Thoracic injuries in urban infants and children.

Trauma is an integral part of our society. That truth is reflected in the fact that about 100,000 children die of some form of injury in the United States every year. Since there is great need for prevention of these deaths the nature and distribution of injuries in chiidren is of primary interest. Study of thoracic injuries is particulariy important since they are a substancial source of crippiing morbidity and mortaiity especialiy when combined with other injuries. In a study of 51 children with thoracic trauma reported by Levy’ at Tulane University, sixteen children had concommitant skuli fractures, nine had ruptured spleens, and thirty-eight had long bone fractures. There was an overali mortality rate of thirty percent (30%) in this series primariiy due to associated head injuries. We set out to study the epidemiology of thoracic injuries in chiidren in a major urban area, Chi cago. In order to obtain an adequate sample for study, we obtained permission to review the injuries brought into five representative hospitais in the northern haif of Chicago, (Fig. 1), (Table 1). The combined study represents a sample of pediatric thor~cic injuries derived from hospitais of 2017 beds with a combined annual emergency room admission rate of 125,000 injuries per year. Each hospital had injuries characteristic of sociologic condi tions in the area it served. The combined experience, however, cut across ali segments of society so that this series is representative of the general metropolitan experience with chest trauma in children. The 424 cases represented an incidence of 0.35 percent of ali emergency room admissions. Of the 424 cases, twenty percent (20%) were injuries associated with birth; twenty-nine percent (29%) resuited from aspiration o! foreign bodies; 21. 93% were caused by blunt trauma to the chest; 18.16% resulted from penetrating injuries to the chest; three percent (3%) were compression fractures of the vertebral column; and seven percent (7%) were the resuit of burns to the thoracic wall. The types of injuries sustained were closeiy allied with the patient’s age. In the newborn period, chest injuries usuaiiy resuited from birth trauma. Somewhere .about the third to the fifth year, there is a peak in the incidence of foreign body aspiration. At the end of the first decade of life, when the children are small, tender, difficult to see and easiiy subjected to blunt physicai forces, there is a high incidence of blunt injuries to the chest. Finaily, as the children grow older and become teenagers, there is a signifi cant increase in the incidence of penetrating wounds to the chest. Most of these latter injuries occur in the savage environment of the ghetto. Compression injuries to the