McNamara Caitlin, Mironova Irina, Lehman Erik, Olympia Robert P
Penn State University College of Medicine, Hershey, PA.
Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA.
J Emerg Med. 2017 Jun;52(6):793-800. doi: 10.1016/j.jemermed.2016.11.031. Epub 2016 Dec 18.
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.
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.
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.
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%).
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.
胸部损伤是儿童钝性创伤相关死亡的主要原因。与胸部计算机断层扫描（CT）相比，通过胸部X线检查筛查损伤一直存在争议，权衡特异性的益处与辐射暴露的损害。
确定在钝性躯干创伤后作为创伤激活而送至一级创伤中心的儿童胸部损伤的预测因素，并将这些预测因素与文献中先前报道的因素进行比较。
我们对2010年6月至2013年6月间因钝性躯干创伤后作为创伤激活而送至一级创伤中心急诊科且接受胸部诊断性成像作为初始评估一部分的儿科患者（<18岁）进行了回顾性病历审查。
对166例患者进行了数据分析。33例患者（20%）在胸部诊断性成像中检测到45处异常，最常见的异常为肺挫伤（36%）、气胸（22%）和肋骨骨折（13%）。胸部诊断性成像异常的统计学显著预测因素包括格拉斯哥昏迷量表（GCS）评分<15（异常者为27%，无异常者为13%）、低氧血症（22%对5%）、晕厥/意识丧失（55%对35%）、颈椎压痛（12%对3%）、胸腰段脊柱压痛（41%对17%）以及腹部/骨盆压痛（12%对3%）。
根据我们的数据，儿童钝性躯干创伤后胸部损伤的预测因素包括GCS<15、低氧血症、晕厥/头晕、颈椎压痛、胸腰段脊柱压痛以及腹部/骨盆压痛。
