Clinical considerations for blunt laryngotracheal trauma in children

Objective: Systematic review of blunt pediatric laryngeal and tracheal trauma and development of proposed evaluation and management strategy. Study design: Systematic review and proposed clinical consideration algorithm. Data sources: PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. Review methods: A medical librarian was utilized. Results: 329 titles and abstracts were identified, and 50 reports were included. A total of 66 children were identified, with a majority of males (76.1%). Average agewas 9.5 +/- 4.4 years [range 2-17]. CT was employed in 66.7% of cases. False negative CT occurred in 29.5% of cases. Treatment consisted of observation (9.1%), endoscopy alone (31.8%), endoscopic repair (7.6%), and open neck explorationwith repair/open reduction internal fixation (ORIF) (51.5%). Tracheotomy was utilized in 33.3% of the cases. Mortality was rare, with only one (1.5%) reported and occurred within one hour after presentation. Conclusions: Significant deviation and variation from recommended previously proposed management algorithms exists in reported cases. Awareness of the natural clinical history, potential for severe morbidity or mortality, and associated complications are extremely important. CT and fiberoptic, bedside laryngoscopy may not play a significant role but may add to clinical evaluation prior to operative intervention. If employed, care must be taken to not create an unstable clinical scenario. Operative endoscopy is recommended in cases with positive physical examination findings, and treatment tailored to extent of injury. (C) 2017 Elsevier Inc. All rights reserved.