Urgent Video-Assisted Thoracoscopic Surgery After Penetrating Pediatric Trauma: A Propensity- Matched Analysis

Urgent Video-Assisted Thoracoscopic Surgery After Penetrating Pediatric Trauma: A Propensity- Matched Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Urgent Video-Assisted Thoracoscopic Surgery After Penetrating Pediatric Trauma: A Propensity- Matched Analysis Daniel Mangan, Jeffry Nahmias, Peter Nguyen, Matthew Dolich, Sebastian Schubl, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6542458/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract INTRODUCTION : Outcomes following urgent video-assisted thoracoscopic surgery (VATS) after penetrating thoracic trauma in pediatric patients is unknown. We hypothesized that patients undergoing urgent VATS would have a higher risk of in-hospital mortality and complications, compared to similarly matched patients not undergoing VATS. METHODS : The 2017-2019 Trauma Quality Improvement Program database was queried for patients <17-years of age presenting after isolated penetrating thoracic trauma. Patients undergoing VATS within 6-hours were compared to those not undergoing VATS using a 1:1 propensity-score model. RESULTS : From 18,596 isolated penetrating trauma patients, 369 (2.0%) underwent VATS within six hours. 360 patients undergoing VATS were matched to 360 patients not undergoing VATS. There were no differences in age, sex, race, and comorbidities (all p>0.05). The VATS group had a higher rate of hypotension on admission (10.8% vs. 2.6%, p<0.001) and more often required blood transfusions within the first 4-hours (22.0% vs. 9.4%, p<0.001). The VATS group had a higher rate of injuries to the lung (26.1% vs. 11.4%, p<0.001), diaphragm (11.7% vs. 0.6%, p<0.001), spine (10.0% vs. 3.3%, p<0.001), and heart (5.3% vs. 0.6%, p<0.001). The overall rate and associated risk of major complications (5.8% vs. 0.3%, p<0.001; OR 22.24, CI 2.98-166.24, p=0.003) were higher in the VATS group, as was the risk of death (5.8% vs. 0.3%, p<0.001; OR 7.00 CI 2.06-23.77, p=0.002). CONCLUSION : Urgent pediatric VATS after isolated penetrating thoracic trauma occurs in 2% of cases. These patients have a 22-fold higher associated risk of complications and 7-fold higher risk of death. Trauma Thoracic Video-Assisted Thoracoscopic Surgery (VATS) Pediatric INTRODUCTION Nearly 60% of all pediatric deaths are related to traumatic injury with the most common mechanism being firearm related injury, which surpassed motor vehicle collisions in 2020. 1 , 2 Up to 8% of pediatric trauma patients will present with an injury to the thorax which has an estimated mortality between 14–50%. 3,4 In adults, Video-Assisted Thoracoscopic Surgery (VATS) has become the standard of care for a wide array of thoracic conditions and its use has expanded to include thoracic trauma. 5 It has been previously estimated that VATS can replace thoracotomy in up to 60% of adult thoracic trauma patients. 6 In infants and children, VATS has been safely used for a variety of conditions and it’s been postulated that it may be associated with less complications and a shorter hospital length of stay (LOS), compared to open surgery. 7 In penetrating pediatric trauma, VATS has been successfully used to manage retained hemothorax with only a 15% conversion rate to a thoracotomy. 