title: Preoperative evaluation of penetrating esophageal trauma in the current era: An analysis of the National Trauma Data Bank.
abstract: BACKGROUND
  Preoperative diagnostic evaluation (PDE) of penetrating esophageal injury (PeEsIn) can delay treatment and increase morbidity. We sought to study the relationship among PDE, delay in definitive treatment, and patient mortality in PeEsIn.
  
  
  METHODS
  The 2008-2010 National Trauma Data Banks were queried for PeEsIn. Exclusion criteria were death within 1 day of injury, and missing data about survival to discharge or operative intervention. Data extracted included demographics, vital signs, injury severity, diagnostic procedures (endoscopy, computed tomography, and fluoroscopy), time to procedures and/or operation, hospital-free days, and mortality.
  
  
  RESULTS
  Of 280 patients, 75 underwent PDE and 205 did not. There were no significant differences in baseline demographics, vital signs or injury severity between the two groups. The median time to the first operation was shorter in the nonPDE cohort compared to the PDE cohort (2 vs. 3 h; P = 0.018). Median hospital-free days at day 60 were significantly less in nonPDE (42 days, interquartile range ([IQR] = [28, 50]) versus PDE patients (47 days, IQR = [38, 51]) (P = 0.007). Mortality was not statistically different.
  
  
  CONCLUSIONS
  PDE in PeEsIn slightly delays the time to operation without worsening mortality, and is a predictor of more hospital-free days.
authors.affiliation: Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care; Harvard Medical School, Boston, MA, USA.
authors.forename: Daniel Dante
authors.initials: DD
authors.lastname: Yeh
authors.affiliation: Howard University Hospital, Washington, DC, USA.
authors.forename: John O
authors.initials: JO
authors.lastname: Hwabejire
authors.affiliation: Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care; Harvard Medical School, Boston, MA, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: de Moya
authors.affiliation: Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care; Harvard Medical School, Boston, MA, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: King
authors.affiliation: Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care; Harvard Medical School, Boston, MA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Fagenholz
authors.affiliation: Howard University Hospital, Washington, DC, USA.
authors.forename: Haytham Ma
authors.initials: HM
authors.lastname: Kaafarani
authors.affiliation: Department of Surgery, Hartford Hospital, Hartford, Connecticut, USA.
authors.forename: Eric N
authors.initials: EN
authors.lastname: Klein
keywords: Endoscopy; esophagus; penetrating; trauma