J. Tashiro1, C. J. Allen1, J. Rey2, E. A. Perez1, C. M. Thorson1, B. Wang1, J. E. Sola1 1University Of Miami,Division Of Pediatric Surgery, DeWitt-Daughtry Department Of Surgery,Miami, FL, USA 2University Of Miami,Division Of Vascular And Endovascular Surgery, DeWitt-Daughtry Department Of Surgery,Miami, FL, USA
Introduction: Aortic injuries are rare, but have a high mortality rate in children and adolescents. We sought to investigate mechanisms of injury and predictors of survival.
Methods: Kids’ Inpatient Database was used to identify cases of thoracic and abdominal aortic injury (ICD-9-CM 901.0, 902.0) in patients aged <20 yrs (1997-2009). Demographic and clinical characteristics were analyzed using standard and multivariate methods. Cases were limited to emergent or urgent admissions.
Results: Overall, 468 cases were identified. Survival was 65% for the cohort, 63% for boys, and 68% for girls. Average length of stay was 10.7±14.0 days with charges 105,110±121,838 USD. Adolescents (15-19 years) and males comprised the majority of the group (84% and 79%, respectively). Patients were predominantly Caucasian (45%) and privately insured (51%). Injuries tended to affect patients in the lowest income quartile (36%) and most presented to large (78%) or urban teaching (83%) hospitals. The most common mechanism of injury was motor vehicle-related (77%), followed by other penetrating trauma (10%) and firearm injury (8%). On logistic regression modeling, select diagnoses and procedures, along with gender, race group, payer / income status, and hospital type were found to be significant determinants of mortality. Boys (OR: 0.15 [95% CI: 0.05, 0.44]) and Hispanic children (OR: 0.14 [0.04, 0.55]) had lower associated mortality vs. girls and Caucasian patients, respectively. Self-pay patients (OR: 6.91 [2.01, 23.8]) had higher mortality vs. privately insured patients. Children in the lowest income quartile (OR: 15.5 [4.16, 57.6]) had higher mortality vs. highest income patients. Patients admitted to urban non-teaching hospitals (OR: 0.13 [0.03, 0.55]) had lower mortality vs. those admitted to urban teaching hospitals. Patients with traumatic shock (OR: 47.8 [12.4, 184]) or necessitating exploratory laparotomy (OR: 13.9 [2.12, 91.8]) had the lowest associated survival overall. Patients undergoing repair of vessel (OR: 0.25 [0.10, 0.62]) or resection of thoracic vessel with replacement (OR: 0.18 [0.04, 0.73]) had higher associated survival. Survival increased over the study period between 1997 and 2009, p<0.01.
Conclusion: Motor vehicle-related injuries are the predominant mechanism of aortic injury in the pediatric population. Gender, race, payer status, income quartile, and hospital type, along with associated procedures and diagnoses, are significant determinants of mortality on multivariate analysis.
