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Pediatric Neck Trauma: 14-Year Experience From an Urban Level 1 Pediatric Trauma Center
Robert Tessler, MD, UCSF East Bay Department of Surgery, San Francisco CA; Huong Nguyen, BA, Christopher Newton, MD, James Betts, MD, UCSF Benioff Children's Hospital Oakland Pediatric Surgical Associates, Oakland CA

Abstract:
Background: Management of neck trauma in adults has been well described, however data in the pediatric population is sparse. Anatomic and physiologic differences in the pediatric population pose unique clinical challenges and raise questions about the applicability of the adult experience in children. Setting: Dedicated children's hospital/Level I urban trauma center Methods: Charts were selected and reviewed based on ICD-9 codes between 2001 and 2014. Results: A total of 113 patients were identified with neck injuries, of which 64 (56.6%) were male. Ages ranged from 8 months to 16 years with an average of 8.2 years. Seventy-two patients (63.7%) were blunt trauma, and 41 patients (36.3%) were penetrating. Sixteen patients underwent neck exploration with injuries identified in seven patients including one tracheal injury and two esophageal injuries. Seven patients underwent bronchoscopy (4 tracheal injuries identified). Five patients underwent esophagoscopy (no injuries identified). Two patients received a surgical airway. There were three mortalities. Two had non-survivable injuries and died prior to any therapeutic or diagnostic intervention. Ninety-two patients (81.4%) received observation only without morbidity or mortality. Conclusions: Experience with pediatric neck trauma is limited. However management algorithms should ideally evolve from pediatric specific data. This is the largest reported experience with pediatric specific neck injuries, showing that simple observation is the most common management strategy employed in over 81% of this cohort with low morbidity and mortality. Invasive interventions are relatively infrequent. Major injuries are potentially devastating, but are fortunately uncommon and often clinically apparent.
Objective:
Evaluate pediatric patients with blunt and penetrating neck injuries.
Objective Content: The learner will appreciate the differences between pediatric and adult neck anatomy, distinguish blunt from penetrating injuries, and understand the diagnostic options available for neck injuries and how they were employed in this cohort of patients.


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