Thoracostomy in children with severe trauma: An overview of the paediatric experience in Victoria, Australia

EMA - Emergency Medicine Australasia - Tập 32 Số 1 - Trang 117-126 - 2020
Nuala Quinn1,2,3, Cameron S. Palmer4,3, Stephen Bernard5,4,6, Michael Noonan7,8,9, Warwick J. Teague10,11,12,3
1Department of Emergency Medicine, Temple Street Children's University Hospital, Dublin, Ireland
2Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
3Trauma Service, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
4Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
5Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
6Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
7Alfred Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
8Central Clinical School, Monash University, Melbourne, Victoria, Australia
9National Trauma Research Institute, Melbourne, Victoria, Australia
10Department of Paediatric Surgery, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
11Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
12Surgical Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia

Tóm tắt

AbstractObjectiveThoracic trauma is a leading cause of paediatric trauma deaths. Traumatic cardiac arrest, tension pneumothorax and massive haemothorax are life‐threatening conditions requiring emergency and definitive pleural decompression. In adults, thoracostomy is increasingly preferred over needle thoracocentesis for emergency pleural decompression. The present study reports on the early experience of thoracostomy in children, to inform debate regarding the best approach for emergency pleural compression in paediatric trauma.MethodsRetrospective review of Ambulance Victoria and The Royal Children's Hospital Melbourne, Trauma Registry between August 2016 and February 2019 to identify children undergoing thoracostomy for trauma, either pre‐hospital or in the ED.ResultsFourteen children aged 1.2–15 years underwent 23 thoracostomy procedures over the 31 month period. The majority of patients sustained transport‐related injuries, and underwent thoracostomies for the primary indications of hypoxia and hypotension. Two children were in traumatic cardiac arrest. Ten children underwent needle thoracocentesis prior to thoracostomy, but all required thoracostomy to achieve the necessary definitive decompression. All patients were severely injured with multiple‐associated serious injuries and median Injury Severity Score 35.5 (17–75), three of whom died from their injuries. Thoracostomy in our cohort had a low complication rate.ConclusionIn severely injured children, thoracostomy is an effective and reliable method to achieve emergency pleural decompression, including in the young child. The technical challenges presented by children are real, but can be addressed by training to support a low complication rate. We recommend thoracostomy over needle thoracocentesis as the first‐line intervention in children with traumatic cardiac arrest, tension pneumothorax and massive haemothorax. [Correction added on 23 September 2019 after first online publication: in the second sentence of the conclusion, the words “under review process” were mistakenly added and have been removed.]

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EMA - Emergency Medicine Australasia

Tập 32 Số 1

117-126

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