Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
Trauma Service, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
Emerg Med Australas. 2020 Feb;32(1):117-126. doi: 10.1111/1742-6723.13392. Epub 2019 Sep 18.
Thoracic trauma is a leading cause of paediatric trauma deaths. Traumatic cardiac arrest, tension pneumothorax and massive haemothorax are life-threatening conditions requiring emergency and definitive pleural decompression. In adults, thoracostomy is increasingly preferred over needle thoracocentesis for emergency pleural decompression. The present study reports on the early experience of thoracostomy in children, to inform debate regarding the best approach for emergency pleural compression in paediatric trauma.
Retrospective review of Ambulance Victoria and The Royal Children's Hospital Melbourne, Trauma Registry between August 2016 and February 2019 to identify children undergoing thoracostomy for trauma, either pre-hospital or in the ED.
Fourteen children aged 1.2-15 years underwent 23 thoracostomy procedures over the 31 month period. The majority of patients sustained transport-related injuries, and underwent thoracostomies for the primary indications of hypoxia and hypotension. Two children were in traumatic cardiac arrest. Ten children underwent needle thoracocentesis prior to thoracostomy, but all required thoracostomy to achieve the necessary definitive decompression. All patients were severely injured with multiple-associated serious injuries and median Injury Severity Score 35.5 (17-75), three of whom died from their injuries. Thoracostomy in our cohort had a low complication rate.
In severely injured children, thoracostomy is an effective and reliable method to achieve emergency pleural decompression, including in the young child. The technical challenges presented by children are real, but can be addressed by training to support a low complication rate. We recommend thoracostomy over needle thoracocentesis as the first-line intervention in children with traumatic cardiac arrest, tension pneumothorax and massive haemothorax. [Correction added on 23 September 2019 after first online publication: in the second sentence of the conclusion, the words "under review process" were mistakenly added and have been removed.].
胸部创伤是导致儿童创伤死亡的主要原因。创伤性心脏骤停、张力性气胸和大量血胸是危及生命的情况，需要紧急和明确的胸膜减压。在成人中，胸腔穿刺术越来越被认为是紧急胸膜减压的首选方法。本研究报告了儿童胸腔穿刺术的早期经验，旨在为儿童创伤的紧急胸膜减压最佳方法的争论提供信息。
回顾 2016 年 8 月至 2019 年 2 月期间，维多利亚救护车和墨尔本皇家儿童医院创伤登记处的病历，以确定因创伤而接受胸腔穿刺术的儿童，包括院前和急诊科。
在 31 个月的时间里，14 名年龄在 1.2-15 岁的儿童进行了 23 次胸腔穿刺术。大多数患者发生与运输相关的损伤，并因缺氧和低血压的主要指征而进行胸腔穿刺术。两名儿童发生创伤性心脏骤停。10 名儿童在进行胸腔穿刺术之前进行了胸腔穿刺术，但所有儿童都需要进行胸腔穿刺术以实现必要的明确减压。所有患者均受重伤，伴有多处严重损伤，损伤严重程度评分中位数为 35.5（17-75），其中 3 人因伤死亡。在我们的队列中，胸腔穿刺术的并发症发生率较低。
在严重受伤的儿童中，胸腔穿刺术是一种有效且可靠的方法，可以实现紧急胸膜减压，包括在幼儿中。儿童所面临的技术挑战是真实存在的，但通过培训可以解决这些挑战，以降低并发症发生率。我们建议在创伤性心脏骤停、张力性气胸和大量血胸的儿童中，将胸腔穿刺术作为一线干预措施。
