Stafford P W, Harmon C M
Division of Pediatric Surgery, Children's Hospital of Philadelphia, PA 19104-4399.
Curr Opin Pediatr. 1993 Jun;5(3):325-32. doi: 10.1097/00008480-199306000-00014.
Thoracic trauma in children is an infrequent but potentially lethal injury often associated with coexisting significant injury to other systems. Most reports suggest that the incidence of chest trauma in the injured child is approximately 10%. The most frequently associated trauma is, unfortunately, to the central nervous system and is an unusually deadly combination of injuries. As such, the thoracic injuries serve as a reliable marker for injury severity in children, mandating meticulous evaluation of the child presenting with thoracic trauma. The diagnosis of the thoracic injury may be difficult on cursory clinical examination and supine chest radiograph, and a thorough and focused evaluation of the child's thoracic injuries is required to discover the extent and severity of these injuries. This is particularly important because most of the thoracic injuries that may be immediately life threatening may be expediently and easily treated in the emergency department during the primary survey phase of Advanced Trauma Life Support. But when the injuries are not suspected, diagnosed, and treated, the child's morbidity and mortality risk rises exponentially and approaches 50%. Many current published reports have concentrated on the overall epidemiology of childhood thoracic trauma in order to focus medical attention on the importance of thoracic trauma to medical planning. Much of the remaining pertinent clinical literature on thoracic trauma during the last several years has looked at particular markers of injury severity and on the recognition and management of the rare but morbid cardiovascular and tracheobronchial injuries. Each of these topics is reviewed, with particular attention to the recent literature over the past 12 months.
儿童胸部创伤虽不常见，但可能致命，且常伴有其他系统的严重损伤。大多数报告表明，受伤儿童胸部创伤的发生率约为10%。不幸的是，最常伴发的创伤是中枢神经系统创伤，这是一种异常致命的损伤组合。因此，胸部损伤是儿童损伤严重程度的可靠指标，要求对胸部创伤患儿进行细致评估。仅凭粗略的临床检查和仰卧位胸部X线片可能难以诊断胸部损伤，需要对患儿的胸部损伤进行全面、重点评估，以明确损伤的范围和严重程度。这一点尤为重要，因为大多数可能立即危及生命的胸部损伤在高级创伤生命支持的初级评估阶段可在急诊科得到迅速且简便的治疗。但如果未怀疑、诊断和治疗这些损伤，患儿的发病和死亡风险将呈指数级上升，接近50%。许多当前发表的报告集中在儿童胸部创伤的总体流行病学上，以便让医疗界关注胸部创伤对医疗规划的重要性。过去几年中，其余许多有关胸部创伤的相关临床文献关注的是损伤严重程度的特定指标，以及罕见但严重的心血管和气管支气管损伤的识别与处理。本文将对每个主题进行综述，特别关注过去12个月的最新文献。
