Chest auscultation is recommended and an anteroposterior (AP) chest x-ray becomes valuable, "because it’s quick, simple, and yields a lot of information," he said. He characterized a thoracic CT scan as "an excellent study" that can help with the diagnosis of aortic and diaphragmatic injuries which can be missed on chest x-ray. "However, there is a lot more radiation with a chest CT," Dr. Fairbanks noted. "Only 1 in 200 chest CTs for trauma yields a new diagnosis." Other studies to consider include EKG, echocardiogram, bronchoscopy, video-assisted thoracic surgery, radionuclide bone scan, and MRI.
A thoracotomy is indicated when the patient is coding or near coding. The other indications are penetrating wound of the heart or great vessels; massive or continuous intrathoracic bleeding; open pneumothorax with major chest wall defect; aortogram indicating injury to the aorta or major branch; massive or continuing air leak, indicating injury to a major airway; cardiac tamponade; esophageal perforation, or diaphragmatic rupture.
Chest wall soft-tissue injuries are usually not clinically significant, "but they’re a marker for a more serious injury under a bruise," he said. "Rib fractures are less common in children. It’s an indicator of significant force. Treatment is pain control and prevention of atelectasis, which is not as big of a problem in kids as it is in adults. They will heal in 6 weeks. Consider child abuse, specifically in cases of multiple rib fractures and those that don’t make sense with the mechanism of reported injury, or rib fractures that are at different stages of healing."
Dr. Fairbanks said that he had no relevant financial conflicts to disclose.