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Epidemiology of pediatric cardiac injuries: a National Trauma Data Bank analysis
Yvonne E Kaptein1, Peep Talving, Agathoklis Konstantinidis
1Department of Surgery, Division of Acute Care Surgery at Los Angeles County, University of Southern California Medical Center, Los Angeles, CA 90033, USA. ykaptein@usc.edu
Insights
Pediatric cardiac injuries are predominantly blunt, often involving contusion. Despite high in-hospital mortality, adjusted mortality rates for traumatic cardiac injury show no age-related differences.
Area of Science:
- Trauma Surgery
- Pediatric Cardiology
- Epidemiology
Background:
- Limited research exists on pediatric cardiac injuries in large patient groups.
- This study addresses the epidemiology of traumatic cardiac injuries in children within the United States.
Purpose of the Study:
- To investigate the epidemiology of pediatric cardiac injuries.
- To analyze demographic, clinical, and outcome data based on age groups.
- To determine adjusted mortality rates across different pediatric age strata.
Main Methods:
- Utilized the National Trauma Data Bank to identify patients with traumatic cardiac injury.
- Employed International Classification of Diseases, Ninth Revision codes for patient identification.
- Compared demographic, clinical, and in-hospital outcomes across five pediatric age groups using logistic regression analysis.
Main Results:
- Six hundred twenty-six pediatric patients met the criteria for traumatic cardiac injury.
- Cardiac contusion (59%) was the most common injury, followed by laceration (36%).
- Firearm injuries had the highest mortality rate (76%), and overall in-hospital mortality was 40%.
Conclusions:
- Blunt trauma (65%) was the predominant mechanism for pediatric cardiac injury, frequently associated with contusion.
- Pediatric cardiac injury is linked to high in-hospital mortality (40%).
- Adjusted mortality rates for pediatric cardiac injury did not differ significantly across age groups.
Background:
Few studies of pediatric cardiac injuries have been conducted in large cohorts. We, therefore, investigated the epidemiology of these injuries in the United States.
Methods:
We identified patients with traumatic cardiac injury from the National Trauma Data Bank, using the International Classification of Diseases, Ninth Revision, codes. Demographic data, clinical data, and inhospital outcomes were compared among 5 age groups. A logistic regression model was used to determine adjusted mortality among these groups.
Results:
Six hundred twenty-six patients met criteria. Fifty-nine percent sustained cardiac contusion; 36%, laceration. Penetrating injuries proved more severe than blunt, having lower average Glasgow Coma Scale (6.8 vs 8.7) and higher percentage of patients with Glasgow Coma Scale of 8 or lower (68% vs 53%). Associated injuries occurred in 484 (77%), most common being lung injuries (46%), hemopneumothorax (37%), and rib fractures (26%). Eleven percent underwent laparotomy; 9%, thoracotomy; 2%, craniotomy/craniectomy; and 0.2%, sternotomy. Complications occurred in 80 (13%), most common being cardiac arrest (4%). Firearm injuries result in the highest mortality rate (76%), compared with other mechanisms (26%-31%). Crude mortality in different age strata showed significant differences that were lost after adjustment for confounding variables.
Conclusions:
The predominant cardiac injury was blunt (65%; 35% sustained penetrating insults), frequently paired with contusion. Pediatric cardiac injury is associated with excessive inhospital mortality (40%), with no age-related difference in adjusted mortality.
