Emergency department thoracotomy in children—a critical analysis

Steven S. Rothenberg, Ernest E. Moore, Frederick A. Moore, B. Timothy Baxter, John B. Moore, Henry C. Cleveland

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Recent clinical reviews have helped to clarify the role of Emergency Department (E.D.) thoracotomy in critically injured adults. However, guidelines in the pediatric population remain ill defined. The purpose of this report is to examine the yield of E.D. thoracotomy in patients ≤ 18 years of age to allow for a more cost-effective application of this heroic measure. From an 11-year experience of 689 consecutive E.D. thoracotomies, 83 patients (12%) were ≤18 years old. Mechanism of injury was blunt trauma in 57%, gunshot wound in 30%, and stab wound in 13%. Mean age was 15 years and 71% were male. Survival by injury mechanism was 9% (1/11) for stab wound, 4% (1/25) for gunshot wound, and 2% (1/47) for blunt trauma. Sixty-nine patients presented to the E.D. without vital signs and only one, a 16-year-old with stab wounds to the chest and abdomen, survived. In contrast, two (14%) among 14 patients presenting with vital signs were salvaged. As in adults, outcome was largely determined by injury mechanism and physiologic status on E.D. presentation. Blunt trauma, the predominant mechanism of lethal injuries in children, had a dismal outcome, with only 2% salvage and no survivors when vital signs were absent. This study demonstrates a similar outcome for E.D. thoracotomy in children compared to adults, and supports a selective policy of liberal use in penetrating injury irrespective of physiologic status but limited in those arriving lifeless following blunt trauma.

Original languageEnglish (US)
Pages (from-to)1322-1325
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume29
Issue number10
DOIs
StatePublished - Oct 1989

Fingerprint

Thoracotomy
Hospital Emergency Service
Wounds and Injuries
Stab Wounds
Vital Signs
Gunshot Wounds
Nonpenetrating Wounds
Abdomen
Survivors
Thorax
Guidelines
Pediatrics
Costs and Cost Analysis
Survival
Population

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Emergency department thoracotomy in children—a critical analysis. / Rothenberg, Steven S.; Moore, Ernest E.; Moore, Frederick A.; Timothy Baxter, B.; Moore, John B.; Cleveland, Henry C.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 29, No. 10, 10.1989, p. 1322-1325.

Research output: Contribution to journalArticle

Rothenberg, Steven S. ; Moore, Ernest E. ; Moore, Frederick A. ; Timothy Baxter, B. ; Moore, John B. ; Cleveland, Henry C. / Emergency department thoracotomy in children—a critical analysis. In: Journal of Trauma - Injury, Infection and Critical Care. 1989 ; Vol. 29, No. 10. pp. 1322-1325.
@article{9a24268ed1fd4613acb936a3bf58fb4b,
title = "Emergency department thoracotomy in children—a critical analysis",
abstract = "Recent clinical reviews have helped to clarify the role of Emergency Department (E.D.) thoracotomy in critically injured adults. However, guidelines in the pediatric population remain ill defined. The purpose of this report is to examine the yield of E.D. thoracotomy in patients ≤ 18 years of age to allow for a more cost-effective application of this heroic measure. From an 11-year experience of 689 consecutive E.D. thoracotomies, 83 patients (12{\%}) were ≤18 years old. Mechanism of injury was blunt trauma in 57{\%}, gunshot wound in 30{\%}, and stab wound in 13{\%}. Mean age was 15 years and 71{\%} were male. Survival by injury mechanism was 9{\%} (1/11) for stab wound, 4{\%} (1/25) for gunshot wound, and 2{\%} (1/47) for blunt trauma. Sixty-nine patients presented to the E.D. without vital signs and only one, a 16-year-old with stab wounds to the chest and abdomen, survived. In contrast, two (14{\%}) among 14 patients presenting with vital signs were salvaged. As in adults, outcome was largely determined by injury mechanism and physiologic status on E.D. presentation. Blunt trauma, the predominant mechanism of lethal injuries in children, had a dismal outcome, with only 2{\%} salvage and no survivors when vital signs were absent. This study demonstrates a similar outcome for E.D. thoracotomy in children compared to adults, and supports a selective policy of liberal use in penetrating injury irrespective of physiologic status but limited in those arriving lifeless following blunt trauma.",
author = "Rothenberg, {Steven S.} and Moore, {Ernest E.} and Moore, {Frederick A.} and {Timothy Baxter}, B. and Moore, {John B.} and Cleveland, {Henry C.}",
year = "1989",
month = "10",
doi = "10.1097/00005373-198910000-00004",
language = "English (US)",
volume = "29",
pages = "1322--1325",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Emergency department thoracotomy in children—a critical analysis

