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| CASE REPORT |
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| Year : 2014 | Volume
: 3
| Issue : 1 | Page : 49-51 |
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Mother to child impact: An unusual cause of blunt chest trauma
Kelechi E Okonta, Emmanuel O Ocheli, Peter D Okoh, Uriah S Etawo
Department of Surgery, Division of Cardiothoracic Surgery, University of Port Harcourt Teaching Hospital, Rivers, Nigeria
| Date of Web Publication | 26-Aug-2014 |
Correspondence Address:
Kelechi E Okonta
Department of Surgery, Division of Cardiothoracic Surgery, PMB 6173, University of Port-Harcourt Teaching Hospital, Rivers
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1597-1112.139486
The presence of airbags in the internal front row of cars is the main reason for not allowing children occupy the front seat while in a car. Its deployment in low-speed collision may cause injury to the front occupant especially children because of the difference in sizes. An 18-month-old girl presented in the emergency with progressive dyspnea 6 h following a road traffic accident. She was carried on the laps of her unbelted mother in the front row of a car which had low-speed collision with a stationary car parked off the road. The mother was propelled forward; hitting her head on the dash board with laceration on the forehead with the child sustaining a crush injury which was deployed by the mother instead of the airbag. This resulted in bilateral hemothoraces and lung contusion. Even when the airbag was not deployed in low-speed collusion state, the compressive effect of the passenger holding a child protectively might cause severe crushing injury like blunt chest trauma. Keywords: Airbag deployment, bilateral hemothoraces, commotio cordis, pediatric chest trauma
How to cite this article:
Okonta KE, Ocheli EO, Okoh PD, Etawo US. Mother to child impact: An unusual cause of blunt chest trauma. Afr J Trauma 2014;3:49-51 |
| Introduction | |  |
The protection against severe injury such as chest trauma in the front row seated passengers in the car is made necessary by the presence of airbag, [1] and of course; it is the main reason for not allowing children to seat in the front while in the car because of disparities in pressure and sizes. [1],[2] However, in cases in which they find themselves in the front row it is thought to be wisely done in the accompaniment of a parent, who will provide the necessary restraints. Equally, important to note is that this bag does not always go off and may thus lead to forward propelling of the passenger especially when they are not with the seat belt. In this setting the compressive effect may now be provided by the parent causing blunt chest injury to the baby.
| Case Report | | |
An 18-month-old girl admitted in the emergency unit following a 4 day history of progressive dyspnea 6 h after a road traffic accident. She was carried by the unbelted mother on the lap when the car had low-speed collision with a stationary car off the road with the mother propelling forward while protecting the child thus hitting her head on the dash board sustaining laceration [Figure 1], while the child [Figure 2] in her arms was crushed in the effect. There was no driver injury sustained. The child had immediate loss of consciousness which was regained after few minutes. The chest radiograph done at a private hospital showed bilateral peripheral rims of hemothoraces layered off up to the apical areas worse on the right than left with associated right lower and middle lobes contusion [Figure 3]. The neurological evaluation and skull radiograph showed no evidence of extracerebral hemorrhage; abdominal ultrasound and plain abdominal radiograph were normal. She was subsequently placed on intravenous antibiotics. However, repeated chest radiograph done on the 3 rd day on admission showed left peripheral hemothorax was increasing while the contusion resolved on the right side [Figure 4]. The patient was referred to the teaching hospital after 5 days. | Figure 3: Chest radiograph. A = Left hemothorax, B = Right hemothorax, C = Area of contusion
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On examination, she was dyspneic, not pale (Packed Cell Volume (PCV) =36%), afebrile (T = 37.1±C). Respiratory rate was 56/min, dull percussion note over the left hemithorax, with decreased air entry over same area. She had thoracocentesis that yielded altered blood with insertion of chest tube that drained 300 ml of altered blood at insertion and subsequently serosanguinous [Figure 4] and the postintubation showed adequate drainage [Figure 5]. The post extubation chest radiography showed adequate lung reexpansion with the baby discharged 10 days after admission.
