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Current Opinion in Pediatrics Jun 1993Thoracic trauma in children is an infrequent but potentially lethal injury often associated with coexisting significant injury to other systems. Most reports suggest... (Review)
Review
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.
Topics: Blood Vessels; Bronchi; Child; Heart Injuries; Humans; Multiple Trauma; Postoperative Care; Thoracic Injuries; Trachea
PubMed: 8374652
DOI: 10.1097/00008480-199306000-00014 -
Critical Care Nursing Clinics of North... Sep 1991Thoracic trauma is usually accompanied by other body system injury, most frequently head and skeletal injury. Developmental changes throughout childhood make the... (Review)
Review
Thoracic trauma is usually accompanied by other body system injury, most frequently head and skeletal injury. Developmental changes throughout childhood make the consequences of such injuries more severe, as children develop respiratory and circulatory compromise quickly. Blunt trauma predominates in pediatric thoracic trauma. Trauma to the thoracic cavity may involve fractures of the ribs or injuries where the ribs remain intact. Trauma involving the pleural space affects ventilation that may evolve into circulatory failure if not addressed promptly. Pulmonary contusion is among the most frequent and most fatal of thoracic injuries. Rupture of the tracheobronchial tree, esophagus, or diaphragm may have both short- and long-term consequences. Trauma to the heart and/or great vessels may be fatal at the scene of the accident, in the emergency department, or in the intensive care unit. Pain management is an essential part of caring for children with thoracic injury. A variety of methods have become available within the past several years that promote better pain relief and shorter recovery periods with less side effects. Nursing care of the child with PCA, epidural analgesia, or intercostal nerve blocks requires specific knowledge and assessment skills. Nonpharmacologic methods of pain relief may be used as an adjunct to pharmacologic methods.
Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Nursing Assessment; Pain; Thoracic Injuries
PubMed: 1883583
DOI: No ID Found -
Traffic Injury Prevention 2022The objective of this study is to generate age targeted versions of the male and female Global Human Body Models Consortium (GHBMC) occupant human body models (HBMs), to...
OBJECTIVE
The objective of this study is to generate age targeted versions of the male and female Global Human Body Models Consortium (GHBMC) occupant human body models (HBMs), to validate each in frontal impacts, and to assess rib fracture probability of each.
METHODS
Six age targeted models were developed based on the GHBMC average male and small female occupant models (M50-O v6.0 and F05-O v6.0, respectively). All age targeted models were modified to represent population means for height, weight, shape, and relevant material properties. The thin plate spline method was used to morph models, and material properties were modified using available literature. Validation focused on chest response. Models were evaluated in a rigid body frontal chest impact at 6.7 m/s. Furthermore, the male and female age targeted models were evaluated against published data from 40 km/hr and 30 km/hr frontal sled tests respectively.
RESULTS
Chest deflections and landmark kinematics reasonably matched the respective corridors in the M50-O and F05-O aged models. Regional probability of rib fracture was assessed using probabilistic methods based on cortex strain. Increasing rib fracture with age was observed in both impacts for both sexes. For the rigid chest impact, the M50-O 70YO resulted in 10 ribs exceeding 50% probability of fracture whereas the younger ages reported 4 to 6 ribs exceeding the same probability. In the same simulation, the F05-O 70YO resulted in 8 regions exceeding 50% probability of rib fracture as opposed to 3 and 0 such regions at the youngest ages. Sled simulation demonstrated similar trends. The 70YO age adjusted models best aligned with the reported extent of fractures from the referenced PMHS studies, which tend to be composed of subjects of advanced age.
CONCLUSIONS
Age targeted HBMs demonstrated increased fracture probability with age when subjected to equivalent impacts. Gross model kinematics approximate PMHS data but showed little difference between targeted age models. The findings indicate that while gross kinematics are unaffected by age-targeting models, such models can capture trends of increased thoracic injury risk observed in experimental and field studies, and further suggest their potential use to target interventions for vulnerable driving populations, such as older adults.