8 However, clinical outcomes following urgent VATS after penetrating trauma in the pediatric population have not been previously reported and therefore it is difficult to prognosticate outcomes for patients and parents. Therefore, this study aimed to evaluate clinical outcomes after urgent VATS in the pediatric population to better define the risk of morbidity and mortality compared to similarly matched patients who did not undergo VATS. Our hypothesis was that patients undergoing urgent VATS would have a higher rate and risk of in-hospital mortality and complications compared to patients not undergoing VATS. METHODS This study was deemed exempt by our institutional review board as it utilizes a national deidentified database. The 2017–2019 Trauma Quality Improvement Program database was queried for patients ≤ 17-years of age presenting after isolated penetrating trauma to the thorax. An isolated thoracic injury was defined by an abbreviated injury scale (AIS) ≤ 1 for the head, neck, and abdomen. Patients that died in the emergency department or were transferred from another hospital were excluded. Patients undergoing VATS within 6-hours were compared to those not undergoing VATS. Due to the observed imbalances of pediatric trauma patients who did and did not undergo VATS within 6-hours of arrival, a propensity-matched analysis was performed using a 1:1 model. We chose to match patients based on demographics and not the injury profile as the injuries and vitals on admission likely influenced the decision to proceed with VATS. This would allow us to determine clinical outcomes for patients that presented with injuries severe enough to warrant an urgent VATS. Patients were matched based on pre-hospital variables including age, sex, race, and comorbidities. The comorbidities matched for included attention-deficit hyperactivity disorder, hypertension, diabetes, smoking, mental personality disorder and substance abuse. The only cases that were entered into our analysis were within 0.001 of the estimated logit, defined as caliper matching. This is a validated method of emulating randomization in observational studies. 9 We then preformed a Mann-Whitney U test for all continuous variables and a chi-squared test for all categorical variables. These bivariate analyses were performed for all pre-hospital variables to confirm a successfully matched cohort. The primary outcome was mortality. The secondary outcome was major complications defined as cardiac arrest, unplanned intubation, myocardial infarction (MI), acute respiratory distress syndrome (ARDS), unplanned return to OR, and stroke. Additional outcomes evaluated included unplanned intensive care unit (ICU) admission, length of stay (LOS) and ICU LOS. We additionally performed a univariable logistic regression analysis to identify the odds of mortality or major complication. All p-values were two-sided, with a statistical significance level of < 0.05. All Analysis were performed with IBM SPSS Statistics for Windows, Version 28 (Armonk, NY: IBM corp). RESULTS Demographics of pediatric VATS patients and non-VATS patients From 18,596 pediatric isolated penetrating thoracic trauma patients, 369 (2.0%) underwent urgent VATS within six hours. Of these, 360 (97.6%) patients undergoing VATS were successfully matched to 360 patients not undergoing VATS. There was no difference in age, sex, race, and comorbidities between the two groups (all p>0.05). The most common mechanism of injury in both groups was a gunshot wound (VATS, 61.9% vs. non-VATS, 57.2%, p=0.20). The VATS group had a higher rate of hypotension on admission (10.8% vs. 2.6%, p<0.001) and more often required blood transfusions within the first 4-hours (22.0% vs. 9.4%, p<0.001). The VATS group also had a higher rate of injuries to the lung (26.1% vs. 11.4%, p<0.001), diaphragm (11.7% vs. 0.6%, p<0.001), spine (10.0% vs. 3.3%, p<0.001), and heart (5.3% vs. 0.6%, p<0.001) ( Table 1 ). VATS patients underwent lung resection in 9% of cases and diaphragm repair in 6.4% of cases. Primary and Secondary Outcomes The overall rate and associated risk of major complications were higher in the VATS group (5.8% vs. 0.3%, p<0.001; OR 22.24, CI 2.98-166.24, p=0.003), as was the rate and associated risk of death (5.8% vs. 0.3%, p 24-hours from arrival. The most common complication in the VATS group was cardiac arrest (1.4%) ( Table 2 ). Patients in the VATS cohort had a longer median LOS (6 vs. 2 days, p<0.002) and ICU LOS (3 vs. 2 days, p=0.015), compared to the non-VATS cohort. They also were more likely to have an unplanned ICU admission (1.1% vs. 0%, p=0.045) and more likely to have an unplanned return to the OR (2.2% vs. 0%, p=0.004) ( Table 3 ). DISCUSSION The use of minimally invasive surgery including VATS has increased exponentially in both the elective and more emergent setting for both adult and pediatric patients. 