RESUMO
Background: pediatric trauma remains a major health and social problem. Thoracic injuries are the second leading cause of death in children
Aim of the work: to evaluate our experience in diagnosis and management of serious chest trauma in children either blunt or penetrating which required emergency thoracotomy
Patients and methods: this is a retrospective study of all emergency thoracotomies performed for pediatric patients at Mansoura University Emergency Hospital [MUEH] from January 1997 to December 2002. We reviewed the hospital charts of all patients admitted with the diagnosis of chest injuries either blunt or penetrating injury and selected cases needed emergency thoracotomy. Of the pediatric group, only 50 patients [5%] had serious chest injury, either blunt or penetrating and required emergency thoracotomy were included in this study. Hospital charts of this group of patients were reviewed and classified according to the mechanism of trauma into two groups: Group A: Patients with blunt thoracic trauma; 26 patients [52 %]. Group B Patients with penetrating thoracic trauma; 24 patients [48%]
Results: in the blunt group, 20 patients [76.9%] were males and 6 patients [23.1%] were females, with age ranged from 1 to 16 years [mean 10.0+/-6.4]. In penetrating group, 20 patients [83.3%] were males and 4 patients [16.7 %] were females, with age ranged from 6 to 17 years [mean 12.6+/- 3.4]. In the blunt group, the mechanism of injury was: road traffic accidents in 18 patients [69.26] and falling from height in 8 patients [30.8%]. In the penetrating group, the mechanism of injury was: stab injury in 17 patients [70.8%], gunshot injury in 2 patients [8.4%], 4 patients [16.7%] were victims of iatrogenic trauma and one patient [4.2%] was involved in explosion injury. In both groups the most common side of injury was the left side 29 patients [58 %]. Fifteen patients [57.3%] were in the blunt group and 14 patients [58.3] were in the penetrating group. The pediatric trauma score [PTS] of all children was calculated, it was found that 7 patients [26.9%] of the blunt group and 8 patients [33.3%] of the penetrating group had PTS
Conclusion: from this study concludes that: *A high survival rate can be achieved if emergency thoracotomy, when indicated, is done as long as the patients shows vital signs on admission. *Excellent results are predicted when the surgical interference is performed within the first 2 hours of injury. The emergency thoracotomy could be done in the operating room or in the emergency room provided that the good monitoring and ventilation is available, then patients can be transferred after resuscitation to the operating room for definitive repair of the injuries