Eur J Pediatr Surg 2014; 24(06): 508-513
DOI: 10.1055/s-0033-1354583
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Multiply Trauma in Children: Pulmonary Contusion does not Necessarily Lead to a Worsening of the Treatment Success

Jan Goedeke
1   Department of Pediatric Surgery, Ludwig-Maximilians-University, Munich, Germany
,
Roland Boehm
2   Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
,
Hans-Georg Dietz
1   Department of Pediatric Surgery, Ludwig-Maximilians-University, Munich, Germany
› Author Affiliations
Further Information

Publication History

02 April 2013

16 July 2013

Publication Date:
02 September 2013 (online)

Abstract

Aim The aim of the study is to evaluate the impact of pulmonary contusion on the overall outcome in children with multiply injury.

Patients and Methods Retrospective review of 123 multiply injured children during a 10-year period (January 2000 to February 2010) who were admitted to the intensive care unit of a university affiliated, tertiary care pediatric trauma center. The diagnosis of pulmonary contusion (case group) was defined by the clinical context and the results of chest X-ray and blood gas analysis. Data were compared with a matched control group without the diagnosis of pulmonary contusion. Matching criteria were as follows: (1) age difference within 2 years; (2) sex; (3) similar injury pattern; (4) Pediatric Trauma Score (PTS) difference within 2 points; (5) Glasgow Coma Score (GCS) in two categories.

Results The risk of pulmonary contusion must not be underestimated in multiply injured children. In our study, 49 of 123 patients (40%) showed signs of pulmonary contusion. A matched and pair analysis was performed in 46 patients (94%). Pulmonary contusion had an impact on the Pao2/ FIo2 ratio. It was significantly reduced in patients and caused insignificant extension of the ventilation time. Overall length of stay (LOS), LOS at pediatric intensive care unit, complication rate, mortality rate, and short-term outcome did not differ significantly between cases and controls.

Conclusions Pulmonary contusion alters gas exchange but does not appear to increase morbidity and mortality of pediatric patients with multiply injury. Interpretation may be limited by sample size.

 
  • References

  • 1 Dietz HG. Prinzipien der pädiatrischen traumatologie. 1st ed. In: von Schweinitz D, Ure B, , eds. Kinderchirurgie: Viszerale und allgemeine Chirurgie des Kindesalters. Berlin, Germany: Springer-Verlag; 2009: 145-147
  • 2 Schmittenbecher PP. C.S., Polytrauma in Children. 3rd ed. In: Benson M, Fixen J, Macnicol M, Parsch K, eds. Children's Orthopaedics and Fractures. London: Springer-Verlag; 2009: 671-686
  • 3 Peclet MH, Newman KD, Eichelberger MR , et al. Patterns of injury in children. J Pediatr Surg 1990; 25 (1) 85-90 , discussion 90–91
  • 4 Bliss D, Silen M. Pediatric thoracic trauma. Crit Care Med 2002; 30 (11, Suppl): S409-S415
  • 5 Dykes EH. Paediatric trauma. Br J Anaesth 1999; 83 (1) 130-138
  • 6 UNICEF; A league table of child deaths by injury in rich nations, Innocenti Report Card, No.2. Florence, Italy: UNICEF; 2001
  • 7 Sartorelli KH, Vane DW. The diagnosis and management of children with blunt injury of the chest. Semin Pediatr Surg 2004; 13 (2) 98-105
  • 8 Black TL, Snyder CL, Miller JP, Mann Jr CM, Copetas AC, Ellis DG. Significance of chest trauma in children. South Med J 1996; 89 (5) 494-496
  • 9 Tovar JA. The lung and pediatric trauma. Semin Pediatr Surg 2008; 17 (1) 53-59
  • 10 Nicolai T , ed. Pädiatrische Notfall- und Intensivmedizin. 4th ed. Heidelberg, Germany: Springer-Verlag; 2012: 275-291
  • 11 Newman KD, Eichelberger MR. The child with thoracic trauma. In: Fallis J, Filler R, Lemoine G, , ed. Pediatric Thoracic Surgery. Elsevier Science Publishing Co.: New York; 1991: 277-285
  • 12 Hamrick MC, Duhn RD, Ochsner MG. Critical evaluation of pulmonary contusion in the early post-traumatic period: risk of assisted ventilation. Am Surg 2009; 75 (11) 1054-1058
  • 13 Strumwasser A, Chu E, Yeung L, Miraflor E, Sadjadi J, Victorino GP. A novel CT volume index score correlates with outcomes in polytrauma patients with pulmonary contusion. J Surg Res 2011; 170 (2) 280-285
  • 14 Hamrick MC, Duhn RD, Carney DE, Boswell WC, Ochsner MG. Pulmonary contusion in the pediatric population. Am Surg 2010; 76 (7) 721-724
  • 15 Horovitz JH, Carrico CJ, Shires GT. Pulmonary response to major injury. Arch Surg 1974; 108 (3) 349-355
  • 16 Samarasekera SP, Mikocka-Walus A, Butt W, Cameron P. Epidemiology of major paediatric chest trauma. J Paediatr Child Health 2009; 45 (11) 676-680
  • 17 Cohn SM. Pulmonary contusion: review of the clinical entity. J Trauma 1997; 42 (5) 973-979
  • 18 Haxhija EQ, Nöres H, Schober P, Höllwarth ME. Lung contusion-lacerations after blunt thoracic trauma in children. Pediatr Surg Int 2004; 20 (6) 412-414
  • 19 Schalamon J, , v Bismarck S, Schober PH, Höllwarth ME. Multiple trauma in pediatric patients. Pediatr Surg Int 2003; 19 (6) 417-423
  • 20 Letts M, Davidson D, Lapner P. Multiple trauma in children: predicting outcome and long-term results. Can J Surg 2002; 45 (2) 126-131
  • 21 Albanese J, Leone M, Martin C. Severe head injury in patients with multiple trauma. In: Vincent JL, , ed. Yearboook of intensive care and emergency medicine. Berlin, Germany: Springer-Verlag; 2001: 353-375
  • 22 Jones PA, Andrews PJ, Midgley S , et al. Measuring the burden of secondary insults in head-injured patients during intensive care. J Neurosurg Anesthesiol 1994; 6 (1) 4-14
  • 23 Chesnut RM, Marshall LF, Klauber MR , et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma 1993; 34 (2) 216-222
  • 24 Pfenninger EG, Lindner KH. Arterial blood gases in patients with acute head injury at the accident site and upon hospital admission. Acta Anaesthesiol Scand 1991; 35 (2) 148-152
  • 25 Kwon A, Sorrells Jr DL, Kurkchubasche AG, Cassese JA, Tracy Jr TF, Luks FI. Isolated computed tomography diagnosis of pulmonary contusion does not correlate with increased morbidity. J Pediatr Surg 2006; 41 (1) 78-82 , discussion 78–82
  • 26 Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma 2000; 49 (3) 496-504