10 To our knowledge, this is the first national study to compare similarly matched penetrating pediatric trauma patients who did or did not undergo urgent VATS. Although the pre-hospital demographics were the same between the two groups, the injuries they presented with were expectedly different. The VATS group had a larger injury burden which undoubtedly led to the decision to undergo surgical intervention and the substantially higher risk of mortality and complications compared to patients not undergoing VATS. In turn this led to a four day longer hospital LOS as well. Penetrating thoracic trauma can cause significant injury requiring surgical intervention. In our study population, over 60% of VATS patients presented after a firearm injury. This is significantly higher than the general pediatric trauma population which has a penetrating trauma rate of 10–20%. 11 The most common injury found in patients undergoing urgent VATS was to the lung. In cases of peripheral lung lacerations, VATS can be used in conjunction with surgical stapling devices to effectively control hemorrhage or an air leak. In adult populations, about 25% of patients undergoing VATS for lung injury ultimately require a wedge resection. 12 We found the rate in pediatric thoracic trauma to be much lower at just under 10%. The second most common injury in our study population of pediatric patients undergoing urgent VATS was to the diaphragm. VATS has an invaluable role in the diagnosis of diaphragm injuries with a sensitivity rate of up to 100%. 13 Additionally, VATS has the added benefit of allowing for repair of smaller diaphragm injuries. Our study found that about 6% of pediatric patients undergoing urgent VATS also had a concurrent diaphragm repair. This is in contrast to the 9% of adult patients that undergo diaphragm repair with VATS. 12 Urgent VATS may be associated with a higher risk of mortality in trauma patients. In adult trauma patients, the mortality rate attributed to VATS is < 2%. 12,14–17 However, these studies do not specifically differentiate mortality risk between patients undergoing emergent, urgent, early, or delayed VATS. 16 , 17 Our study is the first to report the mortality rate and risk for pediatric trauma patients undergoing urgent VATS. We found that the risk of death is over 7-fold higher compared to patients not undergoing urgent VATS. This may be a result of unsalvageable injuries or the inappropriate selection of VATS as the initial intervention. Most deaths occurred after 24-hours suggesting patients did not die intraoperatively or from immediate hemorrhage, which would have likely necessitated an open thoracotomy approach. Unfortunately the TQIP database is not granular enough to include the indication(s) for operation or intraoperative findings. Future prospective research is needed to determine the ideal pediatric trauma population for urgent VATS, which should also include a comparison of patients undergoing VATS versus thoracotomy. In addition to mortality there has come to be increased focus on other metrics of hospital performance such as LOS. This study found children undergoing urgent VATS after trauma had an increased LOS compared to children not undergoing VATS by a median of 4 days. In comparison Goodman et al. demonstrated adult patients undergoing VATS within 24 hours had a LOS of less than 6 days, however this definition of within 24 hours is different than our urgent definition of within 6 hours and thus may include patients with less substantial injury burden (e.g., early VATS for retained hemothorax). 