Penetrating Diaphragm Injuries in Children and Predictors of Mortality: An Analysis of the National Trauma Data Bank.
Background (issue): Traumatic diaphragm injuries in are rare and more likely to be missed in children than adults. We used the National Trauma Databank (NTDB) to review injury patterns and outcomes associated with penetrating diaphragmatic injuries in children.
Methods: Children ≤18 years presenting with penetrating diaphragm injuries were identified in the 2007-2016 NTDB research datasets. Data on patient demographics, associated injuries, procedures, complications, and disposition were analyzed using descriptive statistics and logistic regression analysis.
Findings: 656 pediatric patients with penetrating diaphragmatic injuries were identified. Median age was 17 (15-18). Most injuries were firearm related (72%). Most common locations of injury were the street (30%) and at home (30%). Median lengths of stays in the ICU and hospital were 4 (I2-7) and 8 (4-15) days respectively. Pneumonia was the most common complication (7%). In hospital mortality rate was 11% and most deaths occurred within 2 days of presentation. Average injury severity scores were significantly greater in patients who died compared to survivors (42 vs 26, p<0.0001). Those who died compared to survivors also had a significantly lower average initial heart rate (77 vs 95, p=0.02), respiratory rate (15 vs 20, p=0.009), and oxygen saturation (72 vs 96 p=0.002). Self-pay/uninsured patients had 2.04-fold greater odds of death than privately insured patients (p=0.05). Those requiring nonoperative intubation had 99% greater odds of death (p= 0.006).
Conclusions (implications for practice): Penetrating diaphragmatic injuries in children are associated with significant mortality. Understanding the associated injury patterns and identifying those with predictors of mortality could help improve outcomes.
Boudiab E, Lai S, Karabon P, Novotny N, Morden R, Akay B, Stallion A, Brahmamdam P. Penetrating diaphragm injuries in children and predictors of mortality: an analysis of the National Trauma Data Bank. Paper presented at: The 7th Annual Meeting of the Pediatric Trauma Society, 2021 Nov 4-6; Baltimore, MD.