Epidemiology of Traumatic Esophageal Injury: An Analysis of the National Trauma Data Bank
Introduction: Traumatic injury of the esophagus (TIE) is rare, and the existing
literature is limited. The aim of this descriptive study was to comprehensively describe
the clinical characteristics and outcomes of TIE among trauma patients using the
National Trauma Data Bank (NTDB). Methods: Patients with TIE from 2010-2015 were
identified in the NTDB by the Abbreviated Injury Scale. ... read moreThe prevalence of TIE among
trauma patients was estimated. The demographic and clinical characteristics and hospital
outcomes, including hospital length of stay, complications, and mortality, of these
patients were further analyzed according to injury mechanism, injury severity score
(ISS), and sex. Results: 1,411 adult patients with TIE were identified. The prevalence
of TIE among all trauma patients was 37 patients per 100,000 (95% CI: 35, 39). The
prevalence of TIE was 257 cases per 100,000 (95% CI: 250, 270) among patients with
penetrating trauma and 16 cases per 100,000 (95% CI: 15, 18) among patients with blunt
trauma. Patients with ISS ≥ 25 were 34 times more likely to have TIE than those
with ISS 0-9, and TIE was almost 3 times more likely in males as compared to females.
Among cases of TIE, 523 (37%) were blunt and 888 (63%) were penetrating. Compared to
those with blunt TIE, patients with penetrating TIE were significantly younger (34 vs 46
years), more likely to be male (85% vs 74%), and were more severely injured (ISS
≥ 25: 48% vs 40%) (all p < 0.001). Patients with blunt TIE were more likely to
have associated spine injuries as compared to those with penetrating TIE (43% vs 27%, p
< 0.001). Overall in-hospital mortality in patients with TIE was 19%, and patients
with TIE had significantly higher mortality than those without after adjusting for age,
sex, and ISS (OR = 1.4, 95% CI: 1.1, 1.7). There was no statistically significant
difference in mortality between blunt and penetrating TIE in both crude analysis (20% vs
18%) and multivariable adjusted analyses. Conclusion: TIE is associated with more severe
injuries, male sex, and penetrating trauma. Mortality is markedly elevated in trauma
patients with TIE but is not associated with mechanism of
Thesis (M.S.)--Tufts University, 2018.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: Jessica Paulus.
Committee: Janis Breeze, and Nikolay Bugaev.
Keyword: Surgery.read less