A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma

Ann Emerg Med. 2002 May;39(5):492-9. doi: 10.1067/mem.2002.122901.


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.

Publication types

  • Comparative Study

MeSH terms

  • Accidental Falls
  • Accidents, Traffic
  • Adolescent
  • Age Factors
  • Child
  • Child, Preschool
  • Clinical Enzyme Tests
  • Confidence Intervals
  • Contusions / diagnosis
  • Diagnosis, Differential
  • Emergencies
  • Glasgow Coma Scale
  • Hemothorax / diagnosis
  • Humans
  • Infant
  • Infant, Newborn
  • Logistic Models
  • Lung Injury
  • Mediastinal Emphysema / diagnosis
  • Odds Ratio
  • Pneumothorax / diagnosis
  • Predictive Value of Tests
  • Prospective Studies
  • Radiography, Abdominal
  • Radiography, Thoracic
  • Rib Fractures / diagnosis
  • Sensitivity and Specificity
  • Thoracic Injuries / diagnosis*
  • Tomography, X-Ray Computed
  • Trauma Centers
  • Wounds, Nonpenetrating / diagnosis*