Audit of thoracic trauma in children at tertiary care center

Abstract

ABSTRACT Background and Objectives: Thoracic trauma in children is increasing due to rising population, industrialization, modernization, increase in vehicular traffic, terrorist activities, and riots. It requires more caution because of its associated morbidity and mortality. This study is done to know the prognostic factors and outcome of thoracic trauma in children, which helps in decreasing morbidity and mortality. Materials and Methods: This retrospective observational study was conducted from November 2016 to October 2022. Retrospectively, records of all the pediatric patients <18 years of age with a history of thoracic trauma were analyzed. Demographic details, mechanism of injury, nature of the injury, hemodynamic stability, investigations, definitive treatment, and outcome of patients were analyzed. Results: There were 66 children with thoracic trauma. Road traffic accidents were the most common mode of trauma seen in 74.2% of cases, followed by falls in 18.2% of cases. Fifteen (22.7%) cases were hemodynamically unstable. Thirty-two (48.5%) cases required transfusion of blood or blood products. Penetrating trauma was seen in 10 (15.2%) cases. In children with thoracic trauma, up to 29 (43.9%) children had pneumothorax and 21 (31.8%) children had hemothorax. Among the injuries, lung contusions were more commonly seen in 31 (46.9%) cases, followed by rib fractures seen in 24 (36.4%) cases. About 83.3% of cases were managed nonoperatively and 16.7% of cases required surgical intervention. Ten (15.5%) children with thoracic trauma were succumbed to the death. Among the factors leading to mortality delayed presentation and management (50%), hemodynamic instability (100%) patients, requirement of transfusion (100%), penetrating trauma (80%), higher grade of injury (80%), and surgical intervention (80%) were identified to had poor outcome increasing mortality. Site and mechanism of injury are the other factors contributing to and deciding outcomes in pediatric thoracic trauma. Conclusion: Factors such as delayed presentation, hemodynamic instability, penetrating trauma, mediastinal structure injury, higher grade of injury, and surgical intervention had poor outcomes.