Topics: Humans; Male; Female; Aged; Rib Fractures; Human Body; Accidents, Traffic; Thoracic Injuries; Biomechanical Phenomena; Models, Biological; Aging; Cadaver
PubMed: 35862927
DOI: 10.1080/15389588.2022.2097223 -
The Journal of Trauma and Acute Care... Jun 2014The combination of airbag and seat belt is considered to be the most effective vehicle safety system. However, despite the widespread availability of airbags and a belt...
BACKGROUND
The combination of airbag and seat belt is considered to be the most effective vehicle safety system. However, despite the widespread availability of airbags and a belt use rate of more than 85%, US drivers involved in crashes continue to be at risk of serious thoracic injury. The objective of this study was to determine the influence of steering wheel deformation on driver injury risk in frontal automobile crash.
METHODS
The analysis is based on cases extracted from the National Automotive Sampling System Crashworthiness Data System database for case years 1993 to 2011. The approach was to compare the adjusted odds of frontal crash injury experienced by drivers in vehicles with and without steering wheel deformation.
RESULTS
Among frontal crash cases with belted drivers, observable steering wheel deformation occurred in less than 4% of all cases but accounted for 30% of belted drivers with serious (Abbreviated Injury Scale [AIS] score, 3+) thoracic injuries. Similarly, steering wheel deformation occurred in approximately 13% of unbelted drivers but accounted for 60% of unbelted drivers with serious thoracic injuries. Belted drivers in frontal crashes with steering wheel deformation were found to have two times greater odds of serious thoracic injury. Unbelted drivers were found to have four times greater odds of serious thoracic injury in crashes with steering wheel deformation. In frontal crashes, steering wheel deformation was more likely to occur in unbelted drivers than belted drivers, as well as higher severity crashes and with heavier drivers.
CONCLUSION
The results of the present study show that airbag deployment and seat belt restraint do not completely eliminate the possibility of steering wheel contact. Even with the most advanced restraint systems, there remains an opportunity for further reduction in thoracic injury by continued enhancement to the seat belt and airbag systems. Furthermore, the results showed that steering wheel deformation is an indicator of potential serious thoracic injury and can be useful to prehospital personnel in improving the diagnosis of serious injuries.
LEVEL OF EVIDENCE
Prognostic study, level III.
Topics: Abbreviated Injury Scale; Accidents, Traffic; Air Bags; Automobiles; Equipment Failure; Female; Humans; Incidence; Male; Retrospective Studies; Seat Belts; Thoracic Injuries; United States
PubMed: 24854313
DOI: 10.1097/TA.0000000000000222 -
Journal of Biomechanics 1991A major concern in competition taekwondo is the injury potential posed by many of the powerful kicks used. An investigation of the kinetics of four kicks frequently used...
A major concern in competition taekwondo is the injury potential posed by many of the powerful kicks used. An investigation of the kinetics of four kicks frequently used in competition was performed with high speed video. Velocities were measured, and energy was calculated. Typical values for basic swing kicks were 15 ms-1 and 200 J. Basic thrust kicks possessed 45% less velocity but 28% more energy than swing kicks. Linkage models were developed to simulate the motion and kinetics of the kicking leg. Injury potential was evaluated through thoracic compression and viscous criterion models. These models predict a significant probability of serious injury with all kicks, with thoracic deflections from 3 to 5 cm and peak viscous tolerance values from 0.9-1.4 ms-1, when no protective body equipment is used.
Topics: Acceleration; Deceleration; Foot; Heel; Hip Joint; Humans; Knee Joint; Leg; Male; Martial Arts; Models, Biological; Muscles; Pressure; Probability; Stress, Mechanical; Thoracic Injuries; Wounds, Nonpenetrating
PubMed: 1744152
DOI: 10.1016/0021-9290(91)90173-k -
Journal of Veterinary Emergency and... Jul 2019To determine the association between thoracic injuries evaluated by computed tomography (CT) and arterial blood gas and acid-base status in dogs with blunt thoracic...
