Penetrating Trauma Is “Just Ok” For Pediatric Trauma Triage
*Paul McGaha1, Kenneth Stewart1, Tabitha Garwe1, Jeremy Johnson1, *Robert Letton2
1University of Oklahoma Health Science Center, Oklahoma City, OK;2Nemours Children's Specialty Care, Jacksonville, FL
BACKGROUND: Based on previous work, penetrating injury was found independently predictive of the need for surgeon presence (NSP)(previously defined) upon arrival. Moreover, penetrating injury is often used as a trauma triage indicator. However, penetrating injury includes a wide range of specific mechanisms of injury. Here we sought to compare firearm-related and non-firearm related penetrating injury with respect to NSP, ISS and mortality.
METHODS: Patients <18 from the 2016 National Trauma Quality Improvement Program Database were included. Penetrating injury was identified and grouped using ICD-10 mechanism codes into firearm and non-firearm related injury. NSP, ISS, and mortality were compared between the two groups.
RESULTS: A total of 1715 (4.2%) patients with penetrating injury were identified from 40,794 patients with injury type recorded; 832 firearm-related and 883 non-firearm. No deaths occurred among the non-firearm group compared to 94 (11.3%) among firearm-related patients. Seven percent of the non-firearm group had an ISS≥16 versus 33.9% of the firearm-related group. Among non-firearm patients 22.7% had a NSP indicator compared to 51.2% of patients injured by a firearm. Among firearm-related deaths, 3.2% did not have an NSP indicator recorded whereas 9.6% had an ISS<16.
CONCLUSION: Penetrating injury is often simply referred to collectively as an injury type. Dichotomizing penetrating injury into firearm and non-firearm injury clearly demonstrates a significantly higher proportions of severe injury and mortality with firearm injury. Furthermore these data suggest ISS may underestimate penetrating injury severity more frequently than NSP factors.
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