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Traumatic colorectal injuries in children: The National Trauma Database experience
Pamela M Choi1, Michael Wallendorf1, Martin S Keller1
1Division of Pediatric Surgery, Washington University School of Medicine in Saint Louis, One Children's Place, Saint Louis, MO 63110.
Insights
Pediatric colorectal injuries, though rare, cause significant harm. Rectal injuries may benefit from colonic diversion, but colostomies increase hospital stays.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Gastrointestinal Surgery
Background:
- Colorectal injuries in children are uncommon but can lead to severe outcomes.
- Understanding the epidemiology and management of these injuries is crucial for improving pediatric trauma care.
Purpose of the Study:
- To characterize the nature and outcomes of colorectal injuries in pediatric trauma patients.
- To analyze injury patterns based on mechanism, location, and surgical management.
Main Methods:
- Utilized the National Trauma Database (NTDB) for pediatric patients (age ≤14 years) with colorectal injuries from 2013-2014.
- Stratified patients by demographics, injury mechanism (blunt vs. penetrating), and injury type (colon vs. rectal).
- Analyzed outcomes including length of stay, complications, mortality, and colostomy creation using statistical tests (t-test, ANOVA, chi-square).
Main Results:
- 534 pediatric patients sustained colorectal trauma, with blunt mechanisms being more common (81.5%).
- Penetrating injuries were associated with more small intestine/hepatic injuries and higher rates of colostomy.
- Rectal injuries were linked to increased colonic diversion but decreased mortality and length of stay; colostomies increased hospital and ICU length of stay.
Conclusions:
- Colorectal injuries in children are associated with significant morbidity irrespective of the injury mechanism.
- Management strategies, including the necessity of fecal diversion like colostomy, require careful consideration due to potential impacts on hospital stay.
Purpose:
We sought to utilize a nationwide database to characterize colorectal injuries in pediatric trauma.
Methods:
The National Trauma Database (NTDB) was queried for all patients (age≤14years) with colorectal injuries from 2013 to 2014. We stratified patients by demographics and measured outcomes. We analyzed groups based on mechanism, colon vs rectal injury, as well as colostomy creation. Statistical analysis was conducted using t-test and ANOVA for continuous variables as well as chi-square for continuous variables.
Results:
There were 534 pediatric patients who sustained colorectal trauma. The mean ISS was 15.6±0.6 with an average LOS of 8.5±0.5days. 435 (81.5%) were injured by blunt mechanism while 99 (18.5%) were injured by penetrating mechanism. There were no differences between age, ISS, complications, mortality, LOS, ICU LOS, and ventilator days between blunt and penetrating groups. Significantly more patients in the penetrating group had associated small intestine and hepatic injuries as well as underwent colostomies. Patients with rectal injuries (25.7%) were more likely to undergo colonic diversion (p<0.0001), but also had decreased mortality (p=0.001) and decreased LOS (p=0.01). Patients with colostomies (9.9%) had no differences in age, ISS, GCS, transfusion of blood products, and complications compared to patients who did not receive a colostomy. Despite this, colostomy patients had significantly increased hospital LOS (12.1±1.8 vs 8.2±0.5days, p=0.02) and ICU LOS (9.0±1.7 vs 5.4±0.3days, p=0.02).
Conclusion:
Although infrequent, colorectal injuries in children are associated with considerable morbidity regardless of mechanism and may be managed without fecal diversion.
Level Of Evidence:
III.
Study Type:
Epidemiology.
