From the Research
Pulmonary contusion is the most common injury in a child with severe blunt chest trauma, such as being struck by a motor vehicle. This injury involves bruising of the lung tissue without necessarily breaking the ribs, as children have more compliant chest walls than adults. The flexible nature of a child's ribcage allows force to be transmitted directly to the underlying lung parenchyma, causing alveolar hemorrhage and edema without rib fractures. According to a study published in the European journal of cardio-thoracic surgery 1, pulmonary contusion was the most common thoracic injury, occurring in 49.6% of cases.
Clinical Presentation and Management
Clinical presentation typically includes tachypnea, hypoxemia, and respiratory distress, which may develop immediately or progress over 24-48 hours after the injury. Management focuses on supportive care including supplemental oxygen, pain control, and in severe cases, mechanical ventilation. Careful fluid management is essential as excessive fluids can worsen pulmonary edema. Children with pulmonary contusions require close monitoring for respiratory deterioration, though most recover well with appropriate supportive care due to their remarkable healing capacity.
Diagnosis
The diagnosis is typically made with chest X-ray or CT scan, which may show patchy infiltrates in the affected lung areas. A study published in Archivos de bronconeumologia 2 reported that pulmonary contusions were the most frequent injuries, occurring in 27.1% of cases.
Associated Injuries and Mortality
Associated injuries, such as head injuries, bone fractures, and abdominal injuries, are common and can increase the risk of mortality. A study published in the Journal of pediatric surgery 3 reported that all but 3 patients with motor vehicle accident-related blunt chest injuries had serious extrathoracic injuries. The mortality rate was 7.2% in a study published in Archivos de bronconeumologia 2, with multiple trauma being the main cause of death.
Key Points
- Pulmonary contusion is the most common injury in children with severe blunt chest trauma.
- Clinical presentation includes tachypnea, hypoxemia, and respiratory distress.
- Management focuses on supportive care, including supplemental oxygen and careful fluid management.
- Diagnosis is typically made with chest X-ray or CT scan.
- Associated injuries and multiple trauma can increase the risk of mortality.