Nicolson NG, Schwulst S, Esposito TA, Crandall ML. Am. J. Surg. 2015; 210(4): 720-723.
Affiliation
Division of Trauma and Critical Care, Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Suite 650, Chicago, IL 60611, USA.
BACKGROUND: Outcomes in adults who undergo resuscitative thoracotomy are poor. Few studies have examined the procedure's use in pediatric trauma.
METHODS: The Illinois State Trauma Registry was queried for thoracotomy performed in the emergency department from 1999 to 2009, for patients aged 0 to 15. Injury mechanism, vital signs, and mortality were examined while controlling for injury severity.
RESULTS: Resuscitative thoracotomy was infrequently performed in pediatric trauma (n = 25; 2.3/year). Most patients had suffered penetrating injury. Patients who underwent resuscitative thoracotomy were in extremis, with only 17% demonstrating signs of life upon presentation. Although 6 patients (24%) survived initially, only 2 (8%) survived to hospital discharge.
CONCLUSIONS: Resuscitative thoracotomy was rarely performed in children in Illinois emergency departments. Survival is low for thoracotomy in the emergency department, but some patients who presented with penetrating injuries did have positive outcomes, supporting a continued role for the procedure in select cases.