Blunt Trauma and Diaphragm Injury in Children: An Analysis of the National Trauma Data Bank

Background/Objectives: Trauma is the leading cause of mortality and morbidity in children. Traumatic diaphragm rupture (TDR) is a rare but serious injury that can be difficult to identify. The current literature includes individual case reports and single-center case series only, which limits our ability to generalize those findings. The purpose of this study is to use the National Trauma Data Bank (NTDB) in order to examine the clinical outcomes of blunt TDR in the pediatric population. Methods: We included patients from 0 to 18 years of age with blunt TDR using the NTDB from 2007 to 2017. Patient characteristics and demographics, mechanisms of injury, concomitant diagnoses, procedures, and clinical outcomes were extracted from the NTDB. Results: In this study, we identified a total of 88 pediatric patients with blunt TDR. The most common mechanism of injury was motor vehicle accidents (65%). The majority of these blunt TDR injuries were observed in males (73%) with a mean age of 12. Fractures of the spine and ribs (49%) and lacerations of the lungs (42%) were some of the most prevailing associated injuries. Seventy percent of patients were admitted to the ICU. In-hospital mortality was 6%. Conclusions: Overall, TDR is relatively unusual among the pediatric population, but is associated with significant morbidity and mortality. Any significant trauma to neighboring organs-the spine, ribs, and lungs-should heighten awareness of potential diaphragm injury.