title: Traumatic colorectal injuries in children: The National Trauma Database experience.
abstract: OBJECTIVE
  We sought to utilize a nationwide database to characterize colorectal injuries in pediatric trauma.
  
  
  METHODS
  The National Trauma Database (NTDB) was queried for all patients (age≤14years) with colorectal injuries from 2013 to 2014. We stratified patients by demographics and measured outcomes. We analyzed groups based on mechanism, colon vs rectal injury, as well as colostomy creation. Statistical analysis was conducted using t-test and ANOVA for continuous variables as well as chi-square for continuous variables.
  
  
  RESULTS
  There were 534 pediatric patients who sustained colorectal trauma. The mean ISS was 15.6±0.6 with an average LOS of 8.5±0.5days. 435 (81.5%) were injured by blunt mechanism while 99 (18.5%) were injured by penetrating mechanism. There were no differences between age, ISS, complications, mortality, LOS, ICU LOS, and ventilator days between blunt and penetrating groups. Significantly more patients in the penetrating group had associated small intestine and hepatic injuries as well as underwent colostomies. Patients with rectal injuries (25.7%) were more likely to undergo colonic diversion (p<0.0001), but also had decreased mortality (p=0.001) and decreased LOS (p=0.01). Patients with colostomies (9.9%) had no differences in age, ISS, GCS, transfusion of blood products, and complications compared to patients who did not receive a colostomy. Despite this, colostomy patients had significantly increased hospital LOS (12.1±1.8 vs 8.2±0.5days, p=0.02) and ICU LOS (9.0±1.7 vs 5.4±0.3days, p=0.02).
  
  
  CONCLUSIONS
  Although infrequent, colorectal injuries in children are associated with considerable morbidity regardless of mechanism and may be managed without fecal diversion.
  
  
  METHODS
  III.
  
  
  METHODS
  Epidemiology.
authors.affiliation: Division of Pediatric Surgery, Washington University School of Medicine in Saint Louis, One Children's Place, Saint Louis, MO 63110. Electronic address: choip@wudosis.wustl.edu.
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Choi
authors.affiliation: Division of Pediatric Surgery, Washington University School of Medicine in Saint Louis, One Children's Place, Saint Louis, MO 63110. Electronic address: mwallendorf@wustl.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Wallendorf
authors.affiliation: Division of Pediatric Surgery, Washington University School of Medicine in Saint Louis, One Children's Place, Saint Louis, MO 63110. Electronic address: kellerm@wudosis.wustl.edu.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Keller
authors.affiliation: Division of Pediatric Surgery, Texas Children's Hospital, 66701 Fannin Street, Houston, TX 77030. Electronic address: amvogel@texaschildrens.org.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Vogel
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000293:injuries* / Q000601:surgery; D003125:Colostomy / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012007:Rectum / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D014950:Wounds, Penetrating / Q000601:surgery*
keywords: Colorectal injuries; Pediatric trauma