In this section
Significant chest injury is
rare in paediatric trauma. Most cases
occur secondary to blunt chest trauma, with penetrating injuries accounting for
less than 10% or the total reported incidence worldwide.
Over a 5 year period to 2007
there were 204 cases of severe paediatric thoracic trauma in Victoria1. The most common injuries identified were
lung contusion (65%) and haemo/pneumothorax (37%). Blunt trauma accounted for 96% of injuries
and 75% were secondary to motor vehicle accidents (including pedestrian vs motor vehicle). Due to this frequent association
with motor vehicle accidents (MVAs) patients with chest trauma usually have concomitant injuries to other
major systems, most commonly the head and abdomen. In the above study 99% of patients had an
injury to one of more other body regions.
This underscores the high level of force involved in most paediatric
Mortality in children with
chest trauma has been quoted to be as high as 30% although death is not always
related directly to the chest injury. Death usually occurs soon
after the injury in a child, whereas an adult with comparable injuries tends to
In all aspects of trauma
management, the primary survey is first
The purpose of the primary
survey is to identify and manage life threats. The particular thoracic
injuries that are necessary to identify during the primary survey include:
In these injuries frequent
reassessment of ABC is a necessary part of their assessment & management
(see also Management of Traumatic Pneumothorax and Haemothorax)
Figure 1 - surface marking for left sided finger thoracostomy and intercostal catheter insertion
Figure 2 – surface marking for needle
Figure 3 – needle thoracocentesis insertion
There is a 10-20% chance of causing a
pneumothorax if thoracocentesis is attempted in the absence of a pre-existing
pneumothorax. This procedure must be
followed up by a chest x-ray and insertion of an intercostal catheter.
Figure 4 - A 3 sided occlusive dressing
Figure 5 – Flail chest with pulmonary
There is limited evidence for the role of an ED thoracotomy in the paediatric population who have sustained a blunt injury, it should be considered in the event of penetrating trauma
suspected on plain radiography further investigation is required – CT chest,
aortogram or trans-oesophageal echocardiogram.
Figure 6 - diagphragmatic rupture, unable to visualise left diaphragm
Figure 7 - diagphragmatic injury, nasogastric tip visible in left hemithorax
Figure 8 - diaphragmatic injury, contrast within stomach visible in left hemithorax
Contrast study or CT will give definitive diagnosis.