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Traumatic Colorectal injuries in Children: the National Trauma Database Experience
Pamela M. Choi, MD, Michael Wallendorf, PhD,Martin S. Keller, MD, Adam M. Vogel, MD. Washington University School of Medicine, St. Louis, MO, USA.

Background: We sought to utilize a nationwide database to characterize colorectal injuries in pediatric trauma.

Methods: The National Trauma Database (NTDB) was queried for patients (age≤14 years) with colorectal injuries from 2013-2014. Statistical analysis was conducted using t-test and ANOVA for continuous variables as well as chi-square for continuous variables.

Results: There were 534 pediatric patients who sustained colorectal trauma. The average ISS was 15.60.6 with an average LOS of 8.50.5 days. The mechanism of injury was blunt in 435 patients (81.5%) and penetrating in 99 patients (18.5%). The predominant blunt and penetrating etiologies were motor vehicle crashes (52.6%) and firearms injuries (77.8%), respectively. There were no differences between age, ISS, mortality, LOS, ICU LOS, and ventilator days between blunt and penetrating groups (Table 1). Significantly more patients in the penetrating group had associated small intestine and hepatic injuries as well as underwent colostomies. The anatomic distribution of colorectal injuries in both groups included: 13.3% ascending colon, 13.0% transverse colon, 9.6% descending colon, 15.9% sigmoid colon, 25.7% rectum, and 28.6% unspecified. Patients with rectal injuries were more likely to undergo colonic diversion (p <0.0001), but also had decreased mortality (p=0.001) and decreased LOS (p=0.01).

Conclusions: Colorectal injuries in children are associated with considerable morbidity. Although outcomes between blunt and penetrating mechanisms are similar, associated intraabdominal injuries and the morbidity of ostomy creation is more prevalent in penetrating trauma.

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