Research

Severe blunt thoracic trauma: Differences between adults and children in a level 1 trauma centre

David Lee Skinner, Daan den Hollander, Grant L Laing, Reitze N Rodseth, David J J Muckart

Abstract


Background. Trauma is a leading cause of death in the developing world. Blunt thoracic trauma represents a major burden of disease in both adults and children. Few studies have investigated the differences between these two patient groups.

Objective. To compare mechanism of injury, presentation, management and outcome in children and adults with blunt thoracic trauma.

Methods. Patients were identified from the database of the trauma intensive care unit at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. Demographics and relevant data were extracted from a pre-existing database.

Results. Of 415 patients admitted to the unit, 331 (79.7%) were adults and 84 (20.2%) children aged <18 years. The median injury severity score (ISS) was similar for both age groups (32 v. 34; p=0.812). Adults had a higher lactate level at presentation (3.94 v. 2.60 mmol/Ll; p=0.001). Of the children, 96.4% were injured in motor vehicle collisions, 75.0% as pedestrians. Compared with adults, children had significantly fewer rib fractures (20.2% v. 42.0%; p<0.001), flail chests (2.4% v. 26.3%; p<0.001) and blunt cardiac injuries (BCIs) (9.5% v. 23.6%; p=0.004), but sustained more lung contusions (79.8% v. 65.6%; p=0.013). Mortality in children was significantly lower than in adults (16.7% v. 27.8%; p=0.037).

Conclusion. Thoracic injuries in children are the result of pedestrian collisions more often than in adults. They suffer fewer rib fractures and BCIs, but more lung contusions. Despite similar ISSs, children have significantly lower mortality than adults. More effort needs to be concentrated on child safety and preventing pedestrian injury.

Authors' affiliations

David Lee Skinner, Department of Anaesthetics and Critical Care, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Daan den Hollander, Department of Surgery, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Grant L Laing, Department of Surgery, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Reitze N Rodseth, Department of Anaesthetics and Critical Care, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Population Health Research Institute, Hamilton, Canada, and Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA

David J J Muckart, Department of Surgery, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Department of Trauma Surgery: Level I Trauma Unit and Trauma Intensive Care, Inkosi Albert Luthuli Central Hospital, Durban

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Keywords

Paediatric; Thoracic; Trauma

Cite this article

South African Medical Journal 2015;105(1):47-51. DOI:10.7196/SAMJ.8499

Article History

Date submitted: 2014-05-28
Date published: 2014-11-25

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