Nationwide Evaluation of Pediatric Abdominal Wall Hernias Following Blunt Trauma
*Ilan I Maizlin, Tal Koppelmann, *Robert T Russell
Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL
Background: Traumatic abdominal wall hernias (TAWH)followingblunt injuries are extremely rare, requiring sufficient energy transfer to disrupt the musculoaponeurotic layer but not the elastic skin layer. We compared the circumstances and clinical outcomes of pediatric and adult TAWHs.
Methods: The National Trauma Database (2010-2012) was queried for all pediatric patients (≤21 yo) diagnosed with TAWH following blunt trauma. Demographics, patterns of injury, treatment modalities and outcomes were evaluated and compared to adults (≥22 yo) using chi-square and ANOVA tests.
Results: Of 498 patients with TAWH, 78 (16%) were pediatric: 70% male and 49% Caucasian. Pediatric TAWH were more likely to result from motor vehicle accidents (44% vs. 39%,p=0.035) or altercations/fights (26% vs. 21%,p=0.032), and less likely following a fall (20% vs. 30%,p=0.021). Despite similar mean ISS (9.6 vs. 10.8,p=0.343) and GCS on presentation (8.2 vs. 9.4,p=0.169), pediatric patients had significantly shorter mean hospital stay (6.0 vs. 11.3 days, p=0.008), lower rates of ICU admissions (29% vs. 45%,p=0.009) and lower intubation rates (10% vs. 23%,p=0.012). While all patients required eventual surgical correction, 31% of adults underwent immediate surgical repair, with pediatric patients having a lower rate of 26% (p=0.041), usually in traumas with concurrent high abdominal AIS scores. No difference was noted in overall mortality (3.8% vs. 5.2%,p=0.201) or discharge dispositions.
Conclusions: While resulting in lower rates of immediate surgical interventions and critical care resources, pediatric TAWH demonstrated equivalent mortality rates. Pediatric TAWH also resulted from a different set of predominant etiologies, which must be recognized by pediatric trauma providers.
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