Clinical outcomes and diagnostic imaging of pediatric patients with pneumomediastinum secondary to blunt trauma to the chest.

BACKGROUND: Traumatic pneumomediastinum secondary to blunt chest injury in children is concerning for potential life-threatening tracheobronchial, esophageal, or vascular thoracic injuries. These patients often undergo extensive radiologic evaluation and invasive testing due to the unclear risk of traumatic pneumomediastinum.

METHODS: This was a retrospective cohort study in two phases. First, we reviewed the National Trauma Database from 2002 to 2005 for patients younger than 19 years with blunt traumatic pneumomediastinum to describe the epidemiology, clinical course, and associated life-threatening thoracic injuries. Patients with isolated pneumomediastinum were compared with those with pneumomediastinum and other thoracic injuries (complicated pneumomediastinum). Second, we conducted a retrospective case series from our Level I Pediatric Trauma Center from 1995 to 2009 to delineate the clinical course and the utility of diagnostic studies beyond chest X-ray (CXR).

RESULTS: In the National Trauma Database, 8 of 193 patients (4.1%; 95% CI, 1.3-7.0) had life-threatening tracheobronchial, esophageal, or vascular thoracic injuries; all had other organ system injuries and additional thoracic injuries, which would have been visible on CXR. Complicated pneumomediastinum was more highly associated with abnormal vital signs (p=0.02). The retrospective institutional case series identified 18 patients, none with life-threatening thoracic injuries. Fourteen patients with isolated pneumomediastinum had 30 additional studies after initial CXR, with no additional positive findings.

CONCLUSIONS: Tracheobronchial, esophageal, or vascular thoracic injuries were uncommon in children with traumatic pneumomediastinum and occurred in the setting of additional thoracic and other organ system injuries. Pneumomediastinum without radiographic or clinical evidence of other thoracic injuries may not routinely require further diagnostic testing.