Dr. Melvin Stone Jr., Director of the Surgical Intensive Care Unit at NYC Health + Hospitals/Jacobi, published an article this past April in The Journal of Trauma and Acute Care Surgery that presents groundbreaking literature on an unusual injury: penetrating neck trauma in children.
“Penetrating neck trauma in young children is a pretty uncommon event to begin with,” Dr. Stone says. “I can count on my hand how many patients under 15 have come in here with penetrating neck trauma and I’ve been working here for 15 years.”
Dr. Stone says there is not a lot of literature on this mechanism of injury in children, compared with literature on adult penetrating neck injuries, and the literature that does exist is not based on large data sets. He hopes his article helps to fill an important gap in the available literature.
“It’s always important as a traumatologist to look at injury as a disease, like cancer or cardiology,” says Dr. Stone, who is also the Associate Director of Trauma Services and Surgical Critical Care at Jacobi.
“So you need to know the epidemiology of the injury and the specific details: what’s common, what are the mechanisms of penetrating trauma, how is it managed in kids and what are the outcomes — specifically mortality.”
Dr. Stone and his co-authors looked at statistics from 2008 through 2012 from the National Trauma Data Bank, which includes data from trauma centers around the country. They confirmed that penetrating neck trauma among children is extremely rare—representing just 0.28 percent of trauma incidents involving children under the age of 15 (1,238 patients out of 434,788 cases of pediatric trauma.)
Of those patients, more than two-thirds were boys and the most common causes were stabbing (44 percent) and gunshots (24 percent). Most of the patients were treated at pediatric trauma centers (65.8 percent) and almost a quarter went directly to an operating room (23.7 percent). The mortality rate was 5.6 percent.
However, the researchers were unable to make any link between the data and inner city violence because the data is listed only by regions, not by cities.
Dr. Stone presented his article at the annual meeting of the American Association for Surgery of Trauma in Las Vegas on September 9, 2015. He said his fellow surgeons were most surprised at the high rate of gunshots and stabbings and the small number of dog bites causing penetrating neck trauma.
“We were able to take data from trauma centers across the United States to give a better sense of what’s going on, rather than looking at single institutions,” Dr. Stone says. “With our paper, we hopefully have a better understanding of penetrating neck trauma in children.”
Dr. Stone’s co-authors were Dr. Benjamin A. Farber, Odunayo Olorunfemi, MBBS; Stanley Kalata, Dr. James A. Meltzer, Dr. Edward Chao, Dr. Srinivas H. Reddy and Dr. Sheldon Teperman, Director of Trauma Services and Surgical Critical Care at Jacobi.