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Factors Associated with Mortality from Pediatric Blunt Liver Trauma in a State Trauma System
Jonathan I. Groner, MD1, Thant Ko Ko, BS2, Allison Ertl, MS2, Sergey Tarima, PhD2, Laura D. Cassidy, PhD2. 1Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA, 2The Medical College of Wisconsin, Milwaukee, WI, USA.

Background: To determine factors associated with death from blunt liver trauma in children treated in a state-wide trauma system.

Methods: The data source was the Ohio Trauma Registry (OTR) 2007-2011, which contains records from 183 hospitals. Patients age <16 with blunt liver trauma (n = 527) were identified by ICD-9 codes. Hospital of care was dichotomized into pediatric trauma center (PTC) or non-pediatric trauma center (Non-PTC) based on American College of Surgeons verification. Bivariate and multivariate logistic regression analyses were performed to examine factors associated with mortality from blunt liver injuries. The independent variables analyzed included age (grouped by <1, 1-4, 5-9, and 10-15), gender, race, insurance status, and injury severity score (ISS).

Results: 435 patients (83%) were treated at PTCs and 92 (17%) were treated at non-PTCs. Minority children were 1.9 times as likely to die compared to white children (95% CI, 1.0-3.8, p=0.04). Mortality inversely correlated with age: compared to children aged 10-15, children age 1-4 were 4.6 times more likely to die (95% CI, 1.9-11.1, p=0.0007), and children < 1 were 8.5 times more likely to die (95% CI, 3.0-24.3, p<0.0001). Children treated at non-PTCs were 2.8 times more likely to die compared to children treated at PTCs (95% CI, 1.3-6.1, p=0.009).

Conclusions: In a state trauma system, most children with blunt liver trauma are treated at PTCs. Minority children, young children (particularly age < 1 year), and children treated at non-PTCs are more likely to die from blunt liver injuries.

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