Mechanism and mortality of pediatric aortic injuries.
BACKGROUND
Aortic injuries are rare, but have a high mortality rate in children and adolescents. We sought to investigate mechanisms of injury and predictors of survival.


METHODS
The Kids' Inpatient Database (1997-2009) was used to identify cases of thoracic and abdominal aortic injury (International Classification of Diseases, ninth Revision, Clinical Modification codes 901.0, 902.0) occurring in children aged <20 y. Bivariate and risk-adjusted multivariate analyses were used to reveal associated diagnoses and procedures and to identify predictors of in-hospital mortality, respectively. Cases were limited to emergent or urgent admissions.


RESULTS
A total of 468 cases were identified. Survival was 65% overall, 63% for boys and 68% for girls. The most common mechanism of injury was motor vehicle-related (77%), followed by other penetrating trauma (10%) and firearm injury (8%). On multivariate modeling, boys (odds ratio, 0.15 [95% confidence interval, 0.05, 0.45]) and Hispanic children (0.17 [0.05, 0.60]) had lower associated mortality versus girls and Caucasians, respectively. Self-pay patients (6.47 [1.94, 21.6]) had higher mortality versus privately insured patients. Children in the fourth income quartile had lower mortality versus all income quartile patients. Patients admitted to urban nonteaching hospitals (0.15 [0.04, 0.59]) had lower mortality versus those admitted to urban teaching hospitals. Patients with traumatic shock (47.9 [12.3, 187]) or necessitating exploratory laparotomy (13.7 [2.06, 91.4]) had the highest associated mortality overall. Survival increased over the study period between 1997 and 2009.


CONCLUSIONS
Motor vehicle-related injuries are the predominant mechanisms of aortic injury in the pediatric population. Gender, race, payer status, income quartile, and hospital type, along with associated procedures and diagnoses, are significant determinants of mortality on multivariate analysis.
Division of Pediatric Surgery, University of Miami, Miami, Florida.
Jun
J
Tashiro
Division of Pediatric Surgery, University of Miami, Miami, Florida.
William M
WM
Hannay
Division of Pediatric Surgery, University of Miami, Miami, Florida.
Charlene
C
Naves
Division of Pediatric Surgery, University of Miami, Miami, Florida.
Casey J
CJ
Allen
Division of Pediatric Surgery, University of Miami, Miami, Florida.
Eduardo A
EA
Perez
Division of Vascular and Endovascular Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
Jorge
J
Rey
Division of Pediatric Surgery, University of Miami, Miami, Florida. Electronic address: jsola@med.miami.edu.
Juan E
JE
Sola
D000293:Adolescent; D001011:Aorta / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D057772:Vascular System Injuries / Q000209:etiology* / Q000401:mortality*; D055815:Young Adult
Aorta; Outcomes research; Vascular system injuries