Title: Should an ED thoracotomy be performed in pediatrics?<br/>Author: Jenny Guyther<br/><a href='http://umem.org/profiles/faculty/314/'>[Click to email author]</a><hr/><div style="font-family: Arial, Helvetica, sans-serif; font-size: small;">
<font color="#212121" face="BlinkMacSystemFont, -apple-system, Segoe UI, Roboto, Oxygen, Ubuntu, Cantarell, Fira Sans, Droid Sans, Helvetica Neue, sans-serif"><span style="font-size: 16px;">12 pediatric and adult surgeons with pediatric trauma expertise reviewed the literature to form a consensus statement on the indications for ED thoracotomy (EDT) on patients younger than 19 years. Eleven studies were included for a total of 319 children who underwent EDT. 142 patients had penetrating trauma while 177 sustained blunt trauma. Survival in the penetrating group was 13.4% and 2.3% in the blunt group. Many of these patients were 15 and older. Based on the review of the literature, the group made recommendations:</span></font></div>
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<font color="#212121" face="BlinkMacSystemFont, -apple-system, Segoe UI, Roboto, Oxygen, Ubuntu, Cantarell, Fira Sans, Droid Sans, Helvetica Neue, sans-serif"><span style="font-size: 16px;">1) In pediatric patients with signs of life (SOL) who present pulseless in the setting of penetrating trauma, EDT was conditionally recommended.</span></font></div>
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<font color="#212121" face="BlinkMacSystemFont, -apple-system, Segoe UI, Roboto, Oxygen, Ubuntu, Cantarell, Fira Sans, Droid Sans, Helvetica Neue, sans-serif"><span style="font-size: 16px;">2) In pediatric patients <i>without </i>SOL who present pulseless in the setting of penetrating thoracic trauma EDT was conditionally NOT recommended. </span></font></div>
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<font color="#212121" face="BlinkMacSystemFont, -apple-system, Segoe UI, Roboto, Oxygen, Ubuntu, Cantarell, Fira Sans, Droid Sans, Helvetica Neue, sans-serif"><span style="font-size: 16px;">3) </span></font><span style="color: rgb(33, 33, 33); font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;"> </span><span style="color: rgb(33, 33, 33); font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;">In pediatric patients with SOL who present pulseless in the setting of penetrating abdominopelvic trauma EDT was conditionally recommended. </span></div>
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<span style="color: rgb(33, 33, 33); font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;">4) In pediatric patients without SOL who present pulseless in the setting of penetrating abdominopelvic trauma EDT was conditionally NOT recommended. </span></div>
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<span style="color: rgb(33, 33, 33); font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;">5) In pediatric patients with SOL who present pulseless in the setting of blunt trauma EDT was conditionally recommended AFTER emergency adjuncts which include ultrasound and thoracostomies. </span></div>
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<span style="color: rgb(33, 33, 33); font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;">6) </span><span style="color: rgb(33, 33, 33); font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;"> </span><span style="color: rgb(33, 33, 33); font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;">In pediatric patients without SOL who present pulseless in the setting of blunt trauma EDT was NOT recommended. </span></div>
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<font color="#212121" face="BlinkMacSystemFont, -apple-system, Segoe UI, Roboto, Oxygen, Ubuntu, Cantarell, Fira Sans, Droid Sans, Helvetica Neue, sans-serif"><span style="font-size: 16px;">SOL included cardiac electrical activity, respiratory effort, pupillary response, pulses, blood pressure, or extremity movement.</span></font></div>
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<font color="#212121" face="BlinkMacSystemFont, -apple-system, Segoe UI, Roboto, Oxygen, Ubuntu, Cantarell, Fira Sans, Droid Sans, Helvetica Neue, sans-serif"><span style="font-size: 16px;">Bottom line: If the pediatric trauma patient presents pulseless, but with SOL, EDT can be considered. However, e</span></font><span style="color: rgb(33, 33, 33); font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;">vidence is still very limited, especially in children < 15 and these recommendations are conditional.</span></div>
<fieldset><legend>References</legend>
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<span style="color: rgb(33, 33, 33); font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;">Selesner L, Yorkgitis B, Martin M, et al. Emergency department thoracotomy in children: A Pediatric Trauma Society, Western Trauma Association, and Eastern Association for the Surgery of Trauma systematic review and practice management guideline. </span><i style="box-sizing: inherit; color: rgb(33, 33, 33); font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;">J Trauma Acute Care Surg</i><span style="color: rgb(33, 33, 33); font-family: BlinkMacSystemFont, -apple-system, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px;">. 2023;95(3):432-441. doi:10.1097/TA.<wbr />0000000000003879</span></p>
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