Blunt Esophageal Injury and Importance of Early Diagnosis: A National Trauma Data Bank Analysis

Abstract

Objective: Blunt esophageal trauma is a rare entity. The aim of this study is to examine current management strategies, and determine risk factors associated with complications and mortality in the National Trauma Data Bank (NTDB). Materials and methods:Using the NTDB from 2012, we identified adult patients who suffered blunt esophageal trauma. Patients were categorized undergoing early vs delayed management of esophageal injuries. Data collected included age, injury severity score (ISS), abbreviated injury score, length of stay, ventilation days, systolic blood pressure (SBP), time to procedure, comorbidities, esophageal-related procedures, complications, and disposition. Univariate and multivariable analysis were conducted to identify significant predictors of complications and mortality. Results:We identified 160 adult patients with blunt esophageal injuries in the NTDB, of which 78 patients (49%) had data on specific management of the esophageal injury. Forty-five patients (58%) underwent early operative management and 33 (42%) had delayed operative management. Of patients in the early group, 31 (63%) had primary repair, 11 (24.4%) esophageal graft, and 3 (6.6%) esophageal tube placement. In the delayed operative group, 4 (12%) had primary repair, 14 (42%) esophageal graft, 10 (30%) esophageal tube placement, and 5 (15%) had drainage. Early diagnosis was associated with a higher definitive primary repair rate. Mortality was similar between both groups (15.5 and 24.4%, p = 0.336). The delayed group was associated with increased risk of pulmonary complications. Both groups were similar in age, gender, and race. Significant predictors of esophageal-related complications were Abbreviated Injury Scale (AIS) ≥3 and ISS. Conclusion:Although rare, high index of suspicion for early detection of blunt esophageal injury must be maintained. Early operative management was associated with an increased rate of primary repair of the injury and decreased pulmonary complications.