Araştırma Makalesi
The Effect of Quantifying Pulmonary Contusion Extent on The Treatment Management of Blunt Chest Trauma in Children
Öz
Objective: Post-traumatic pulmonary contusion in children is often asymptomatic at diagnosis and has a good prognosis. The aim of this study was to investigate the clinical significance of the extent of post-traumatic pulmonary contusions and evaluate the timing of complications to determine the safe follow-up period in children with lung contusions. Methods: The study included pediatric patients who presented to the emergency department after blunt chest trauma and had pulmonary contusion detected on chest computed tomography (CT) between January 2017 and January 2020. Based on the percentage of total lung capacity occupied on thorax CT, pulmonary contusions were classified as grade 1: <19% (mild), grade 2: 19%-27% (moderate) and grade 3: ≥28% (severe). The relationship between pulmonary contusion grade and pulmonary functional status; complications and intensive care admission was examined and the mean time to complication development was determined. Results: The mean extent of pulmonary contusion after trauma was 17.8±8.6% (min-max, 5-100%) and mild (grade 1) contusion was significantly associated with spontaneous breathing (p=0.009). Contusion grade was not associated with the development of atelectasis, pneumonia, pleural effusion, pneumothorax (p=0.719) or intensive care admission (p=0.176). The mean time to detection of complications (atelectasis, pneumonia, pleural effusion, pneumothorax) on chest X-ray was 6.33±3.78 days (range, 2-9 days). Conclusion: The results suggest that although no statistically significance between the extent of pulmonary contusion and complications, patients should be hospitalized for at least 48 hours, then followed-up with chest X-ray for 1 week due to possible complications after blunt chest trauma in children.
Anahtar Kelimeler
Destekleyen Kurum
non
Kaynakça
- 1) Pearson EG, Fitzgerald CA, Santore MT. Pediatric Thoracic Trauma: Current Trents. Semin Pediatr Surg. 2017; 26: 36-42. DOI:10.1053/j.sempedsurg.2017.01.007
- 2) Holmes JF, Sokolove PE, Brant WE, et al. A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma. Ann Emerg Med. 2002;39:492–9. DOI:10.1067/mem.2002.122901
- 3) Allen GS, Cox CS. Pulmonary contusion in children: Diagnosis and management, South Med J. 1998;91:1099-106. DOI:10.1097/00007611-199812000-00002
- 4) Yanchar NL, Woo K, Brennan M, et al. Chest x-ray as a screening tool for blunt thoracic trauma in children. J Trauma Acute Care Surg. 2013;75:613–9. DOI:10.1097/TA.0b013e31829bb7fe
- 5) Juan AT. The lung and Pediatric Trauma. Semin PediatrSurg. 2008;17:53-9. DOI:10.1053/j.sempedsurg.2007.10.008
- 6) Allen GS, Coates NE. Pulmonary contusion: A collective review. Am Surg. 1996;62:895-900.
- 7) Bakowitz M, Bruns B, McCunn M. Acute lung injury and the acute respiratory distress syndrome in the injured patient. Scand J Trauma Resusc Emerg Med. 2012;20:54. DOI:10.1186/1757-7241-20-54
- 8) Miller PR, Croce MA, Bee TK, et al. ARDS after pulmonary contusion: accurate measurement of contusion volume ıdentifies high-risk patients. J Trauma. 2001;51:223–30. DOI:10.1097/00005373-200108000-00003
- 9) Bliss D, Silen M. Pediatric thoracic trauma. Crit Care Med. 2002;30:409–15. DOI: 10.1097/00003246-200211001-00005
- 10) Nakayama DK, Ramenofsky ML, Rowe MI. Chest injuries in childhood. Ann Surg. 1989;210:770-5. DOI: 10.1097/00000658-198912000-00013
- 11) Wagner RB, Jamieson PM. Pulmonary contusion. Evaluation and classification by computed tomography. Surg Clin North Am. 1989;69:31-40. DOI:10.1016/s0039-6109(16)44732-8
- 12) Cohn SM. Pulmonary contusion: review of the clinical entity. J Trauma. 1997;42:973-9. DOI:10.1097/00005373-199705000-00033
- 13) Richardson JD, Adams L, Flint LM. Selective management of flail chest and pulmonary contusion. Ann Surg. 1982;1968:481-7. DOI:10.1097/00000658-198210000-00012
- 14) Deunk J, Poels TC, Brink M, et al. The clinical outcome of occult pulmonary contusion on multidetector-row computed tomography in blunt trauma patients. J Trauma. 2010;68:387-94. DOI:10.1097/TA.0b013e3181a7bdbd
- 15) Raghavendran K, Davidson BA, Helinski JD, et al. A rat model for isolated bilateral lung contusion from blunt chest trauma. Anesth Analg. 2005;101:1482-9. DOI:10.1213/01.ANE.0000180201.25746.1F
- 16) Oppenheimer L, Craven KD, Forkert L, et al. Pathophysiology of pulmonary contusion in dogs. J Appl Physiol Respir Environ Exerc Physiol. 1979;47:718-28. DOI:10.1152/jappl.1979.47.4.718
- 17) Beshay M, Mertzlufft F, Kottkamp HW, et al. Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study. World Journal of Emergency Surgery. 2020;15:45. DOI: 10.1186/s13017-020-00324-1
