Massachusetts Chapter of the American College of Surgeons

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Pediatric Foregut Trauma: A National Trauma Data Bank Review
Niloufar Hafezi1,2; Jodi L. Raymond2; Matthew P. Landman2
1Baystate Medical Center, Springfield, MA; 2Indiana University School of Medicine, Indianapolis, IN

Background:
Penetrating and blunt foregut (esophageal and gastric) injuries are rare and not well described in the pediatric literature. Here, we review the incidence of these injuries, and predict that blunt foregut trauma is more common and associated with worse outcomes than penetrating.

Methods:
Following IRB approval, patients <18 years in the national trauma data bank (NTDB) between 2008-2016 with foregut trauma were included. Focus was placed on patients with penetrating and blunt injury types, and each group was compared by bivariate analysis; p<0.05 was significant. The main outcomes of interest were overall incidence rates and mortality.

Results:
841,518 trauma patients <18 years presented over the study period, with 2,043 gastric and 757 esophageal injuries, with incidence rates of 0.24% and 0.09%, respectively. Esophageal trauma increased over time while gastric injuries remained relatively stable (Figure). Injury severity scores (ISS) were higher in penetrating esophageal (p<0.001) and gastric trauma (p=0.015). Penetrating gastric trauma patients underwent more procedures (p<0.001) and had longer hospital LOS (p<0.001) than patients with blunt injuries. While mortality in gastric blunt and penetrating traumas were similar (p>0.999), penetrating esophageal injuries were associated with higher mortality (p=0.007).

Conclusion:
Pediatric esophageal and gastric trauma are exceedingly rare, however, traumatic esophageal injuries are increasing in incidence due to a rise in ingestion-related injuries. Penetrating esophageal and gastric injuries are associated with overall worse outcomes.


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