van As Arjan Bastiaan, Manganyi Rodgers, Brooks Andre
Department of Paediatric Surgery, University of Cape Town, Red Cross Children's Hospital, Rondebosch, Cape Town, Western Cape, South Africa.
Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa.
Eur J Pediatr Surg. 2013 Dec;23(6):434-43. doi: 10.1055/s-0033-1363160. Epub 2013 Dec 10.
Thoracic injuries continue to be a leading cause of childhood trauma, despite the government's efforts to curb the scourge of this problem. Our review focuses on the incidence, etiology, and management of thoracic trauma in the pediatric population with reference to the recent experience at our institution in a developing country.
For the literature review, the National Library of Medicine's PubMed database was searched for the following terms: "pediatric," "chest trauma," "hemothorax," "hemopneumothorax," "pneumothorax," "diaphragmatic," "esophageal," and "mediastinal injury." For the hospital data analysis, data of all 378 pediatric patients treated with thoracic injuries under the age of 13 years from 2008 to 2012 (a 5-year period), at the Red Cross War Memorial Children's Hospital, were retrospectively analyzed.
The male to female ratio was 2.1:1 (255 males and 123 females). The mean age was 6.9 ± 2.3 years. Blunt chest trauma was responsible for chest injuries in 90.5%, while penetrating trauma caused 9.5% of the injuries. Road traffic crashes were the mean cause (48.9%) with pedestrian injuries in 72.4% and passenger injuries in 27.6%, respectively. Sports injuries were the cause in 4% and falls from a height in 22%. Most injuries occurred at home: inside one's own home (5%), outside one's own home (52%); inside someone else's home (44%); outside someone else's home (2%). Public space injuries occurred at schools or crèches in 77%, pavement or roads in 6%, and were not specified in 17%. Overall 74% presented with injuries of the thoracic cage; rib fractures occurred in 13%, chest wall contusions in 40%, and abrasions in 31%. Respiratory system injuries occurred in 22%; hemothoraces in 23%, pneumothoraces in 45%, and hemopneumothoraces in 29%. Cardiovascular injuries occurred in 16% of cases with vascular injuries in five patients (two firearms injuries and three motor vehicle crashes). Management was nonoperative in 79.4%, tube thoracotomy in 17.2%, and open surgery in 3.4%. The mortality rate was 1.3%, all contributed by firearm-related injuries and polytrauma.
Thoracic trauma has remained a significant cause of morbidity and mortality in the pediatric population. Concerted effort from governments, civil societies, and the medical profession are needed to address this challenge.
尽管政府努力遏制儿童胸部创伤这一灾祸，但胸部损伤仍是儿童创伤的主要原因。我们的综述结合了我们所在发展中国家机构的近期经验，重点关注儿科人群胸部创伤的发病率、病因及治疗。
为进行文献综述，在国立医学图书馆的PubMed数据库中搜索了以下术语：“儿科”“胸部创伤”“血胸”“血气胸”“气胸”“膈肌”“食管”和“纵隔损伤”。对于医院数据分析，回顾性分析了2008年至2012年（5年期间）在红十字战争纪念儿童医院接受治疗的所有378例13岁以下胸部受伤儿科患者的数据。
男女比例为2.1:1（男性255例，女性123例）。平均年龄为6.9±2.3岁。钝性胸部创伤导致90.5%的胸部损伤，而穿透性创伤导致9.5%的损伤。道路交通事故是主要原因（48.9%），行人受伤占72.4%，乘客受伤占27.6%。运动损伤占4%，高处坠落占22%。大多数损伤发生在家中：自己家中（5%）、自家外（52%）、他人家中（44%）、他人家外（2%）。公共场所损伤发生在学校或托儿所的占77%，人行道或道路的占6%，未明确地点的占17%。总体而言，74%的患者有胸廓损伤；肋骨骨折占13%，胸壁挫伤占40%，擦伤占31%。呼吸系统损伤占22%；血胸占23%，气胸占45%，血气胸占29%。心血管损伤占16%，其中5例有血管损伤（2例火器伤和3例机动车碰撞伤）。79.4%的患者采用非手术治疗，17.2%的患者采用胸腔闭式引流术，3.4%的患者采用开放手术。死亡率为1.3%，均由火器相关损伤和多发伤导致。
胸部创伤仍然是儿科人群发病和死亡的重要原因。政府、民间社会和医疗行业需要共同努力应对这一挑战。
