Penetrating oesophageal injury: a contemporary analysis of the National Trauma Data Bank.
BACKGROUND
Oesophageal trauma is uncommon. The aim of this study was to conduct a descriptive analysis of penetrating oesophageal trauma and determine risk factors for oesophageal related complications and mortality in the National Trauma Data Bank (NTDB).


METHODS
Patients with penetrating oesophageal trauma from Levels 1 and 2 trauma centres in the NTDB (2007 and 2008) that specified how complication and comorbidity data were recorded were selected. Data collected included age, injury severity score (ISS), abbreviated injury scores (AIS), lengths of stay (LOS) and ventilation days, systolic blood pressure (SBP) in the emergency department (ED), comorbidities, oesophageal related procedures, and oesophageal related complications. Univariate and multivariable analyses were conducted to identify significant predictors of oesophageal-related complications and mortality in patients with LOS>24 h.


RESULTS
227 patients from 107 centres were studied. The mean number of patients per centre was 2 (range 1-15). Overall mortality was found to be 44% with 92% of these deaths in less than 24 h. In patients with LOS>24 h, 62% had primary repair, 13% drainage, 4% resection, 1% diversion, and 20% unspecified. No significant difference in mortality was found in patients with oesophageal related complications. The time to first oesophageal related procedure was not significantly different in those with oesophageal related complications or those who died. Significant predictors of oesophageal related complications were age and AIS of the abdomen or pelvic contents ≥3 and the only significant predictor of mortality was ISS.


CONCLUSIONS
Most deaths in penetrating oesophageal trauma occur in the first 24 h due to severe associated injuries. Primary repair was the most common intervention, followed by drainage and resection. Oesophageal related complications were not found to significantly increase mortality and time to first oesophageal related procedure did not affect outcomes in this subset of patients from the NTDB.
University of California, Irvine, United States. patelms@uci.edu
Madhukar S
MS
Patel
Darren J
DJ
Malinoski
Lynn
L
Zhou
Melanie L
ML
Neal
David B
DB
Hoyt
D000007:Abdominal Injuries / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D016208:Databases, Factual; D042241:Early Diagnosis; D004947:Esophagus / Q000293:injuries* / Q000601:surgery; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009104:Multiple Trauma / Q000401:mortality*; D012042:Registries; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D014193:Trauma Centers; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery