Keneally Ryan J, Shields Cynthia H, Hsu Albert, Prior Howard I, Creamer Kevin M
Department of Anesthesiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD.
Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD.
Mil Med. 2018 Nov 1;183(11-12):e596-e602. doi: 10.1093/milmed/usy044.
The objective of this study is to review available data on pediatric thoracic trauma seen at U.S. military treatment facilities in Iraq and Afghanistan and describe the scope of injuries, patterns seen, and associated mortality. The results were compared with adults injured in Iraq and Afghanistan and other reports of pediatric thoracic trauma in the literature.
The investigators received approval from the Uniformed Services University of the Health Sciences' institutional review board before the study. The Joint Theatre Trauma Registry was queried for all patients with an ICD-9 code for thoracic trauma. Two-tailed Student's t-test, Mann-Whitney rank sum, χ2, ANOVA, or multiple logistic regression was used as indicated.
There were 955 patients under the age of 18 yr, just over 12% of all thoracic trauma. Penetrating injuries were common (73.6%), including gunshot wounds. The most common pediatric diagnoses were contusions (45%), pneumothorax (40%), and rib and/or sternal fractures (18%). The overall mortality for children was 15.2% compared with 13.8% and 9% for civilian adults and Coalition members with thoracic trauma, respectively. Mortality was inversely related to age among pediatric patients. Children under 2 yr of age had the highest mortality (25.1%). Patients under 12 yr of age were more likely to die than those between 12 and 18 (OR 2.02, 95% CI 1.27-3.22) yr. Thoracic vascular injuries and cardiac injuries resulted in the highest mortality among pediatric patients. The presence of a hemothorax was independently associated with an increased risk for mortality (OR 1.78, 95% CI 1.06-2.99) as was a concomitant head injury (OR 2.17, 95% CI 1.33-3.54). There was a 2.7% incidence of burns among pediatric patients with a high associated mortality (46.2%). Nearly one-half of all the children identified required a transfusion (47%).
Penetrating injuries predominated and these children commonly required a transfusion. Mortality was inversely related to age. Children with a hemothorax or a concomitant head injury had significant increases in mortality. Children with thoracic injury as the result of a burn suffered the highest mortality.
本研究的目的是回顾美国在伊拉克和阿富汗军事治疗机构中所见小儿胸部创伤的现有数据，并描述损伤范围、所见模式及相关死亡率。将结果与在伊拉克和阿富汗受伤的成人以及文献中其他小儿胸部创伤报告进行比较。
研究人员在研究前获得了美国军医大学机构审查委员会的批准。查询联合战区创伤登记处，获取所有国际疾病分类第九版（ICD - 9）编码为胸部创伤的患者信息。根据需要使用双尾学生t检验、曼 - 惠特尼秩和检验、χ²检验、方差分析或多元逻辑回归。
有955名18岁以下患者，占所有胸部创伤患者的12%多一点。穿透伤很常见（73.6%），包括枪伤。小儿最常见的诊断是挫伤（45%）、气胸（40%）以及肋骨和/或胸骨骨折（18%）。小儿的总体死亡率为15.2%，而平民成人和联军胸部创伤患者的死亡率分别为13.8%和9%。小儿患者的死亡率与年龄呈负相关。2岁以下儿童死亡率最高（25.1%）。12岁以下患者比12至18岁患者更易死亡（比值比2.02，95%置信区间1.27 - 3.22）。小儿患者中胸血管损伤和心脏损伤导致的死亡率最高。血胸的存在与死亡率增加独立相关（比值比1.78，95%置信区间1.06 - 2.99），同时存在头部损伤也是如此（比值比2.17，95%置信区间1.33 - 3.54）。小儿患者中有2.7%发生烧伤，烧伤相关死亡率较高（46.2%）。几乎一半确诊的儿童需要输血（47%）。
穿透伤占主导，这些儿童通常需要输血。死亡率与年龄呈负相关。有血胸或同时存在头部损伤的儿童死亡率显著增加。因烧伤导致胸部损伤的儿童死亡率最高。