AU - Rothenberg, Steven S.

AU - Moore, Ernest E.

AU - Moore, Frederick A.

AU - Timothy Baxter, B.

AU - Moore, John B.

AU - Cleveland, Henry C.

PY - 1989/10

Y1 - 1989/10

N2 - Recent clinical reviews have helped to clarify the role of Emergency Department (E.D.) thoracotomy in critically injured adults. However, guidelines in the pediatric population remain ill defined. The purpose of this report is to examine the yield of E.D. thoracotomy in patients ≤ 18 years of age to allow for a more cost-effective application of this heroic measure. From an 11-year experience of 689 consecutive E.D. thoracotomies, 83 patients (12%) were ≤18 years old. Mechanism of injury was blunt trauma in 57%, gunshot wound in 30%, and stab wound in 13%. Mean age was 15 years and 71% were male. Survival by injury mechanism was 9% (1/11) for stab wound, 4% (1/25) for gunshot wound, and 2% (1/47) for blunt trauma. Sixty-nine patients presented to the E.D. without vital signs and only one, a 16-year-old with stab wounds to the chest and abdomen, survived. In contrast, two (14%) among 14 patients presenting with vital signs were salvaged. As in adults, outcome was largely determined by injury mechanism and physiologic status on E.D. presentation. Blunt trauma, the predominant mechanism of lethal injuries in children, had a dismal outcome, with only 2% salvage and no survivors when vital signs were absent. This study demonstrates a similar outcome for E.D. thoracotomy in children compared to adults, and supports a selective policy of liberal use in penetrating injury irrespective of physiologic status but limited in those arriving lifeless following blunt trauma.

AB - Recent clinical reviews have helped to clarify the role of Emergency Department (E.D.) thoracotomy in critically injured adults. However, guidelines in the pediatric population remain ill defined. The purpose of this report is to examine the yield of E.D. thoracotomy in patients ≤ 18 years of age to allow for a more cost-effective application of this heroic measure. From an 11-year experience of 689 consecutive E.D. thoracotomies, 83 patients (12%) were ≤18 years old. Mechanism of injury was blunt trauma in 57%, gunshot wound in 30%, and stab wound in 13%. Mean age was 15 years and 71% were male. Survival by injury mechanism was 9% (1/11) for stab wound, 4% (1/25) for gunshot wound, and 2% (1/47) for blunt trauma. Sixty-nine patients presented to the E.D. without vital signs and only one, a 16-year-old with stab wounds to the chest and abdomen, survived. In contrast, two (14%) among 14 patients presenting with vital signs were salvaged. As in adults, outcome was largely determined by injury mechanism and physiologic status on E.D. presentation. Blunt trauma, the predominant mechanism of lethal injuries in children, had a dismal outcome, with only 2% salvage and no survivors when vital signs were absent. This study demonstrates a similar outcome for E.D. thoracotomy in children compared to adults, and supports a selective policy of liberal use in penetrating injury irrespective of physiologic status but limited in those arriving lifeless following blunt trauma.

UR - http://www.scopus.com/inward/record.url?scp=0024465192&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0024465192&partnerID=8YFLogxK

U2 - 10.1097/00005373-198910000-00004

DO - 10.1097/00005373-198910000-00004

M3 - Article

C2 - 2810405

AN - SCOPUS:0024465192

VL - 29

SP - 1322

EP - 1325

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 10

ER -