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Penetrating Diaphragm Injuries In Children And Predictors Of Mortality: An Analysis Of The National Trauma Data Bank
Elizabeth Boudiab1, Sammie Lai2, Patrick Karabon2, Nathan Novotny3, Robert Morden3, *Begum Akay3, Anthony Stallion3, Pavan Brahmamdam3
1Department of General Surgery, Beaumont Health, Royal Oak, MI;2Oakland University William Beaumont School of Medicine, Rochester, MI;3Department of Pediatric Surgery, Beaumont Children’s, Royal Oak, MI

Background (issue): Traumatic diaphragm injuries in are rare and more likely to be missed in children than adults. We used the National Trauma Databank (NTDB) to review injury patterns and outcomes associated with penetrating diaphragmatic injuries in children.
Methods: Children ≤18 years presenting with penetrating diaphragm injuries were identified in the 2007-2016 NTDB research datasets. Data on patient demographics, associated injuries, procedures, complications, and disposition were analyzed using descriptive statistics and logistic regression analysis.
Findings: 656 pediatric patients with penetrating diaphragmatic injuries were identified. Median age was 17 (15-18). Most injuries were firearm related (72%). Most common locations of injury were the street (30%) and at home (30%). Median lengths of stays in the ICU and hospital were 4 (I2-7) and 8 (4-15) days respectively. Pneumonia was the most common complication (7%). In hospital mortality rate was 11% and most deaths occurred within 2 days of presentation. Average injury severity scores were significantly greater in patients who died compared to survivors (42 vs 26, p<0.0001). Those who died compared to survivors also had a significantly lower average initial heart rate (77 vs 95, p=0.02), respiratory rate (15 vs 20, p=0.009), and oxygen saturation (72 vs 96 p=0.002). Self-pay/uninsured patients had 2.04-fold greater odds of death than privately insured patients (p=0.05). Those requiring nonoperative intubation had 99% greater odds of death (p= 0.006).
Conclusions (implications for practice): Penetrating diaphragmatic injuries in children are associated with significant mortality. Understanding the associated injury patterns and identifying those with predictors of mortality could help improve outcomes.


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