Citation

Stone ME, Farber BA, Olorunfemi O, Kalata S, Meltzer JA, Chao E, Reddy SH, Teperman S. J. Trauma Acute Care Surg. 2016; 80(4): 604-609.

Affiliation

1 Department of Surgery, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 2 Albert Einstein College of Medicine, Bronx, NY 3 Department of Pediatrics, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY.

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000000976

PMID

26808024

Abstract

BACKGROUND: Penetrating neck trauma is uncommon in children; consequently, data describing epidemiology, injury pattern and management is sparse. The aim of this study was to use the National Trauma Data Bank (NTDB) to describe pediatric penetrating neck trauma (PPNT).

METHODS: The NTDB was queried for children (defined as <15 years old) with PPNT between years 2008-2012. Descriptive analysis was used to describe age groups (0-5, 6-10, 11-14) and injury type categorized as aero-digestive, vascular, cervical spine and nerve.

RESULTS: A total of 1,238 patients with penetrating neck trauma were identified among 434,788 children in the NTDB (0.28%). Mean age was 7.9 years and 70.6% of patients were male. The most common mechanisms of injury were stabbing (44%) and gunshot/firearm (24%). Most patients were treated at a pediatric trauma center (65.8%). CT scan was the most frequent (42.2%) diagnostic study performed followed by laryngoscopy (27.0%) and esophagoscopy (27.4%). Almost a quarter of patients (23.7%) went directly to the operating room from the emergency department (ED). Aero-digestive injuries were most common and occurred more frequently in the youngest age group (p<0.001). Operative procedures for aero-digestive type injuries were the most common (82.7%). There were 69 deaths yielding a mortality rate of 5.6%. Adjusting for age, admission to a pediatric trauma center, and injury type, only vascular injury (OR 3.92, 95% CI: 2.19-7.24, p<0.0001) and ED hypotension (27.12, 95% CI: 15.11-48.67, p<0.0001) were found to be independently associated with death.

CONCLUSIONS: PPNT is extremely rare-0.28% reported NTDB incidence. Age appears to influence injury type, but does not affect mortality. CT scan is the dominant diagnostic study utilized for selective management. Vascular injury type and hypotension on presentation to the ED were independently associated with mortality. LEVEL OF EVIDENCE: Level III STUDY TYPE: Prognostic.

Language: en