title: Trauma Whipple: do or don’t after severe pancreaticoduodenal injuries? An analysis of the National Trauma Data Bank (NTDB).
abstract: BACKGROUND
  Pancreaticoduodenectomy for trauma (PDT) is a rare procedure, reserved for severe pancreaticoduodenal injuries. Using the National Trauma Data Bank (NTDB), our aim was to compare outcomes of PDT patients to similarly injured patients who did not undergo a PDT.
  
  
  METHODS
  Patients with pancreatic or duodenal injuries treated with PDT (ICD-9-CM 52.7) were identified in the NTDB 2008–2010 Research Data Sets. We excluded those who underwent delayed PDT (>4 days). The PDT group (n = 39) was compared to patients with severe combined pancreaticoduodenal injuries (grade 4 or 5) who did not undergo PDT (non-PDT group, n = 38). Patients who died in the emergency department or did not undergo a laparotomy were excluded. Our primary outcome was death. Secondary outcomes were intensive care unit length of stay (LOS), hospital LOS, and total ventilator days. A multivariate model was used to determine predictors of in-hospital mortality within each group and in the overall cohort.
  
  
  RESULTS
  The non-PDT group had a significantly lower systolic blood pressure and Glasgow Coma Scale values at baseline and more severe duodenal, pancreatic, and liver injuries. There were no significant differences in outcomes between the two groups. The Injury Severity Score was the only independent predictor of mortality among PDT patients [odds ratio (OR) 1.12, 95 % confidence interval (CI) 1.01–1.24] and in the entire cohort (OR 1.06, 95 % CI 1.01–1.12). The operative technique did not influence any of the outcomes.
  
  
  CONCLUSIONS
  Compared to non-PDT, PDT did not result in improved outcomes despite a lower physiologic burden among PDT patients. More conservative procedures for high-grade injuries of the pancreaticoduodenal complex may be appropriate.
authors.forename: Gwendolyn M
authors.initials: GM
authors.lastname: van der Wilden
authors.forename: D  Dante
authors.initials: D
authors.lastname: Yeh
authors.forename: John O
authors.initials: JO
authors.lastname: Hwabejire
authors.forename: Eric N
authors.initials: EN
authors.lastname: Klein
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fagenholz
authors.forename: David R
authors.initials: DR
authors.lastname: King
authors.forename: Marc A
authors.initials: MA
authors.lastname: de Moya
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004386:Duodenum / Q000293:injuries*; D005260:Female; D005704:Gallbladder / Q000293:injuries; D006801:Humans; D007902:Length of Stay; D008099:Liver / Q000293:injuries; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery; D010179:Pancreas / Q000293:injuries*; D016577:Pancreaticoduodenectomy; D055815:Young Adult