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2008 Annual Meeting Abstracts

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Patterns and Outcomes of Hospital Admissions for Pediatric Facial Trauma in the United States: a Survey of the National Trauma Data Bank.
Scott D. Imahara, MD, Richard A. Hopper, MD, MS, Jin Wang, PhD, Frederick P. Rivara, MD, MPH, Matthew B. Klein, MD.
University of Washington, Seattle, WA, USA.

PURPOSE: Trauma is the leading cause of morbidity and mortality in children. The purpose of this study was to examine patterns of pediatric craniofacial injury and outcomes of these injuries utilizing a national trauma database.
METHODS: A retrospective, national population based study was performed among all children age (0-18 years) with bony and soft tissue craniofacial injuries identified in the national database of pediatric injury utilizing the National Trauma Data Bank (2001-2005). Injuries were identified using ICD-9 codes and AIS codes. We analyzed injury patterns and outcomes as a function of age and the presence of craniofacial injuries.
RESULTS: A total of 277,008 pediatric trauma patients (age 0-18 years) were identified during the study period (representing 18.9% of the total patient population). Of these patients, 37,864 (13.7%) children with craniofacial injuries were identified. Among the pediatric population in general, 4.6% had facial fracture (n = 12,739), and 11.6% had facial soft tissues injuries (n = 32,043). An overall male:female ratio of 2:1 was observed with a mean age of 10.3 ± 6.0 years. Overall mortality was 3.5% (n = 1,347). Among pediatric patients with craniofacial injuries overall, motor vehicle collision (51%), motor vehicle versus pedestrian (10.1%), and falls (8.0%) were the most common mechanisms. Among infants and toddlers (0 - 4 years), fall was the second most common mechanism (23.4%); whereas among the older age groups, bicycle, pedestrian and assault related injuries predominated. The most common bony injuries were nasal (10.0%), maxillary/zygoma (9.3%), and mandible (8.6%) fractures, a trend that was similarly observed overall all age subgroups. The incidence of craniofacial injury appears to increase with age from 10.1% among infants and toddlers (0 - 4 years) to 18.5% among adolescents (10 - 18 years, p < 0.001). Associated bony cervical spine fractures were relatively rare (2.6%). Compared with patients without craniofacial injuries, patient with craniofacial injuries more severe associated injury, defined by organ specific abbreviated injury score (AIS ≥ 3), to the head (14.4% vs 8.9%, p< 0.001) and to the chest (7.3% vs 4.6%, p< 0.001). Similarly, patients with craniofacial injuries exhibited significantly greater mean age (11.7 ± 5.9 vs. 10.1 ± 6.0 years, p < 0.001), injury severity scores (11.5 ± 11.0 vs 7.7 ± 8.9, p < 0.001), hospital lengths of stay (4.5 ± 8.9 vs. 3.3 ± 8.0 days, p < 0.001), ICU lengths of stay (0.8 ± 5.2 vs. 2.2 ± 5.5, p < 0.001) and hospital charges (,984 ± 15,241 vs ,008 ± 19243, p < 0.001). Although, overall mortality was low, it was significantly higher among patients with craniofacial injuries (3.5% vs. 2.4%, p < 0.001).
CONCLUSIONS: Age related trends in craniofacial trauma exist. Although bony and soft tissue craniofacial trauma is relatively uncommon among the pediatric patient population, it remains a significant source of morbidity and hospital cost.


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