Pediatric emergency department thoracotomy: A large case series and systematic review

Casey J. Allen, Evan J. Valle, Chad M. Thorson, Anthony Richard Hogan, Eduardo Perez, Nicholas Namias, Tanya Zakrison, Holly Neville, Juan E Sola

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background/purpose: The emergency department thoracotomy (EDT) is rarely utilized in children, and is thus difficult to identify survival factors. We reviewed our experience and performed a systematic review of reports of EDT in pediatric patients. Methods: Patients age ≤. 18. years who received an EDT from 1991 to 2012 at our institution and all published case series were reviewed. Data analyzed include age, sex, mechanism of injury (MOI), injury patterns, presence of vital signs (VS) or signs of life (SOL) in the field/ED, return of spontaneous circulation (ROSC), and survival. Results: A total of 252 patients were analyzed. 84% were male. 51% sustained penetrating injuries, and median age was 15. years. Upon arrival, 17% had VS, and 35% had SOL. After EDT, 30% experienced ROSC. The survival rate was 1.6% for blunt trauma, 10.2% for penetrating injuries, and 6.0% overall. Conclusion: Survival of pediatric patients following EDT is comparable to recent analyses in adults. Children who sustain blunt injury and are without SOL have been uniformly unsalvageable. Children who sustain penetrating trauma and have SOL or are without SOL for a short time prior to arrival have been salvageable. There are no reported EDT survivors less than 14. years of age following blunt injury.

Original languageEnglish
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Oct 5 2014

Fingerprint

Thoracotomy
Hospital Emergency Service
Pediatrics
Wounds and Injuries
Nonpenetrating Wounds
Vital Signs
Survival
Survivors
Survival Rate

Keywords

  • Adolescents
  • Children
  • Kids
  • Resuscitative thoracotomy

Cite this

@article{4bef08ba528b461fa74e7810528dfe5f,
title = "Pediatric emergency department thoracotomy: A large case series and systematic review",
abstract = "Background/purpose: The emergency department thoracotomy (EDT) is rarely utilized in children, and is thus difficult to identify survival factors. We reviewed our experience and performed a systematic review of reports of EDT in pediatric patients. Methods: Patients age ≤. 18. years who received an EDT from 1991 to 2012 at our institution and all published case series were reviewed. Data analyzed include age, sex, mechanism of injury (MOI), injury patterns, presence of vital signs (VS) or signs of life (SOL) in the field/ED, return of spontaneous circulation (ROSC), and survival. Results: A total of 252 patients were analyzed. 84{\%} were male. 51{\%} sustained penetrating injuries, and median age was 15. years. Upon arrival, 17{\%} had VS, and 35{\%} had SOL. After EDT, 30{\%} experienced ROSC. The survival rate was 1.6{\%} for blunt trauma, 10.2{\%} for penetrating injuries, and 6.0{\%} overall. Conclusion: Survival of pediatric patients following EDT is comparable to recent analyses in adults. Children who sustain blunt injury and are without SOL have been uniformly unsalvageable. Children who sustain penetrating trauma and have SOL or are without SOL for a short time prior to arrival have been salvageable. There are no reported EDT survivors less than 14. years of age following blunt injury.",
keywords = "Adolescents, Children, Kids, Resuscitative thoracotomy",
author = "Allen, {Casey J.} and Valle, {Evan J.} and Thorson, {Chad M.} and Hogan, {Anthony Richard} and Eduardo Perez and Nicholas Namias and Tanya Zakrison and Holly Neville and Sola, {Juan E}",
year = "2014",
month = "10",
day = "5",
doi = "10.1016/j.jpedsurg.2014.10.042",
language = "English",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Pediatric emergency department thoracotomy

T2 - A large case series and systematic review

AU - Allen, Casey J.

AU - Valle, Evan J.

AU - Thorson, Chad M.

AU - Hogan, Anthony Richard

AU - Perez, Eduardo

AU - Namias, Nicholas

AU - Zakrison, Tanya

AU - Neville, Holly

AU - Sola, Juan E

PY - 2014/10/5

Y1 - 2014/10/5

N2 - Background/purpose: The emergency department thoracotomy (EDT) is rarely utilized in children, and is thus difficult to identify survival factors. We reviewed our experience and performed a systematic review of reports of EDT in pediatric patients. Methods: Patients age ≤. 18. years who received an EDT from 1991 to 2012 at our institution and all published case series were reviewed. Data analyzed include age, sex, mechanism of injury (MOI), injury patterns, presence of vital signs (VS) or signs of life (SOL) in the field/ED, return of spontaneous circulation (ROSC), and survival. Results: A total of 252 patients were analyzed. 84% were male. 51% sustained penetrating injuries, and median age was 15. years. Upon arrival, 17% had VS, and 35% had SOL. After EDT, 30% experienced ROSC. The survival rate was 1.6% for blunt trauma, 10.2% for penetrating injuries, and 6.0% overall. Conclusion: Survival of pediatric patients following EDT is comparable to recent analyses in adults. Children who sustain blunt injury and are without SOL have been uniformly unsalvageable. Children who sustain penetrating trauma and have SOL or are without SOL for a short time prior to arrival have been salvageable. There are no reported EDT survivors less than 14. years of age following blunt injury.

AB - Background/purpose: The emergency department thoracotomy (EDT) is rarely utilized in children, and is thus difficult to identify survival factors. We reviewed our experience and performed a systematic review of reports of EDT in pediatric patients. Methods: Patients age ≤. 18. years who received an EDT from 1991 to 2012 at our institution and all published case series were reviewed. Data analyzed include age, sex, mechanism of injury (MOI), injury patterns, presence of vital signs (VS) or signs of life (SOL) in the field/ED, return of spontaneous circulation (ROSC), and survival. Results: A total of 252 patients were analyzed. 84% were male. 51% sustained penetrating injuries, and median age was 15. years. Upon arrival, 17% had VS, and 35% had SOL. After EDT, 30% experienced ROSC. The survival rate was 1.6% for blunt trauma, 10.2% for penetrating injuries, and 6.0% overall. Conclusion: Survival of pediatric patients following EDT is comparable to recent analyses in adults. Children who sustain blunt injury and are without SOL have been uniformly unsalvageable. Children who sustain penetrating trauma and have SOL or are without SOL for a short time prior to arrival have been salvageable. There are no reported EDT survivors less than 14. years of age following blunt injury.

KW - Adolescents

KW - Children

KW - Kids

KW - Resuscitative thoracotomy

UR - http://www.scopus.com/inward/record.url?scp=84908494626&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84908494626&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2014.10.042

DO - 10.1016/j.jpedsurg.2014.10.042

M3 - Article

C2 - 25598119

AN - SCOPUS:84922554277

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

ER -