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Penetrating injuries to the duodenum: An analysis of 879 patients from the National Trauma Data Bank, 2010 to 2014

Phillips, Bradley MD; Turco, Lauren MD; McDonald, Dan MD; Mause, Alison; Walters, Ryan W. PhD

Journal of Trauma and Acute Care Surgery: November 2017 - Volume 83 - Issue 5 - p 810–817
doi: 10.1097/TA.0000000000001604
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BACKGROUND Despite wide belief that the duodenal Organ Injury Scale has been validated, this has not been reported in the published literature. Based on clinical experience, we hypothesize that the American Association for Surgery of Trauma Organ Injury Scale (AAST-OIS) for duodenal injuries can independently predict mortality. Our objectives were threefold: (1) describe the national profile of penetrating duodenal injuries, (2) identify predictors of morbidity and mortality, and (3) validate the duodenum AAST-OIS as a statistically significant predictor of mortality.

METHODS Using the Abbreviated Injury Scale 2005 and International Classification of Diseases—9th Rev.—Clinical Modification (ICD-9-CM) E-codes, we identified 879 penetrating duodenal trauma patients from the National Trauma Data Bank between 2010 and 2014. We controlled patient-level covariates of age, biological sex, systolic blood pressure (SBP), Glasgow Coma Scale (GCS) score, pulse, Injury Severity Score (ISS), and Organ Injury Scale (OIS) grade. We estimated multivariable generalized linear mixed models to account for the nesting of patients within trauma centers.

RESULTS Our results indicated an overall mortality rate of 14.4%. Approximately 10% of patients died within 24 hours of admission, of whom 76% died in the first 6 hours. Patients averaged approximately five associated injuries, 45% of which involved the liver and colon. Statistically significant independent predictors of mortality were firearm mechanism, SBP, GCS, pulse, ISS, and AAST-OIS grade. Specifically, odds of death were decreased with 10 mm Hg higher admission SBP (13% decreased odds), one point higher GCS (14.4%), 10-beat lower pulse (8.2%), and 10-point lower ISS (51.0%).

CONCLUSION This study is the first to report the national profile of penetrating duodenal injuries. Using the National Trauma Data Bank, we identified patterns of injury, predictors of outcome, and validated the AAST-OIS for duodenal injuries as a statistically significant predictor of morbidity and mortality.

LEVEL OF EVIDENCE Epidemiologic/Prognostic, level IV.

Supplemental digital content is available in the text.

From the Department of Surgery, Department of Clinical Science and Translational Research, (B.P., A.M.), Creighton University School of Medicine, Omaha, Nebraska; Department of Surgery (L.T.), University of Kansas Medical Center, Kansas City, Kansas; Department of Anesthesiology (D.M.), University of Nebraska Medical Center; and Department of Medicine (R.W.W.), Creighton University School of Medicine, Omaha, Nebraska.

Submitted: April 26, 2017, Revised: May 17, 2017, Accepted: May 19, 2017, Published online: June 27, 2017.

The NTDB remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any claims arising from works based on the original Data, Text, Tables, or Figures.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

Address for reprints: Bradley J. Phillips, MD, Department of Surgery, Department of Clinical and Translational Science Creighton University School of Medicine Creighton University Medical Center 601 North 30th Street, Suite 3701 Omaha, NE 68131-2137; email: bjpmd02@gmail.com.

© 2017 Lippincott Williams & Wilkins, Inc.