- 18) Tepas JJ 3rd, Ramenofsky ML, Mollitt DL, et al. The Pediatric Trauma Score as a predictor of injury severity: an objective assessment. J Trauma. 1988;28:425-9. DOI:10.1097/00005373-198804000-00001
- 19) Nair AB, Cohen MJ, Flori HR. Clinical Characteristics, Major Morbidity, and Mortality in Trauma-Related Pediatric Acute Respiratory Distress Syndrome. Pediatr Crit Care Med. 2020;21:122-8. DOI:10.1097/PCC.0000000000002175
- 20) Hildebrand F, van Griensven M, Garapati R, et al. Diagnostics and Scoring in Blunt Chest Trauma. Eur J Trauma. 2002;28:157–67. DOI: 10.1007/s00068-002-1192-1
- 21) Marts B, Durham R, Shapiro M, et al. Computed tomography in the diagnosis of blunt thoracic injury. Am J Surg. 1994;168:688-92. DOI:10.1016/s0002-9610(05)80146-1
Yıl 2021,
Cilt: 12 Sayı: 4, 714 - 719, 29.09.2021
Öz
Kaynakça
- 1) Pearson EG, Fitzgerald CA, Santore MT. Pediatric Thoracic Trauma: Current Trents. Semin Pediatr Surg. 2017; 26: 36-42. DOI:10.1053/j.sempedsurg.2017.01.007
- 2) Holmes JF, Sokolove PE, Brant WE, et al. A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma. Ann Emerg Med. 2002;39:492–9. DOI:10.1067/mem.2002.122901
- 3) Allen GS, Cox CS. Pulmonary contusion in children: Diagnosis and management, South Med J. 1998;91:1099-106. DOI:10.1097/00007611-199812000-00002
- 4) Yanchar NL, Woo K, Brennan M, et al. Chest x-ray as a screening tool for blunt thoracic trauma in children. J Trauma Acute Care Surg. 2013;75:613–9. DOI:10.1097/TA.0b013e31829bb7fe
- 5) Juan AT. The lung and Pediatric Trauma. Semin PediatrSurg. 2008;17:53-9. DOI:10.1053/j.sempedsurg.2007.10.008
- 6) Allen GS, Coates NE. Pulmonary contusion: A collective review. Am Surg. 1996;62:895-900.
- 7) Bakowitz M, Bruns B, McCunn M. Acute lung injury and the acute respiratory distress syndrome in the injured patient. Scand J Trauma Resusc Emerg Med. 2012;20:54. DOI:10.1186/1757-7241-20-54
- 8) Miller PR, Croce MA, Bee TK, et al. ARDS after pulmonary contusion: accurate measurement of contusion volume ıdentifies high-risk patients. J Trauma. 2001;51:223–30. DOI:10.1097/00005373-200108000-00003
- 9) Bliss D, Silen M. Pediatric thoracic trauma. Crit Care Med. 2002;30:409–15. DOI: 10.1097/00003246-200211001-00005
- 10) Nakayama DK, Ramenofsky ML, Rowe MI. Chest injuries in childhood. Ann Surg. 1989;210:770-5. DOI: 10.1097/00000658-198912000-00013
- 11) Wagner RB, Jamieson PM. Pulmonary contusion. Evaluation and classification by computed tomography. Surg Clin North Am. 1989;69:31-40. DOI:10.1016/s0039-6109(16)44732-8
- 12) Cohn SM. Pulmonary contusion: review of the clinical entity. J Trauma. 1997;42:973-9. DOI:10.1097/00005373-199705000-00033
- 13) Richardson JD, Adams L, Flint LM. Selective management of flail chest and pulmonary contusion. Ann Surg. 1982;1968:481-7. DOI:10.1097/00000658-198210000-00012
- 14) Deunk J, Poels TC, Brink M, et al. The clinical outcome of occult pulmonary contusion on multidetector-row computed tomography in blunt trauma patients. J Trauma. 2010;68:387-94. DOI:10.1097/TA.0b013e3181a7bdbd
- 15) Raghavendran K, Davidson BA, Helinski JD, et al. A rat model for isolated bilateral lung contusion from blunt chest trauma. Anesth Analg. 2005;101:1482-9. DOI:10.1213/01.ANE.0000180201.25746.1F
- 16) Oppenheimer L, Craven KD, Forkert L, et al. Pathophysiology of pulmonary contusion in dogs. J Appl Physiol Respir Environ Exerc Physiol. 1979;47:718-28. DOI:10.1152/jappl.1979.47.4.718
- 17) Beshay M, Mertzlufft F, Kottkamp HW, et al. Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study. World Journal of Emergency Surgery. 2020;15:45. DOI: 10.1186/s13017-020-00324-1
- 18) Tepas JJ 3rd, Ramenofsky ML, Mollitt DL, et al. The Pediatric Trauma Score as a predictor of injury severity: an objective assessment. J Trauma. 1988;28:425-9. DOI:10.1097/00005373-198804000-00001
- 19) Nair AB, Cohen MJ, Flori HR. Clinical Characteristics, Major Morbidity, and Mortality in Trauma-Related Pediatric Acute Respiratory Distress Syndrome. Pediatr Crit Care Med. 2020;21:122-8. DOI:10.1097/PCC.0000000000002175
- 20) Hildebrand F, van Griensven M, Garapati R, et al. Diagnostics and Scoring in Blunt Chest Trauma. Eur J Trauma. 2002;28:157–67. DOI: 10.1007/s00068-002-1192-1
- 21) Marts B, Durham R, Shapiro M, et al. Computed tomography in the diagnosis of blunt thoracic injury. Am J Surg. 1994;168:688-92. DOI:10.1016/s0002-9610(05)80146-1
Toplam 21 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Cerrahi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Eylül 2021 |
| Gönderilme Tarihi | 30 Haziran 2021 |
| Yayımlandığı Sayı | Yıl 2021Cilt: 12 Sayı: 4 |
