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Fri Nov 21 21:17:40 GMT 2008

Just pulled the JPedSurg paper off our web subscription.  

Avg age of the thoracic aorta group: 15.8 years (min 13).
Avg age of those requiring operation: 17.5 years (min 16).

At least insofar as this paper is concerned, I rest my case.

As for Stephen's numbers: I forgot you were talking about air crashes.
I seem to recall a famous study from a big crash in the nineties (?),
wherein an astonishing number of victims had classic and universally
fatal deceleration injuries (high spines and aortas).  Just speaks to
mechanism; doesn't translate to more typical kinematics, and certainly
says zilch about first-phase survivors.

Have to admit, though: Dr. Moore's two cases in a year are one hell of a
blip.  

Two questions: was the fatal injury immediately so?  And did the
survivor require operation?

Interesting thread.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
Sent: Friday, November 21, 2008 3:35 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: WIDE MEDIASTINUM IN CHILDREN

I don't abandon my paradigms so easily: do you have the ages of the
(seven) thoracic aortas this study identified (over a decade)?
According to the abstract, they're as old as nineteen.

And please give me a reference for aortic injuries being in the top two
or three causes of death in pedi trauma.  I'm not saying I don't believe
you (I excel at being wrong); but I've seen my share of dead kids.  I
don't recall any aortas.

But hey, at least we kicked Dr. Moore's thread into life...

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Stephen Richey
Sent: Friday, November 21, 2008 3:19 PM
To: Trauma &amp, Critical Care mailing list
Subject: Re: WIDE MEDIASTINUM IN CHILDREN

On Fri, Nov 21, 2008 at 3:08 PM, Bjorn, Pret <pbjorn at emh.org> wrote:

> I'm disappointed that your interesting question hasn't found a reply.
> My long experience as a member and admirer of the Trauma List leaves
me
> thinking that there simply isn't a good answer.
>
> That said, and assuming you're looking for an aortic injury, I think
the
> incidence among pre-adolescents is almost exactly zero.  Isn't it?

Actually, no it's not.  Aortic trauma is still in the top two or three
causes of death in most series of fatal pediatric trauma cases
(including
those who do not survive to hospital admission), including the small
series
of cases in my own project.

There was actually a study published over the summer on this subject:

Anderson SA, Day M, Chen MK, Huber T, Lottenberg LL, Kays DW, Beierle
EA:
Traumatic aortic injuries in the pediatric population. J Pediatr Surg.
2008
Jun;43(6):1077-81.
They describe the frequency of such injuries as "rare" but this is
likely a
selection bias due to most of the victims dying within moments to
minutes of
injury and never making it to the hospital.  That being said, your point
is
valid in that there it is not a huge problem, but it is still something
we
should do our best to be prepared for.

>  So
> in practical terms you're talking about a small handful of teenagers,
> for whom the 8-cm rule (and a whole lot of clinical context) should
> suffice.
>
> Points for trying?
>
> Pret Bjorn, RN
> Bangor, ME USA
>
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of moore677 at aol.com
> Sent: Wednesday, November 19, 2008 2:01 PM
> To: trauma-list at trauma.org
> Subject: WIDE MEDIASTINUM IN CHILDREN
>
>
> We have defined a wide mediastinum in an adult trauma patient as
>8cm.?
> Can anyone tell me how we define a pediatric patient with a wide
> mediastinum?
>
>
>
> Forrest "Dell" Moore, MD, FACS
> Trauma Critical Care Surgery
> St. Joseph's Hospital and Medical Center
> Phoenix, AZ
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-- 
Stephen L. Richey, CRT
Aviation Injury Research Project Leader
Saginaw Valley State University
Work E-mail: slrichey at svsu.edu
Home Office Phone: 248-366-4452

"Hier stehe ich. Ich kann nicht anders. Gott helfe mir. Amen."- Martin
Luther, before the Diet of Worms, 16. April 1521
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