Yıl: 2022 Cilt: 28 Sayı: 7 Sayfa Aralığı: 933 - 939 Metin Dili: İngilizce DOI: 10.14744/tjtes.2021.48961 İndeks Tarihi: 31-10-2022

Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries

Öz:
BACKGROUND: Thoracoabdominal injuries (TAI) are an important cause of trauma-related morbidity in children. Early and correct intervention is essential to reduce mortality. We aimed to determine factors associated with mortality and the need for intensive care in TAI. METHODS: The children admitted to the pediatric emergency department of a tertiary care hospital with TAI in a 6-year-period were enrolled. Demographic data; mechanism of injuries; clinical, laboratory and imaging findings; length of hospital and intensive care unit (ICU) stay; invasive procedures and medical treatments; surgical interventions; and survival outcomes were recorded. RESULTS: The median age of the 136 children was 9 (IQR: 5–14) years and 72.8% were male. The vast majority of injuries were caused by blunt trauma (92.7%). Pulmonary contusion, pneumothorax, splenic, and liver injuries were the most common diagnoses. Motor vehicle accidents were seen in more than half of the cases (52.2%). The median length of hospital stay was 5 (IQR: 2–8) days; 21 patients were hospitalized in the ICU (15.4%). The need for intensive care was higher in patients with lower Glasgow Coma Scale (GCS) scores and lower Pediatric Trauma Scores (PTSs), in the presence of multiple injuries, pulmonary contusion, and pneumothorax (p<0.001). Mortality was seen in nine patients, eight of whom had multiple injuries. The mortality rate was higher in patients with pulmonary contusion and pneumothorax (p=0.002 and p=0.003, respectively). The PTS and GCS were found to be lower in patients who died in hospital (p<0.001). Prolongation of coagulation parameters and hyperglycemia was more common in the non-survivor group (p=0.005 and p=0.004, respectively). CONCLUSION: Although thoracoabdominal trauma is not common in childhood, it is an important part of trauma-associated mortality. Multiple injuries, pulmonary contusion, pneumothorax, lower GCS, and PTSs can be a sign of serious injuries to which physicians must be alert.
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Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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  • 1. Wessen DE, Stylianos S, Pearl RH. Thoracic injuries, abdominal trauma. In: Grosfeld JL, O’neill JA, editors. Pediatric Surgery. 6th ed. Philadelpia, PA: Mosby Inc.; 2006. p. 275–316.
  • 2. Patterson GA, Cooper JD. Deslauriers J, Lerut AE, Luketich JD, Rice TW, editors. Pearson’s Thoracic and Esophageal Surgery. 3rd ed. Philadelphia, PA: Churchill Livingstone; 2008. p. 1719–68.
  • 3. Lynch T, Kilgar J, Al Shibli A. Pediatric abdominal trauma. Curr Pediatr Rev 2018;14:59–63.
  • 4. Tovar JA, Vazquez JJ. Management of chest trauma in children. Paediatr Respir Rev 2013;14:86–91.
  • 5. Reynolds SL. Pediatric thoracic trauma: Recognition and management. Emerg Med Clin North Am 2018;36:473–83.
  • 6. Adelgais KM, Kuppermann N, Kooistra J, Garcia M, Monroe DJ, Maha jan P, et al. Accuracy of the abdominal examination for identifying chil dren with blunt intra-abdominal injuries. J Pediatr 2014;165:1230–5.e5.
  • 7. Stein SC, Hurst RW, Sonnad SS. Meta-analysis of cranial CT scans in children. A mathematical model to predict radiation-induced tumors. Pe diatr Neurosurg 2008;44:448–57.
  • 8. Lecuyer M. Calculated decisions: Pediatric trauma score (PTS). Pediatr Emerg Med Pract 2019;16:3–4.
  • 9. Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, et al. Pediatric advanced life support: 2010 American heart association guidelines for cardiopulmonary resuscitation and emer gency cardiovascular care. Pediatrics 2010;126:1361–99.
