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Blunt Trauma And Diaphragm Injury In Children: An Analysis Of The National Trauma Data Bank
Sammie Lai1, Patrick Karabon1, *Robert Morden2, *Begum Akay2, Nathan Novotny2, Anthony Stallion2, Pavan Brahmamdam2
1Oakland University William Beaumont School of Medicine, Rochester, MI;2Beaumont Children's, Royal Oak, MI

BACKGROUND: Traumatic diaphragm rupture (TDR) is a rare but serious injury that can be difficult to identify. TDR due to a blunt mechanism in the pediatric population has been described in case reports and case series. The purpose of this study was to examine the clinical outcomes of blunt TDR in the pediatric population using data from the National Trauma Data Bank (NTDB).
METHODS: We included patients from 0 to 18 years of age with blunt TDR using the NTDB from 2007 to 2017. Patient characteristics and demographics, mechanisms of injury, concomitant diagnoses, procedures, and clinical outcomes were extracted from the NTDB.
RESULTS: In this study, we identified a total of 88 pediatric patients with blunt TDR with a mean age of 12. The most common mechanism of injury was motor vehicle accidents (65%). The majority of blunt TDR injuries were observed in males (73%). Seventy percent of the patients were admitted to the ICU, the mean injury severity score was 29.89 for the cohort, and in-hospital mortality was 5.68%. Fractures of the spines and ribs (49%), thoracic (42%), and abdominal (37.5%) injuries were the most common associated injuries. Injuries to the lung (42%), liver (37.5%), and spleen (32.9%) were frequently seen. The most common complication seen was pneumonia (16.3%) and 10.2% developed ARDS.
CONCLUSIONS: In summary, TDR is relatively unusual among the pediatric population, but it remains a serious source of morbidity and mortality. Any child with severe injuries to the thoracoabdominal region should prompt trauma providers to the potential of diaphragm rupture.


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