Chest Trauma in Children

Children are just as prone to chest trauma and rib fractures as adults. These types of trauma are associated primarily with motor vehicle accidents, falls from great heights and sports-related trauma. The most common injury with chest trauma in children is a nondisplaced rib fracture or multiple rib fractures. Children can also get a pneumothorax or collapsed lung, a pneumopericardium or air in between the heart and its sac, or bruising of the heart itself.

When blunt trauma to the chest is suspected, doctors can do plain chest x-rays of the chest to rule out rib fractures and the possibility of a hemothorax or hemopericardium. A hemothorax is when blunt trauma or a rib fracture causes bleeding that collects in the lung tissue. A hemopericardium is when blood builds up between the heart and its pericardial sac, preventing full filling of the heart during the diastolic portion of the heart cycle. These can show up on a plain x-ray of the chest.

If there is any question of an injury to the chest that cannot be seen on plain films, a CT scan of the chest can show the major vessels, the lung tissue, the ribs and any detail around the heart. In many cases, a CT scan of the chest is performed any time there is probable severe chest trauma.

In one study, it was noted that the presence of chest trauma marked a severe injury going on and that chest trauma was associated with a high rate of death. The study looked at more than 1300 pediatric trauma patients over a 2 ½ year period. Of the total only 82 patients suffered a chest injury. Almost a quarter of those patients died, however. These patients had a high Injury Severity Score and many had a low Glasgow Coma Score, indicating trauma in other areas besides the chest. A large number of the patients had extrathoracic injuries and 29 percent of these patients died as opposed to only 4.3 percent deaths in patients who only had thoracic injuries. Having rib fractures or pneumothorax did not increase the rate of death unless the patient also had extrathoracic injuries.

The conclusion of the study was that the high rate of death from chest trauma was in fact due to the presence of multiple other injuries and the totality of the injuries that caused the fatalities. This brings the question of what to treat first when dealing with a multiply injured patient. Definitely the ABCs or airway, breathing, circulation needs to be followed; however, it may not need to be the lung trauma or chest trauma that is dealt with first so long as the patient is able to be breathed artificially or spontaneously. Areas of severe bleeding need immediate attention and injuries to the head and brain need to take precedence over the chest trauma.

Emergency situations related to chest trauma include situations of low oxygenation in the presence of adequate artificial or spontaneous respirations, hemopericardium, which needs immediate emptying of the pericardial sac and bilateral hemopneumothorax, in which there is blood and air outside the lung tissue.

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