  • 10. Naqvi G, Johansson G, Yip G, Rehm A, Carrothers A, Stohr K. Mech anisms, patterns and outcomes of paediatric polytrauma in a UK major trauma centre. Ann R Coll Surg Engl 2017;99:39–45.
  • 11. Holmes JF, Sokolove PE, Brant WE, Kuppermann N. A clinical deci sion rule for identifying children with thoracic injuries after blunt torso trauma. Ann Emerg Med 2002;39:492–9.
  • 12. Tracy ET, Englum BR, Barbas AS, Foley C, Rice HE, Shapiro ML. Pedi atric injury patterns by year of age. J Pediatr Surg 2013;48:1384–8.
  • 13. Gittelman MA, Gonzalez-del-Rey J, Brody AS, DiGiulio GA. Clinical predictors for the selective use of chest radiographs in pediatric blunt trauma evaluations. J Trauma 2003;55:670–6.
  • 14. Weerdenburg KD, Wales PW, Stephens D, Beno S, Gantz J, Alsop J, et al. Predicting thoracic injury in children with multitrauma. Pediatr Emerg Care 2019;35:330–4.
  • 15. Drexel S, Azarow K, Jafri MA. Abdominal trauma evaluation for the pe diatric surgeon. Surg Clin North Am 2017;97:59–74.
  • 16. Arbra CA, Vogel AM, Zhang J, Mauldin PD, Huang EY, Savoie KB, et al. Acute procedural interventions after pediatric blunt abdominal trauma: A prospective multicenter evaluation. J Trauma Acute Care Surg 2017;83:597–602.
  • 17. Drucker NA, McDuffie L, Groh E, Hackworth J, Bell TM, Markel TA. Physical examination is the best predictor of the need for abdom inal surgery in children following motor vehicle collision. J Emerg Med 2018;54:1–7.
  • 18. Van As AB, Millar AJ. Management of paediatric liver trauma. Pediatr Surg Int 2017;33:445–3.
  • 19. Wisner DH, Kuppermann N, Cooper A, Menaker J, Ehrlich P, Kooistra J, et al. Management of children with solid organ injuries after blunt torso trauma. J Trauma Acute Care Surg 2015;79:206–14.
  • 20. Tepas JJ, Ramenofsky ML, Mollitt DL, Gans BM, DiScala C. The pedi atric trauma score as a predictor of injury severity: An objective assess ment. J Trauma 1988;28:425–9.
  • 21. Anil M, Saritas S, Bicilioglu Y, Gokalp G, Can FK, Anil AB. The perfor mance of the pediatric trauma score in a pediatric emergency department: A prospective study. J Pediatr Emerg Intensive Care Med 2017;4:1–7.
  • 22. Strumwasser A, Speer AL, Inaba K, Branco BC, Upperman JS, Ford HR, et al. The impact of acute coagulopathy on mortality in pediatric trauma patients. J Trauma Acute Care Surg 2016;81:312–8.
  • 23. Reed CR, Williamson H, Vatsaas C, Kamyszek R, Leraas HJ, Ray C, et al. Higher mortality in pediatric and adult trauma patients with traumatic coagulopathy, using age-adjusted diagnostic criteria. Surgery 2019;165:1108–15.
  • 24. Fu YQ, Chong SL, Lee JH, Liu CJ, Fu S, Loh TF, et al. The impact of early hyperglycaemia on children with traumatic brain injury. Brain Inj 2017;31:396–400.
  • 25. Elkon B, Cambrin JR, Hirshberg E, Bratton SL. Hyperglycemia: An in dependent risk factor for poor outcome in children with traumatic brain injury. Pediatr Crit Care Med 2014;15:623–31.
  • 26. Su WT, Wu SC, Chou SE, Huang CY, Hsu SY, Liu HT, et al. Higher mortality rate in moderate-to-severe thoracoabdominal injury patients with admission hyperglycemia than nondiabetic normoglycemic patients. Int J Environ Res Public Health 2019;16:3562.
  • 27. Santucci CA, Purcell TB, Mejia C. Leukocytosis as a predictor of severe injury in blunt trauma. West J Emerg Med 2008;9:81–5.
