2008 Annual Meeting Abstracts
The Relationship of Gender and Associated Outcomes of Traumatic Diaphragmatic Hernias
Charles Dolce, Jennifer Keller, K. Christian Walters, H. James Norton, David Iannitti, Kent Kercher, B. Todd Heniford.
Carolinas Medical Center, Charlotte, NC, USA.
Objective: To evaluate the outcomes of traumatic diaphragmatic hernias based on gender and mechanism of injury.
Design: Retrospective analysis of data from the National Trauma Data Bank (NTDB) version 6.2
Setting: Tertiary Care Center
Patients: All patients diagnosed with traumatic diaphragmatic hernias.
Main Outcome Measures: Gender, age, mechanism of injury, Injury Severity Score (ISS), hospital length of stay (LOS), days ventilated, days admitted to the Intensive Care Unit (ICU), and in-hospital mortality rate.
Results: 4,086 TDH’s (82.2% male, 66.7% penetrating injury, mean age of 33.3 years) were analyzed. The overall in-hospital mortality was 9.4%. Females diagnosed with TDH’s were more likely to be older (41.7 vs. 31.5 years, p<0.0001), suffering blunt trauma (66.2% vs. 26.3%, p<0.0001), and have higher Injury Severity Scores (ISS) (28.4, vs. 23.9, p<0.0001) than males. Females had longer hospital stays (16.0 vs. 14.1 days, p<0.0001), duration of mechanical ventilation (8.1 vs. 6.2 days, p<0.003), ICU stays (9.8 vs. 7.4 days, p<0.0001), and higher in-hospital mortality (13.9% vs. 8.5%, p<0.0001). When corrected for ISS and injury mechanism, females and males have equivalent in-hospital mortality (p=0.53), LOS (p=0.52), ICU days (p=0.92), and days on mechanical ventilation (p=0.11). Females and males had significantly higher in-hospital mortality with blunt traumas compared to penetrating (females: 18.7% vs. 4.2%, p<0.0001, males: 14.6% vs. 6.3%, p<0.0001).
Conclusions: The majority of TDH’s diagnosed on admission for females are associated with blunt injury. Given this, females have significantly higher ISS and in-hospital mortality. Clinical outcomes are similar between males and females when corrected for injury severity and mechanism. Outcome of TDH is related to mechanism of injury with no gender associated differences.