| Discussion | | |
The mechanisms of injury by the deployment of airbag in low-speed collision are well-documented. [3],[4],[5] The blunt injuries and rarely, chemical pneumonitis are reasons for which babies and young children are not allowed to seat on the front row for fear of causing severe injuries when deployed in situations of even low-speed collision. [1],[2],[3] The larger surface area and force will obviously do more harm in children with smaller sizes and relative large surface area than adults. [6] Equally, the injury from airbag when deployed is more with intrathoracic organs especially in children with more elastic chest wall bone leading to the exchange of energy internally. [1],[2],[3] The injuries are mainly blunt lung injury, commotio cordis, and occasional chemical pnuemonitis. [1],[2],[3],[4],[5]
In the case presented the airbag was not deployed, but the unbelted mother who was carrying the baby on her lap was "deployed" instead creating a new pattern of chest injury that has not been reported in any literature before now.
Also, the pattern of injury was peculiar as presented by our patient: Bilateral hemothoraces with lung contusion [Figure 1] and there was momentary loss of consciousness suspected to be due to commotio cordis, though the neurological evaluation and skull radiological study did not show any evidence of extracerebral hemorrhage. The majority of patients with commotio cordis loss consciousness immediately, after a precordial impact without any head injury. [7] In this patient, the injury was restricted to the chest giving further credence for the exclusion of the head but that was difficult to be substantiated as the child had initial treatment in a private hospital and no electrocardiogram was done.
Of note as to the severity of injury on the baby is the body surface area of the mother who provided the compressive effect on the baby was 2.05, while that of the baby was 0.49 giving a ratio of 4:1. The other meaning is that the baby was also well-accommodated within the compressive area as the calculated thigh length and trunk length area was 2,393 cm 2 for the mother versus 425 cm 2 for the baby with the mother's weight at 96 kg against the baby weight of 10 kg [Table 1] in a vehicle moving at 30-40 km/h which stopped abruptly after collision.
The mother's compressive effect can indeed cause similar injury as would have been expected if the airbag was deployed. The protective arm of the mother in order to prevent the baby from falling off caused the side to side compression resulting in bilateral hemothoraces and the mother chest with the breasts compressing the anterioposterior aspect of the trunk resulting in the right lower and middle lobe contusion. The injury sustained using the injury severity score entail the injury was severe. [8] Even in airbag injury patterns, it was noted to be dependent on the child's age and type of restraint used at the time of collision. [3] Thus, the restraint given to the baby in protective manner contributed to the pattern of injury the baby sustained.
| Conclusion | | |
Even when the airbag is not deployed and does not cause trauma in child in front row in the event of low-collision accident, the compressive effect of the passenger reflexly holding them protectively might cause severe chest injury as in this patient.
| Acknowledgment | | |
Dr. GC Asamole for providing the anthropometric parameters of patients.
| References | | |
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| 2. | Sanders RC. Statement on Parents' Coalition for Air Bag Warnings. Washington, DC: Committee on Commerce, Science, and Transportation, United States Senate; January 9, 1997.
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| 4. | Matthes G, Schmucker U, Lignitz E, Huth M, Ekkernkamp A, Seifert J. Does the frontal airbag avoid thoracic injury? Arch Orthop Trauma Surg 2006;126:541-4.
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| 5. | Marshall KW, Koch BL, Egelhoff JC. Air bag-related deaths and serious injuries in children: Injury patterns and imaging findings. AJNR Am J Neuroradiol 1998;19:1599-607.
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| 6. | Dennis C, Davidson T, Roy G, Kumar R, Whan L. Kaleidoscope paediatric trauma resource manual for emergency department: Hunter New England Health; 2006;2-3.
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| 7. | Link MS, Maron BJ, Wang PJ, Pandian NG, VanderBrink BA, Estes NA 3 rd . Reduced risk of sudden death from chest wall blows (commotio cordis) with safety baseballs. Pediatrics 2002;109:873-7.
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| 8. | Nakayama DK, Ramenofsky ML, Rowe MI. Chest injuries in childhood. Ann Surg 1989;210:770-5.
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Disclosure: Abstract appeared in the book of abstract of AATCS International Conference 30-31 August 2013 in Accra (Ghana).
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1]
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