Significant thoracic trauma in the pediatric population is relatively uncommon, accounting for only 4% to 6% of children admitted to pediatric trauma centers, although this proportion may be higher in level centers Despite a high rate of scene fatalities, mortality rates for children who reach the hospital with isolated thoracic trauma are low; this rate triples when thoracic trauma occurs concurrently with head or abdominal trauma Blunt trauma occurs far more frequently than penetrating trauma and lung injuries outnumber those to the heart and great vessels Emergency evaluation requires careful observation and examination for evidence of impaired respiration or circulation, including any abnormal vital signs Be prepared to immediately secure the airway and support breathing and circulation Most thoracic injuries not require intervention and those that most commonly require only tube thoracostomy RELATED CHAPTERS