Outcomes for Initially Hemodynamically Stable Pediatric Patients With Thoracic Trauma Undergoing Emergency Department Thoracotomy.

BACKGROUND

Resuscitative thoracotomy, performed in only 10%-15% of pediatric thoracic trauma cases, yields a dismally low survival rate of 3.4%. As such, an investigation into the mechanisms of such high mortality associated with this emergent procedure is warranted.

OBJECTIVE

This study aims to evaluate the clinical outcomes of initially hemodynamically stable pediatric patients requiring an emergency department thoracotomy (EDT) at pediatric trauma centers (PTC), combined adult/PTCs (CTC), and adult-only trauma centers (ATC).

METHODS

The American College of Surgeons-Trauma Quality Improvement Program database (2017-2021) was utilized in this retrospective cohort analysis to evaluate outcomes among initially hemodynamically stable pediatric (age <18) patients with moderate-severe Abbreviated Injury Score (AIS chest >2) blunt or penetrating thoracic trauma undergoing an EDT. The primary outcome of interest was mortality (defined as emergency department, 24-hour, and in-hospital mortality) evaluated by trauma center type.

RESULTS

A total of 314 patients were identified, with 219 patients (69.7%) treated at ATCs, 77 patients (24.5%) treated at CTCs, and 18 patients (5.7%) treated at PTCs. There was no significant association between 24-hour mortality and treatment at a CTC when compared to treatment at an ATC for patients with penetrating (odds ratio [OR] 0.02, 95% confidence interval [CI] [0.00, 1444.90], p = .501) or blunt (OR 0.26, 95% CI [0.01, 7.98], p = .440) injuries.

DISCUSSION: Among initially hemodynamically stable pediatric trauma patients with moderate-severe blunt or penetrating thoracic injuries undergoing EDT, patients treated at a CTC, when compared to an ATC, showed comparable mortality.