  • 28. Akkose S, Bulut M, Armagan E, Balci V, Yolgosteren A, Ozguc H. Does the leukocyte count correlate with the severity of injury? Turk J Trauma Emerg Surgery 2003;9:111–3.
  • 29. Rovlias A, Kotsou S. The blood leukocyte count and its prognostic signif icance in severe head injury. Surg Neurol 2001;55:190–6.
  • 30. Holmes JF, Lillis K, Monroe D, Borgialli D, Kerrey BT, Mahajan P, et al. Identifying children at very low risk of clinically important blunt abdom inal injuries. Ann Emerg Med 2013;62:107–6.e2.
APA Akgül F, Er A, Çağlar A, ulusoy e, Çitlenbik H, Duman M, YILMAZ D (2022). Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries. , 933 - 939. 10.14744/tjtes.2021.48961
Chicago Akgül Fatma,Er Anıl,Çağlar Aykut,ulusoy emel,Çitlenbik Hale,Duman Murat,YILMAZ DURGÜL Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries. (2022): 933 - 939. 10.14744/tjtes.2021.48961
MLA Akgül Fatma,Er Anıl,Çağlar Aykut,ulusoy emel,Çitlenbik Hale,Duman Murat,YILMAZ DURGÜL Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries. , 2022, ss.933 - 939. 10.14744/tjtes.2021.48961
AMA Akgül F,Er A,Çağlar A,ulusoy e,Çitlenbik H,Duman M,YILMAZ D Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries. . 2022; 933 - 939. 10.14744/tjtes.2021.48961
Vancouver Akgül F,Er A,Çağlar A,ulusoy e,Çitlenbik H,Duman M,YILMAZ D Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries. . 2022; 933 - 939. 10.14744/tjtes.2021.48961
IEEE Akgül F,Er A,Çağlar A,ulusoy e,Çitlenbik H,Duman M,YILMAZ D "Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries." , ss.933 - 939, 2022. 10.14744/tjtes.2021.48961
ISNAD Akgül, Fatma vd. "Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries". (2022), 933-939. https://doi.org/10.14744/tjtes.2021.48961
APA Akgül F, Er A, Çağlar A, ulusoy e, Çitlenbik H, Duman M, YILMAZ D (2022). Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries. Ulusal Travma ve Acil Cerrahi Dergisi, 28(7), 933 - 939. 10.14744/tjtes.2021.48961
Chicago Akgül Fatma,Er Anıl,Çağlar Aykut,ulusoy emel,Çitlenbik Hale,Duman Murat,YILMAZ DURGÜL Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries. Ulusal Travma ve Acil Cerrahi Dergisi 28, no.7 (2022): 933 - 939. 10.14744/tjtes.2021.48961
MLA Akgül Fatma,Er Anıl,Çağlar Aykut,ulusoy emel,Çitlenbik Hale,Duman Murat,YILMAZ DURGÜL Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries. Ulusal Travma ve Acil Cerrahi Dergisi, vol.28, no.7, 2022, ss.933 - 939. 10.14744/tjtes.2021.48961
AMA Akgül F,Er A,Çağlar A,ulusoy e,Çitlenbik H,Duman M,YILMAZ D Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries. Ulusal Travma ve Acil Cerrahi Dergisi. 2022; 28(7): 933 - 939. 10.14744/tjtes.2021.48961
Vancouver Akgül F,Er A,Çağlar A,ulusoy e,Çitlenbik H,Duman M,YILMAZ D Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries. Ulusal Travma ve Acil Cerrahi Dergisi. 2022; 28(7): 933 - 939. 10.14744/tjtes.2021.48961
IEEE Akgül F,Er A,Çağlar A,ulusoy e,Çitlenbik H,Duman M,YILMAZ D "Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries." Ulusal Travma ve Acil Cerrahi Dergisi, 28, ss.933 - 939, 2022. 10.14744/tjtes.2021.48961
ISNAD Akgül, Fatma vd. "Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries". Ulusal Travma ve Acil Cerrahi Dergisi 28/7 (2022), 933-939. https://doi.org/10.14744/tjtes.2021.48961