Department of Pediatric Emergency Care, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2022 Jul;28(7):933-939. doi: 10.14744/tjtes.2021.48961.
Thoracoabdominal injuries (TAI) are an important cause of trauma-related morbidity in children. Early and correct intervention is essential to reduce mortality. We aimed to determine factors associated with mortality and the need for intensive care in TAI.
The children admitted to the pediatric emergency department of a tertiary care hospital with TAI in a 6-year-period were enrolled. Demographic data; mechanism of injuries; clinical, laboratory and imaging findings; length of hospital and intensive care unit (ICU) stay; invasive procedures and medical treatments; surgical interventions; and survival outcomes were recorded.
The median age of the 136 children was 9 (IQR: 5-14) years and 72.8% were male. The vast majority of injuries were caused by blunt trauma (92.7%). Pulmonary contusion, pneumothorax, splenic, and liver injuries were the most common diagnoses. Motor vehicle accidents were seen in more than half of the cases (52.2%). The median length of hospital stay was 5 (IQR: 2-8) days; 21 patients were hospitalized in the ICU (15.4%). The need for intensive care was higher in patients with lower Glasgow Coma Scale (GCS) scores and lower Pediatric Trauma Scores (PTSs), in the presence of multiple injuries, pulmonary contusion, and pneumothorax (p<0.001). Mortality was seen in nine patients, eight of whom had multiple injuries. The mortality rate was higher in patients with pulmonary contusion and pneumothorax (p=0.002 and p=0.003, respectively). The PTS and GCS were found to be lower in patients who died in hospital (p<0.001). Prolongation of coagulation parameters and hyperglycemia was more common in the non-survivor group (p=0.005 and p=0.004, respectively).
Although thoracoabdominal trauma is not common in childhood, it is an important part of trauma-associated mortality. Multiple injuries, pulmonary contusion, pneumothorax, lower GCS, and PTSs can be a sign of serious injuries to which physicians must be alert.
胸腹部损伤（TAI）是儿童创伤相关发病率的重要原因。早期和正确的干预对于降低死亡率至关重要。我们旨在确定与 TAI 死亡率和需要重症监护相关的因素。
在 6 年期间，将因 TAI 入住三级保健医院儿科急诊的儿童纳入研究。记录人口统计学数据；损伤机制；临床、实验室和影像学表现；住院和重症监护病房（ICU）留观时间；有创操作和医疗治疗；外科干预；以及生存结果。
136 名儿童的中位年龄为 9（IQR：5-14）岁，72.8%为男性。绝大多数损伤为钝性创伤所致（92.7%）。肺挫伤、气胸、脾和肝损伤是最常见的诊断。超过一半的病例（52.2%）为机动车事故。中位住院时间为 5（IQR：2-8）天；21 名患者入住 ICU（15.4%）。格拉斯哥昏迷评分（GCS）和儿科创伤评分（PTS）较低、存在多发伤、肺挫伤和气胸的患者需要重症监护的可能性更高（p<0.001）。9 名患者死亡，其中 8 名患者有多发伤。有肺挫伤和气胸的患者死亡率更高（p=0.002 和 p=0.003）。住院死亡患者的 PTS 和 GCS 较低（p<0.001）。凝血参数延长和高血糖症在非幸存者组更为常见（p=0.005 和 p=0.004）。
尽管胸腹部创伤在儿童中并不常见，但它是与创伤相关死亡率的重要组成部分。多发伤、肺挫伤、气胸、GCS 和 PTS 较低可能是严重损伤的标志，医生必须对此保持警惕。
