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A National Analysis of Pediatric Duodenal Injuries
Max D. Hazeltine, Zachary Ballinger, Alyssa Stetson, Erin Caffrey, Michael P. Hirsh, Jeremy T. Aidlen, Muriel A. Cleary
Surgery, UMass Chan Medical School, Worcester, Massachusetts, United States


Objective:
To analyze demographic and clinical characteristics of children with duodenal injuries using a weighted, national database.

Design:
Cases of duodenal injury were identified in a cross-sectional analysis of the 2016 Kids' Inpatient Database using ICD-10 codes. Demographic and clinical characteristics of patients age <18 years with duodenal injuries were compared to all other trauma hospitalizations age <18 years old through multivariable logistic regression to determine odds of hospitalization for duodenal injuries.

Setting:
The Kids' Inpatient Database is assembled from administrative data and discharge abstracts which encompass all-payer pediatric inpatient data from 4000 US community hospitals. It estimates roughly 7 million hospitalizations (weighted).
Patients or Other Participants:
237 patients were hospitalized after duodenal injury in 2016 in the Kids' Inpatient Database based on ICD-10 code queries.

Interventions:
None

Main Outcome Measures:
Hypothesis: duodenal injuries in children have higher Injury Severity Scores, longer lengths of stay, and more concomitant injuries to critical organ systems. Secondary analysis was performed on NAT, and gender and age demographic characteristics.

Results:
Duodenal injury patients were frequently older (10.3 vs 9.1 years), male (71.4% vs 57.1%) and victims of NAT (5.3% vs 1.7%, all p<0.05). They had a higher Injury Severity Score (18.8 vs 5.3), and longer length of stay (12.9 vs 5.2 mean days, all p<0.001). The most common mechanism was motor vehicle collision (22.8%), and bicyclist (8.2%). Patients with duodenal injuries more often had lung (42.1% vs 4.3%), liver (33.7% vs 1.7%), pancreas (23.6% vs 0.2%), and large bowel injuries (18.3% vs 0.5%, all p<0.001); and more frequently underwent laparotomy (7.0% vs 0.1%), large bowel resection (6.8% vs 0.2%), parenteral nutrition (20.0% vs 1.5%), and received moreblood transfusions (9.4% vs 4.0%, all p<0.001). NAT sub-analysis demonstrated that as compared to non-NAT duodenal injuries, those with duodenal injuries due to NAT were younger (2.3 vs 10.7 years, p<0.001), more often in the Northeast (43.6% vs 14.4%, p=0.007), and more often had government insurance (88.4% vs 45.1%, p=0.013). 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. Younger patients presenting with this injury are more likely to be victims of 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. Duodenal injury in patients under three years of age should raise the index of suspicion for NAT.


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