title: Epidemiology of pediatric cardiac injuries: a National Trauma Data Bank analysis.
abstract: BACKGROUND
  Few studies of pediatric cardiac injuries have been conducted in large cohorts. We, therefore, investigated the epidemiology of these injuries in the United States.
  
  
  METHODS
  We identified patients with traumatic cardiac injury from the National Trauma Data Bank, using the International Classification of Diseases, Ninth Revision, codes. Demographic data, clinical data, and inhospital outcomes were compared among 5 age groups. A logistic regression model was used to determine adjusted mortality among these groups.
  
  
  RESULTS
  Six hundred twenty-six patients met criteria. Fifty-nine percent sustained cardiac contusion; 36%, laceration. Penetrating injuries proved more severe than blunt, having lower average Glasgow Coma Scale (6.8 vs 8.7) and higher percentage of patients with Glasgow Coma Scale of 8 or lower (68% vs 53%). Associated injuries occurred in 484 (77%), most common being lung injuries (46%), hemopneumothorax (37%), and rib fractures (26%). Eleven percent underwent laparotomy; 9%, thoracotomy; 2%, craniotomy/craniectomy; and 0.2%, sternotomy. Complications occurred in 80 (13%), most common being cardiac arrest (4%). Firearm injuries result in the highest mortality rate (76%), compared with other mechanisms (26%-31%). Crude mortality in different age strata showed significant differences that were lost after adjustment for confounding variables.
  
  
  CONCLUSIONS
  The predominant cardiac injury was blunt (65%; 35% sustained penetrating insults), frequently paired with contusion. Pediatric cardiac injury is associated with excessive inhospital mortality (40%), with no age-related difference in adjusted mortality.
authors.affiliation: Department of Surgery, Division of Acute Care Surgery at Los Angeles County, University of Southern California Medical Center, Los Angeles, CA 90033, USA. ykaptein@usc.edu
authors.forename: Yvonne E
authors.initials: YE
authors.lastname: Kaptein
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Agathoklis
authors.initials: A
authors.lastname: Konstantinidis
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: David
authors.initials: D
authors.lastname: Plurad
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D015600:Glasgow Coma Scale; D006335:Heart Injuries / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000601:surgery; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000601:surgery