Clinically significant thoracic trauma occurs in 4-6% of injured children. Although the frequency of penetrating injuries continues to increase in both urban and rural centers, injuries due to blunt trauma, primarily from motor vehicle crashes and pedestrian trauma, predominate, accounting for more than 85% of cases. Isolated thoracic injuries are rare in children, and instead occur much more commonly in association with multi-system trauma. When present, they are a marker for severe, life threatening injuries. In fact, regardless of the mechanism, an associated thoracic injury more than triples the risk of death. Data from the National Pediatric Trauma Registry reports an overall mortality of 15% for children with blunt thoracic injury.