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Blunt Cerebrovascular Injuries in Pediatric Trauma Patients
Mubina Isani, MD, Michael Mallicote, MD, Jamie Golden, MD, Henri Ford, MD, MHA, Jeffrey Upperman, MD, Christopher Gayer, MD, PhD,

Background: In adults, traumatic diaphragmatic injuries (TDI) are associated with high morbidity and mortality; however, little data are available regarding this injury in the pediatric population. We sought to characterize pediatric TDI with respect to associated injury patterns, injury severity, and outcomes.

Methods: Data for this analysis was derived from the National Trauma Data Bank Research Data Set (NTDB RDS) over 3 years (2012-2014). TDI was searched via ICD 9 coding (862.0 and 862.1) in the pediatric population (ages 1-17). Specific data compiled for analysis included diagnoses, Glasgow Coma Score (GCS), injury severity score (ISS), and outcomes.

Results: From the NTDB RDS registry, 335,469 injured children were identified with an overall mortality of 1.57%. Of this population, 620 had TDI with an associated mortality of 23.71%. Analysis of additional injuries noted association of pediatric TDI with other organ system injuries: hepatic (59.52%), splenic (35.32%), pulmonary (48.39%), rib fracture (20.97%), vascular (vena cava- 2.58%; aorta- 2.26%), renal (22.90%), colon (15.00%), and gastrointestinal (25.97%). Outcome measures of TDI in comparison with overall pediatric population showed differences in GCS (11.25 vs. 14.33), ISS (27.23 vs. 6.91), and length of stay (9.81 vs. 2.71).

Conclusions: Diaphragm injury in the pediatric population is a rare diagnosis but has significant implications manifest in the number and severity of associated injuries. These results demonstrate the diagnosis of TDI is associated with significantly worse patient outcome. Diagnosis of TDI should raise clinical suspicion for associated injuries in the pediatric population.

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