Incidence of Morbidity From Penetrating Palate Trauma WHAT’S KNOWN ON THIS SUBJECT: Reports of previous studies of oropharyngeal injury in children have described wound characteristics, injury vectors, and results from radiologic studies. The true risk of stroke and infection is unknown. Providers face decisions regarding which patients require computed tomographic angiography, an otorhinolaryngologist consultation, or hospitalization. WHAT THIS STUDY ADDS: This study’s results reveal an incidence of 0% for stroke and 0.9% for infection and confirm a wide variation in testing and treatment and an increase in the rate of computed tomographic angiography and hospitalization over time. Positive computed tomographic angiography results did not lead to significant interventions. abstract BACKGROUND: The true rate of neurologic sequelae and infection from penetrating palatal trauma in children is unknown, which leads to significant variation in testing and treatment. OBJECTIVES: To (1) determine the incidence of stroke and infection in well-appearing children with penetrating palatal trauma and (2) describe patterns of testing and treatment for uncomplicated palatal trauma. METHODS: We assembled a retrospective cohort of children aged 9 months to 18 years with palatal trauma seen in the emergency depart- ment (ED) at a tertiary care pediatric hospital. Patients met the follow- ing definition: well-appearing with normal neurologic examination and a palate laceration but no findings requiring immediate operative care. Stroke was defined as any abnormal neurologic examination second- ary to palatal trauma. Infection was defined as cellulitis or abscess secondary to palatal injury. All abnormal computed tomographic an- giography (CTA) findings, except for free air, were considered positive and potentially significant. RESULTS: We identified 1656 potential subjects. A total of 995 of 1656 subjects were screened, and 205 of 995 met the case definition. A total of 122 of 205 had follow-up through at least 1 week after injury. The incidence of stroke in our study population was 0% (95% confidence interval [CI]: 0 –2.5). One of 116 patients developed infection, for an incidence of 0.9% (95% CI: 0 –5.3). A total of 90 of 205 (44%) subjects had CTA scans; the results of 9 (10%) were positive. No patients with posi- tive CTA findings required operative care. No patients received antico- agulant medications. CONCLUSIONS: The incidence of morbidity from penetrating palatal trauma in the well-appearing child is extremely low. Diagnostic evalu- ation in the ED did not prompt clinical interventions other than antibi- otics. Pediatrics 2010;126:e1578–e1584 AUTHORS: Kara Hennelly, MD, a Amir Kimia, MD, a Lois Lee, MD, MPH, a Dwight Jones, MD, b and Stephen C. Porter, MD, MPH, MSc, a,b,c a Division of Emergency Medicine, b Department of Otolaryngology, and c Children’s Hospital Informatics Program, Children’s Hospital Boston, Boston, Massachusetts KEY WORDS trauma, oropharynx, palate, stroke, emergency medical services, pediatric, diagnostic tests ABBREVIATIONS ED—emergency department CTA—computed tomographic angiography CI—confidence interval www.pediatrics.org/cgi/doi/10.1542/peds.2010-1059 doi:10.1542/peds.2010-1059 Accepted for publication Aug 11, 2010 Address correspondence to Kara Hennelly, MD, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115. E-mail: kara.hennelly@childrens.harvard.edu PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2010 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. e1578 HENNELLY et al by guest on August 6, 2018 www.aappublications.org/news Downloaded from