OBJECTIVE
To determine the association between thoracic injuries evaluated by computed tomography (CT) and arterial blood gas and acid-base status in dogs with blunt thoracic trauma caused by motor vehicle accidents.
DESIGN
Prospective observational clinical study.
SETTING
University teaching hospital.
ANIMALS
Thirty-one client owned traumatized dogs and 15 healthy dogs.
PROCEDURES
All trauma group dogs underwent a CT scan and simultaneous arterial blood gas analysis within 24 hours, but not before 4 hours, after the traumatic incident within a 45-month enrollment period.
MEASUREMENTS AND MAIN RESULTS
Thorax injuries were classified as pulmonary, pleural space, or rib cage and each of these components was scored for severity using a CT composite pulmonary, pleural, and rib score. The trauma group arterial blood gas and acid-base status were evaluated for statistical difference from the control group. The pulmonary-arterial oxygen pressure was significantly lower in the trauma group compared to the control group that was supported by significant differences in the calculated variables of arterial blood oxygenation as well. There was also a significant correlation between the composite lung score and pleural score and the variables of arterial oxygen status. The pulmonary-arterial carbon dioxide pressure was not significantly different to any of the thoracic injury variables indicating normal alveolar ventilation. Acid-base imbalances were generally mild, insignificant, and variable.
CONCLUSIONS AND CLINICAL RELEVANCE
Blunt thoracic trauma causes significant pulmonary and pleural injury and the blood oxygen economy is significantly affected by this. The functional measures of arterial blood oxygenation were well correlated with thoracic CT pathology. Alveolar ventilation was mostly spared but a clinically significant ventilation perfusion mismatch was present.
Topics: Acid-Base Equilibrium; Animals; Blood Gas Analysis; Dogs; Female; Lung; Male; Oxygen; Prospective Studies; Thoracic Injuries; Tomography, X-Ray Computed; Wounds, Nonpenetrating
PubMed: 31231948
DOI: 10.1111/vec.12863 -
Kyobu Geka. the Japanese Journal of... Jul 2015The thoracic wall protects the heart, great vessels, lungs, trachea, and bronchus, which are organs important for maintaining respiration/circulation, against external...
The thoracic wall protects the heart, great vessels, lungs, trachea, and bronchus, which are organs important for maintaining respiration/circulation, against external forces. Therefore, injury of the thoracic wall may necessitate emergency treatment. Such injury primarily consists of rib and sternal fractures. In particular, fractures of 2 or more consecutive ribs with each rib being fractured at 2 or more sites and serial rib fracture with sternal fracture lead to reverse thoracic movement involving contraction on inhalation and expansion on expiration. Such thoracic injury is termed flail chest. Injury of the thoracic wall, such as flail chest, markedly influences the prognosis. Therefore, it is necessary to promptly evaluate the general condition, involving respiratory/circulatory kinetics, confirm the presence or absence of concomitant injury, such as bruises of the lungs/heart, and accurately select therapeutic strategies, including artificial respiration and surgical intervention.
Topics: Female; Humans; Middle Aged; Rib Fractures; Surgical Equipment; Thoracic Injuries; Thoracic Surgical Procedures; Thoracic Wall; Tomography, X-Ray Computed
PubMed: 26197917
DOI: No ID Found -
Current Opinion in Anaesthesiology Feb 2008Trauma remains a leading cause of death across all age groups. Thoracic injury is a contributing cause in approximately half of these. Despite being potentially life... (Review)
Review
PURPOSE OF REVIEW
Trauma remains a leading cause of death across all age groups. Thoracic injury is a contributing cause in approximately half of these. Despite being potentially life threatening, most thoracic trauma is managed nonoperatively or with an intercostal catheter. Only 10% of thoracic trauma patients will require emergency thoracotomy. Many more will undergo emergency or urgent surgical intervention for coexisting injuries. Thoracic injuries are dynamic. It is crucial for the anesthesiologist to continually reassess the patient, so that the manifestations of evolving injuries may be detected as early as possible and appropriate management decisions made. Up-to-date knowledge of injury patterns, mechanisms, pathophysiology, and operative and nonoperative management will facilitate optimal management of these patients.
