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Original Investigation |

Resource Utilization and National Demographics of Laryngotracheal Trauma in Children

Michael E. McCormick, MD1; Thomas M. Fissenden, MD2; Robert H. Chun, MD1; Lina Lander, ScD3; Rahul K. Shah, MD, MBA2,4
[+] Author Affiliations
1Department of Otolaryngology, Medical College of Wisconsin, Milwaukee
2Department of Otolaryngology, George Washington University, Washington, DC
3Department of Epidemiology, University of Nebraska Medical Center, Omaha
4Division of Pediatric Otolaryngology, Children’s National Medical Center, Washington, DC
JAMA Otolaryngol Head Neck Surg. 2014;140(9):829-832. doi:10.1001/jamaoto.2014.1410.
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Importance  Pediatric laryngotracheal trauma is rare but can carry considerable morbidity and health care resource expenditure. However, the true cost of these injuries has not been thoroughly investigated.

Objective  To use a national administrative pediatric database to identify normative data on pediatric laryngotracheal trauma, specifically with regard to cost and resource utilization.

Design and Participants  Retrospective medical record review using the Kids’ Inpatient Database (KID) 2009. Inclusion criteria were admissions with International Classification of Diseases, Ninth Revision, Clinical Modification, codes for fractures or open wounds of the larynx and trachea.

Main Outcomes and Measures  Among many data analyzed were demographic information and admission characteristics, including length of stay, diagnoses, procedures performed, and total charges.

Results  There were 106 admissions that met inclusion criteria. Patient mean (SE) age was 15.9 (0.45) years, and 79% were males. The mean (SE) length of stay (LOS) was 8.4 (1.1) days; more than 50% of patients had a LOS longer than 4 days. The mean number of diagnoses per patient was 6.9 (0.6); other traumatic injuries included pneumothorax (n = 18). More than 75% of patients underwent more than 2 procedures during their admission; 60.2% underwent a major operative procedure. The most common procedures performed were laryngoscopy (n = 54) and operative repair of the larynx and/or trachea (n = 32). Tracheostomy was performed in only 30 patients. The mean (SE) total charge was $90 879 ($11 419), and one-third of patients had total charges more than $100 000.

Conclusions and Relevance  Pediatric laryngotracheal trauma remains a relatively rare clinical entity. These injuries primarily affect older children and are associated with long hospitalizations, multiple procedures, and high resource utilization.

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