10.01 Characteristics and Resource Utilization in Pediatric Blunt and Penetrating Trauma

J. W. Nielsen1, J. Shi2, K. Wheeler2, H. Xiang2, B. D. Kenney1  1Nationwide Children’s Hospital,Division Of Pediatric Surgery,Columbus, OH, USA 2Nationwide Children’s Hospital,Center For Injury Research And Policy At The Research Institute,Columbus, OH, USA

Introduction:  Trauma is a leading cause of pediatric morbidity and mortality.  Children suffer both from blunt and penetrating injuries but the differences in resource utilization based on cause is not well studied.

Methods:  The National Trauma Data Bank (NTDB) was analyzed for all patients 0-18 years of age with ICD-9 external-cause-of-injury codes for blunt and penetrating trauma from 2007-2012.  Demographics, causes, treatments, complications, and outcomes were assessed.   T-test for continuous variables, and Chi-square tests for categorical variables were performed with a significance level of p<0.05.

Results: A total of 748,347 pediatric trauma patients were assessed.  Blunt trauma was identified as the cause in 601,898 (80.43%) patients compared to 55,597 (7.4%) patients with penetrating trauma.  Blunt trauma patients were younger on average (10.2 years vs. 14.7 years, p<0.001) and more likely to be female (34.5% vs. 16.4%, p<0.001).   Despite having only a slightly higher mean ISS (injury severity score) (7.9 vs. 7.6, p<0.001), blunt trauma patients had shorter lengths of stay (LOS) in the hospital (2.9 vs. 4.3 days, p<0.001), fewer complications (34.8% vs. 38.6%, p<0.001), and a much lower mortality rate (1.3% vs. 7.1%, p<0.001).  Penetrating trauma patients were more likely to receive transfusions (5.5% vs. 1.8%, p<0.001) and to undergo exploratory laparotomy (9.4% vs. 0.9%, p<0.001) and thoracotomy (1.7% vs. 0.07%, p<0.001).  Blunt trauma patients were more likely to undergo CT scanning (23.4% vs. 13.0%, p<0.001).  African American mortality was higher than Caucasians for both penetrating (7.9% vs. 5.2%, p<0.001) and blunt (1.3% vs. 1.1%, p<0.001) trauma.

Conclusion:   Blunt trauma is much more common than penetrating trauma among pediatric patients. Blunt trauma patients have shorter LOS, less complications, and lower mortality than penetrating trauma patients.  Penetrating trauma patients are more likely to need operative intervention and blood transfusions.  Racial disparities in outcome exist.