RECENT FINDINGS
There is recent literature discussing the surgical, anesthetic and critical care management of a range of thoracic injuries resulting from either blunt or penetrating trauma.
SUMMARY
Initial resuscitation and surgical management of patients with thoracic trauma continue to evolve. Improvements in prehospital care and diagnostic techniques as well as development of minimally invasive interventions mean that the anesthesiologist may be required to provide care to unstable patients in an expanded range of scenarios and environments.
Topics: Anesthesia; Aorta; Contusions; Hemothorax; Humans; Lung Injury; Thoracic Injuries; Thoracic Surgery, Video-Assisted; Wounds, Nonpenetrating
PubMed: 18195608
DOI: 10.1097/ACO.0b013e3282f2aadc -
Chirurgie (Heidelberg, Germany) Sep 2023Thoracic trauma is associated with a high morbidity and mortality. Assessing the risk for complications is essential for planning the further treatment strategies and...
BACKGROUND
Thoracic trauma is associated with a high morbidity and mortality. Assessing the risk for complications is essential for planning the further treatment strategies and managing resources in thoracic trauma.
OBJECTIVE
The aim of the study was to analyze concomitant injuries in unilateral and bilateral rib fractures and pulmonary contusions and evaluate differences in complication rates between the two.
MATERIAL AND METHODS
In a retrospective study, data from all patients diagnosed with thoracic trauma at a level I trauma center were analyzed. Bivariate and multivariate analysis were used to examine an association of unilateral or bilateral rib fractures, serial rib fractures, and pulmonary contusions with multiple injuries and outcomes. In addition, multivariate regression analysis was utilized to determine the impact of age, gender and additional injuries on outcome.
RESULTS
A total of 714 patients were included in the analysis. The mean Injury Severity Score (ISS) was 19. Patients with an additional thoracic spine injury had a significantly higher incidence of bilateral rib fractures. Pulmonary contusions were associated with younger age. Abdominal injuries were predictors for bilateral pulmonary contusions. Complications occurred in 36% of the patients. Bilateral injuries increased the complication rate up to 70%. Pelvic and abdominal injuries as well as the need for a chest drain were significant risk factors for complications. The mortality rate was 10%, with higher age, head and pelvic injuries as predictors.
CONCLUSION
Patients with bilateral chest trauma had an increased incidence of complications and a higher mortality rate. Bilateral injuries and significant risk factors must therefore be considered. Injury of the thoracic spine should be excluded in those patients.
Topics: Humans; Rib Fractures; Retrospective Studies; Wounds, Nonpenetrating; Thoracic Injuries; Lung Injury; Contusions; Abdominal Injuries
PubMed: 37268786
DOI: 10.1007/s00104-023-01891-0 -
Critical Care Medicine Nov 2002Although thoracic injuries occur less frequently in children than adults, they remain a source of substantial morbidity and mortality. Disparate problems such as rib... (Review)
Review
Although thoracic injuries occur less frequently in children than adults, they remain a source of substantial morbidity and mortality. Disparate problems such as rib fractures, lung injury, hemothorax, pneumothorax, mediastinal injuries, and others may present in isolation or in combination with one another. Knowledge of the manner in which pediatric anatomy, physiology, and injury patterns change with age may expedite the evaluation of the pediatric chest after trauma. Differences in pulmonary functional residual capacity, blood volume, chest wall and spinal soft-tissue mobility, and cardiac function may translate into problems or benefits of important consequence. For example, although more predisposed to hypoxemia, young children may remain well compensated hemodynamically, despite significant blood loss. Rare injuries in children, such as cardiac and great vessel trauma, may remain undiagnosed precisely because of their scarcity and protean symptoms.
Topics: Adolescent; Child; Child Abuse; Child, Preschool; Humans; Radiography; Respiratory Distress Syndrome; Rib Fractures; Thoracic Injuries
PubMed: 12528782
DOI: 10.1097/00003246-200211001-00005