Esophagogastric Trauma in Scotland

• Published in: World journal of surgery 2012-08, Vol.36 (8), p.1779-1784
• Main Authors: Skipworth, Richard J. E., McBride, Olivia M. B., Kerssens, Jan J., Paterson-Brown, Simon
• Format: Article
• Language: English
• Subjects: Abbreviate Injury Scale; Abdominal Surgery; Adolescent; Adult; Aged; Blunt Trauma; Cardiac Surgery; Chi-Square Distribution; Esophagus - injuries; Female; General Surgery; Glasgow Coma Scale; Hemodynamic Compromise; Humans; Incidence; Injury Severity Score; Logistic Models; Male; Medicine; Medicine & Public Health; Middle Aged; Prospective Studies; Risk Factors; Scotland - epidemiology; Statistics, Nonparametric; Stomach - injuries; Surgery; Thoracic Surgery; Vascular Surgery; Wounds, Nonpenetrating - etiology; Wounds, Nonpenetrating - mortality; Wounds, Nonpenetrating - surgery; Wounds, Penetrating - etiology; Wounds, Penetrating - mortality; Wounds, Penetrating - surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-012-1602-4

Background This study was designed to investigate the incidence of esophageal (ET) and gastric trauma (GT) in Scotland and to identify factors associated with adverse outcome. Methods Population-based study of a prospective multicenter database of 52,887 trauma patients, admitted to 25 hospitals from 1992 to 2002. Results Thirty patients [0.06 %; median age, 32 year (range, 15–79); 86.7 % male] sustained ET [17 (56.7 %) blunt vs. 13 (43.3 %) penetrating]. The most common causes of injury were road traffic accidents (RTAs; n  = 11; 36.7 %) and assaults ( n  = 10; 33.3 %). Most patients ( n  = 25; 83.3 %) had injury severity scores (ISS) >15, consistent with severe trauma. Fifteen patients (50 %) underwent surgery, of whom 8 (53.3 %) died. Another 13 patients died, yielding an overall mortality rate of 70 %. In contrast, 149 patients [0.29 %; median age, 28 year (range, 13–74); 90.6 % male] sustained GT [124 (83.2 %) penetrating vs. 25 (16.8 %) blunt]. The predominant cause was assault ( n  = 119; 79.9 %). Most patients ( n  = 134; 89.9 %) underwent surgery, of which 23 (17.2 %) died. Another 12 patients died, yielding an overall mortality rate of 23.5 %. Factors associated independently with GT mortality included higher ISS, lower Glasgow coma scale (GCS), and hemodynamic compromise. Conclusions Esophagogastric trauma occurs predominantly in young males. The incidence of GT, although low, is five times that of ET. Predominant mechanisms of GT are penetrating compared with blunt for ET. Both ET and GT are commonly found in the presence of other multiple injuries, and are associated with high mortality. Operative management of GT is associated with reduced mortality, but outcome is worse for patients with hemodynamic compromise, low GCS, and high ISS.