGW和EW儿童的住院时间值显著更高。
如果没有严重肺裂伤和气道损伤，大多数儿童TFI可通过胸腔闭式引流术成功治疗。SGW和EW通常与更高的ISS和住院时间相关。发现ISS是开胸需求以及发病率和死亡率的独立预测指标。
