Characteristics of pediatric trauma in an urban city in Japan

The management and outcome of pediatric blunt chest-abdominal injuries

BACKGROUND

The aim of this study was to determine the frequency and nature of pediatric blunt chest-abdominal injuries (BCAIs) and to summarize their management, ranging from non-operative management (NOM), with or without angioembolization (AE), to surgical treatment.

METHODS

This retrospective study included patients admitted to our hospital for BCAIs from January 1996 to December 2017. The age, injury pattern, organs of injury, outcome, and treatment were summarized.

RESULTS

One hundred and thirty-two patients (98 males, 34 females, mean age 7.68 years ± 3.58, range 1-15 years) were included in the study. Their injuries resulted from motor-vehicle traffic incidents (n = 60), single-bicycle injuries (n = 16), falls (n = 33), sports (n = 10), assault (n = 6), abuse (n = 3), and others (n = 4). There were no injured organs in 31 cases, while there were 130 injured organs in 101 cases, including the liver (n = 42), spleen (n = 35), lung (n = 23), kidney (n = 13), intestine (n = 10), pancreas (n = 5), and adrenal gland (n = 2). Angiography (AG) was performed in 20 cases, and NOM with AE was performed in 16 cases, including 17 organs (liver injury [n = 9], splenic injury [n = 5], and kidney injury [n = 4]). Surgical treatment was performed in eight cases (splenic injury in one, pancreas injury in one, and intestinal injury in six). NOM without AE was performed in the other cases.

CONCLUSIONS

The management of organ injury must take into consideration the management of integrated bleeding. It is recommended that children with severe organ injury are treated in dedicated trauma centers in which AE is available.

Studying patients of severe traumatic brain injury with severe abdominal injury in Japan

Background:

Characteristics of extracranial injury in patients with diffuse axonal injury (DAI) have not been clarified.

Materials and Methods:

This retrospective study reviewed medical records from January 2003 to December 2007. Subjects comprised 35 patients meeting the following criteria: 1) head injury without mass lesion; 2) Glasgow coma scale (GCS) on arrival <15; and 3) magnetic resonance imaging (MRI) examination including T2*-weighted imaging. Subjects were divided into two groups: severe traumatic brain injury (TBI) group (patients with GCS ≤8, n=19) and moderate TBI group (patients with GCS >8, n=16).

Results:

Shock index (heart rate/systolic blood pressure) was significantly higher in the severe TBI group than in the moderate TBI group, while base excess on arrival was significantly lower in the severe TBI group than in the moderate TBI group. The abbreviated injury scale (AIS) for the face, thorax, extremities and external structures showed no significant differences between the severe TBI group, but AIS for the abdomen and the sum of extracranial AIS was greater in the severe TBI group than in the moderate TBI group. Duration of hospitalization was longer and outcomes were worse in the severe TBI group than in the moderate TBI group.

Conclusion:

Because patients with severe TBI are more likely to have abdominal injury than patients with moderate TBI, physicians should be aware of the potential for such complications when treating severe TBI.

A case of thoracic degloving injury with flail chest

A 75-year-old male patient suffered a chest degloving injury when he fell on his back and was run over by a small farm tractor he was pulling. At the time of patient admission, the paradoxical motion of the right chest wall was remarkable; and he had an open fracture of the right humerus, a dislocation of the right ankle, and a laceration of the right forearm. Chest computed tomography revealed fractures of the fifth to seventh ribs and detachment of both the right pectoralis major muscle and serratus anterior muscle from the chest wall, with a disconnected right thoracic cavity. Because the right flail chest was severe and there was a large amount of air leakage that continued under positive-pressure ventilation for pneumatic stabilization, we performed surgical fixation of the ribs and repaired the lung injury on the fifth hospital day. The patient's postoperative course was uneventful.