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A National Analysis of Pediatric Traumatic Duodenal Injuries
Zachary C Ballinger1, Max D Hazeltine1, Alyssa Stetson1
1University of Massachusetts Chan Medical School, Worcester, Massachusetts.
Insights
Pediatric duodenal injuries are severe, often caused by motor vehicle collisions in males. Young children with duodenal injury may indicate nonaccidental trauma (NAT), requiring increased suspicion.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Public Health
Background:
- Traumatic duodenal injuries in children are rare, severe, and complex to diagnose and manage.
- Utilizing a national database provides a comprehensive overview of pediatric duodenal injury characteristics.
Purpose of the Study:
- To analyze the demographic and clinical features of children experiencing duodenal injuries.
- To compare characteristics of duodenal injury patients with other pediatric trauma hospitalizations.
- To investigate duodenal injuries specifically related to nonaccidental trauma (NAT) in children.
Main Methods:
- Cross-sectional analysis of the 2016 Kids' Inpatient Database.
- Identification of duodenal injury cases using ICD-10-CM codes for patients under 18.
- Multivariable logistic regression to compare duodenal injury hospitalizations with other trauma cases and analyze NAT.
Main Results:
- 237 pediatric duodenal injury cases identified; patients were often older males, victims of NAT, with higher injury severity and longer hospital stays.
- Motor vehicle collisions were the most common cause; frequent concomitant injuries included lung, liver, pancreas, and bowel.
- Males (aOR 1.88), older age (aOR 1.04), and NAT (aOR 4.18) were associated with increased odds of duodenal injury hospitalization.
Conclusions:
- Pediatric duodenal injuries predominantly affect males, often from motor vehicle collisions.
- Duodenal injury in children under 3 warrants suspicion for nonaccidental trauma (NAT).
- These injuries are severe, linked to other significant trauma requiring intervention, and result in prolonged hospital stays.
Introduction:
Traumatic duodenal injuries can be difficult to diagnose and manage due to their severity, rarity, and complexity. This study aimed to analyze demographic and clinical characteristics of children with duodenal injuries using a weighted, national database.
Methods:
Cases of duodenal injury in patients <18 y of age were identified in a cross-sectional analysis of the 2016 Kids' Inpatient Database using International Classification of Diseases, 10th Revision Clinical Modification codes. These were compared to all other trauma hospitalizations age <18 y old through multivariable logistic regression to determine odds of hospitalization for duodenal injuries. Secondary analysis was performed on patients with nonaccidental trauma (NAT).
Results:
Duodenal injury patients (n = 237) were frequently older, male, or victims of NAT. They had a higher injury severity score, and longer length of stay. The most common mechanism was motor vehicle collision. Patients with duodenal injuries more often had concomitant lung, liver, pancreas, and large bowel injuries. They more frequently underwent laparotomy, large bowel resection, required parenteral nutrition, and received more blood transfusions. NAT subanalysis demonstrated that as compared to non-NAT duodenal injuries, those with duodenal injuries due to NAT were younger, more often in the Northeast, and more often had government insurance. Multivariable logistic regression demonstrated increased odds of hospitalization of duodenal injury for males as compared to females (adjusted odds ratio [aOR] 1.88; 95% confidence interval [CI] 1.31-2.67), older age (aOR 1.04, 95% CI 1.01-1.07), and victims of NAT (aOR 4.18, 95% CI 2.19-7.97) CONCLUSIONS: Pediatric duodenal injuries most commonly occur in male patients as a result of motor vehicle collisions. Duodenal injury in patients under 3 y of age should raise the index of suspicion for NAT. These injuries overall are severe, are associated with other significant injuries that require intervention, and have a longer length of stay as compared to all other trauma hospitalizations.
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