| Title | A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma. | | Author(s) | Holmes JF, Sokolove PE, Brant WE, Kuppermann N | | Institution | Division of Emergency Medicine, Department of Internal Medicine, University of California-Davis School of Medicine, Sacramento, CA 95817-2282, USA. jfholmes@ucdavis.edu | | Source | Ann Emerg Med 2002 May; 39(5):492-9. | | MeSH | Accidental Falls
Accidents, Traffic
Adolescent
Age Factors
Child
Child, Preschool
Comparative Study
Confidence Intervals
Contusions
Diagnosis, Differential
Emergencies
Enzyme Tests
Glasgow Coma Scale
Hemothorax
Humans
Infant
Infant, Newborn
Logistic Models
Lung
Mediastinal Emphysema
Odds Ratio
Pneumothorax
Predictive Value of Tests
Prospective Studies
Radiography, Abdominal
Radiography, Thoracic
Rib Fractures
Sensitivity and Specificity
Thoracic Injuries
Tomography, X-Ray Computed
Trauma Centers
Wounds, Nonpenetrating
| | Abstract | STUDY OBJECTIVE: We sought to determine the prevalence of thoracic injuries in children sustaining blunt torso trauma and to develop a clinical prediction rule to identify children with these injuries.
METHODS: We prospectively enrolled pediatric patients (<16 years) who presented to the emergency department of a Level I trauma center with blunt torso trauma and underwent chest radiography. Clinical findings were recorded in a standardized fashion by the ED faculty physician. Thoracic injuries included the following: pulmonary contusion, hemothorax, pneumothorax, pneumomediastinum, tracheal-bronchial disruption, aortic injury, hemopericardium, pneumopericardium, cardiac contusion, rib fracture, sternal fracture, or any injury to the diaphragm. Multiple logistic regression and recursive partitioning analyses were performed to generate a clinical prediction rule for identifying children with these injuries.
RESULTS: Nine hundred eighty-six patients with a mean age of 8.3+/-4.8 years were enrolled. Eighty (8.1%; 95% confidence interval [CI] 6.5% to 10.0%) patients sustained thoracic injuries. Multiple logistic regression and recursive partitioning analyses identified the following predictors of thoracic injuries: low systolic blood pressure (14% with injury versus 2% without injury; adjusted odds ratio [OR] 4.6), elevated age-adjusted respiratory rate (51% versus 16%; adjusted OR 2.9), abnormal results on examination of the thorax (68% versus 36%; adjusted OR 3.6), abnormal chest auscultation findings (14% versus 1%; adjusted OR 8.6), femur fracture (13% versus 5%; adjusted OR 2.2), and a Glasgow Coma Scale (GCS) score of less than 15 (61% versus 26%; adjusted OR 3.3). Seventy-eight (98%; 95% CI 91% to 100%) of the 80 patients with thoracic injuries had at least 1 of these predictive factors. Three hundred thirty-six (37%) children had none of these predictive factors, including 2 (0.6%; 95% CI 0.1% to 2.1%) with thoracic injuries. These 2 injuries, however, did not require any intervention.
CONCLUSION: Predictors of thoracic injury in children sustaining blunt torso trauma include low systolic blood pressure, elevated respiratory rate, abnormal results on thoracic examination, abnormal chest auscultation findings, femur fracture, and a GCS score of less than 15. These predictors can be used to create a sensible clinical decision rule for the identification of children with thoracic injuries. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 11973556 |
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