12 As there is an association between LOS and timing of VATS, this may help explain the discrepancy between our pediatric and previous adult data. 14 , 16 Future studies are needed to define the relationship between LOS and timing of VATS for pediatric trauma patients. This study has multiple limitations, most of which are expected with this type of retrospective database study. These limitations include coding errors, misclassification, and selection bias. Also, as previously mentioned the indication(s) for VATS and granular operative data including precise procedures performed, intraoperative findings, and hemodynamic stability of the patient during the operation are all unknown. Also, the cause of morbidity and mortality and their relationship to the VATS procedure are not available within TQIP. Additionally, although our study was able to demonstrate increased morbidity and mortality for patients undergoing VATS, it was not sufficiently powered to analyze which specific complications are more common in VATS patients. However, our study is strengthened by a large national sample that matched patients based on pre-hospital demographics, and is the first to report clinical outcomes for pediatric patients requiring urgent VATS. CONCLUSION This propensity-matched analysis of 360 isolated thoracic penetrating pediatric trauma patients undergoing urgent VATS demonstrated a 22-fold increased risk of major complications and a 7-fold increased risk of death compared to similarly matched patients not undergoing VATS. This information can help inform the consent process, prognosticate expected postoperative outcomes and aid in family discussions. Future studies should look to further evaluate the proximate causes of increased hospitalization and mortality in this population and determine the ideal population of pediatric trauma patients for urgent VATS, including direct comparisons of patients undergoing VATS versus thoracotomy. Declarations Funding: The authors have no funding to report. Ethics Statement : Ethics Approval was not required. The above research relies on the Trauma Quality Improvement Program (TQIP) database, an anonymous multicenter database. Conflicts of Interests : The authors have no conflicts of interest to report. Informed Consent : Informed consent was not required. The above research relies on the Trauma Quality Improvement Program (TQIP) database, an anonymous multicenter database. Author Contribution J.N. and A.G. contributed to the conceptualization of the study design. A.G. contributed to the data acquisition. D.M., J.N., and A.G. contributed to the data analysis and interpretation. D.M. wrote the original draft of the manuscript and all authors contributed revisions to produce the final manuscript. References Cunningham RM, Walton MA, Carter PM. The Major Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2018 Dec 20;379(25):2468-2475. Goldstick JE, Cunningham RM, Carter PM. Current Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2022 May 19;386(20):1955-1956. doi: 10.1056/NEJMc2201761. Epub 2022 Apr 20. Peclet MH, Newman KD, Eichelberger MR, Gotschall CS, Garcia VF, Bowman LM. Thoracic trauma in children: an indicator of increased mortality. J Pediatr Surg. 1990 Sep;25(9):961-5; discussion 965-6. Cooper A, Barlow B, DiScala C, String D. Mortality and truncal injury: the pediatric perspective. J Pediatr Surg. 1994 Jan;29(1):33-8. Ahmed N, Jones D. Video-assisted thoracic surgery: state of the art in trauma care. Injury. 2004 May;35(5):479-89. Manlulu AV, Lee TW, Thung KH, Wong R, Yim AP. Current indications and results of VATS in the evaluation and management of hemodynamically stable thoracic injuries. Eur J Cardiothorac Surg. 2004 Jun;25(6):1048-53. Ure BM, Schmidt AI, Jesch NK. Thoracoscopic surgery in infants and children. Eur J Pediatr Surg. 2005 Oct;15(5):314-8. Grant HM, Knee A, Coulter AP, Tirabassi MV. Factors Associated With Successful Video-Assisted Thoracoscopic Surgery for Traumatic Hemothorax in Children: A Cross-Sectional Study. J Surg Res. 2022 Nov;279:748-754. Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 2011;10(2)15061 Smith JW, Franklin GA, Harbrecht BG, Richardson JD. Early VATS for blunt chest trauma: a management technique underutilized by acute care surgeons. J Trauma. 2011 Jul;71(1):102-5; discussion 105-7. Cotton BA, Nance ML. Penetrating trauma in children. Semin Pediatr Surg. 2004 May;13(2):87-97. Goodman M, Lewis J, Guitron J, et al. Video-assisted thoracoscopic surgery for acute thoracic trauma. J Emerg Trauma Shock 2013;6:106-9. Paci M, Ferrari G, Annessi V, et al. The role of diagnostic VATS in penetrating thoracic injuries. World J Emerg Surg 2006;1:30. Alwatari Y, Simmonds A, Ayalew D, Khoraki J, Wolfe L, Leichtle SW, Aboutanos MB, Rodas EB. Early video-assisted thoracoscopic surgery (VATS) for non-emergent thoracic trauma remains underutilized in trauma accredited centers despite evidence of improved patient outcomes. Eur J Trauma Emerg Surg. 2022 Aug;48(4):3211-3219. Doi: 10.1007/s00068-022-01881-7. Epub 2022 Jan 27. Liu, Dah-Wei MD; Liu, Hui-Ping MD; Lin, Pyng Jing MD; Chang, Chau-Hsiung MD. Video-assisted Thoracic Surgery in Treatment of Chest Trauma. The Journal of Trauma: Injury, Infection, and Critical Care 42(4):p 670-674, April 1997. Smith, Jason W. MD; Franklin, Glen A. MD; Harbrecht, Brian G. MD; Richardson, J. David MD. Early VATS For Blunt Chest Trauma: A Management Technique Underutilized By Acute Care Surgeons. The Journal of Trauma: Injury, Infection, and Critical Care 71(1):p 102-107, July 2011. Meyer DM, Jessen ME, Wait MA, Estrera AS. Early evacuation of traumatic retained hemothoraces using thoracoscopy: A prospective, randomized trial. Ann Thorac Surg. 1997;64:1396–400. Tables Table 1. Demographics of pediatric penetrating trauma patients with and without Urgent VATS Non-VATS Urgent VATS Characteristic (n=360) (n=360) p-value Age, year, Median (IQR) 16 (2) 16 (2) 0.939 ISS, median (IQR) 4 (8) 5 (9) <0.001 Race, n (%) White 111 (30.8%) 106 (29.4%) 0.685 Black 187 (62.8%) 189 (64.1%) 0.739 Asian 3 (2.6%) 4 (3.6%) 0.666 Comorbidities, n (%) ADHD 15 (4.2%) 15 (4.2%) 1.000 Mental Personality Disorder 17 (4.7%) 18 (5.0%) 0.862 Smoking 41 (11.4%) 41 (11.4%) 1.000 Substance Abuse 27 (7.5%) 27 (7.5%) 1.000 Mechanism, n (%) GSW 206 (57.2%) 223 (61.9%) 0.197 Stab Wound 127 (35.3%) 134 (37.2%) 0.587 Vitals on Admission, n (%) Tachypnea (>22/min) 80 (23.3%) 130 (37.7%) 120/min) 49 (14.0%) 65 (18.5%) 0.105 Hypertension 1 (0.3%) 1 (0.3%) 1.000 Hypotension (SBP <90 mmHg) 9 (2.6%) 38 (10.8%) <0.001 PRBC Transfusion, n (%) 33 (9.4%) 75 (20.8%) <0.001 Injuries, n (%) Thoracic Cord 1 (0.3%) 7 (1.9%) 0.033 Thoracic Vessels 9 (2.5%) 15 (4.2%) 0.213 Heart 2 (0.6%) 19 (5.3%) <0.001 Rib Fracture 17 (4.7%) 30 (8.3%) 0.050 Single Rib Fracture 12 (3.3%) 19 (5.3%) 0.199 Multiple Rib Fractures 5 (1.4%) 11 (3.1%) 0.129 Lung Injury 41 (11.4%) 94 (26.1%) <0.001 Pneumothorax 15 (4.2%) 33 (9.2%) 0.007 Hemothorax 5 (1.4%) 19 (5.3%) 0.004 Hemopneumothorax 15 (4.2%) 39 (10.8%) <0.001 Lung Injury NOS 19 (5.3%) 49 (13.6%) <0.001 Diaphragm 2 (0.6%) 42 (11.7%) <0.001 Esophagus 0 2 (0.6%) 0.157 Spinal Fracture 12 (3.3%) 36 (10.0%) <0.001 VATS = Video-assisted thoracoscopic surgery; IQR = Interquartile Range; ISS = Injury Severity Score ADHD = Attention Deficit/Hyperactivity Disorder GSW = Gunshot Wound; SBP = Systolic Blood Pressure; PRBC = Packed Red Blood Cells Table 2. Risk of Death and Major Complication for Urgent VATS Risk factor OR CI p-value Death 7.00 2.06-23.77 0.002 Major Complications 22.24 2.98-166.24 0.003 VATS = Video-assisted thoracoscopic surgery; OR = Odds Ratio; CI = Confidence Interval Table 3. Clinical outcomes of pediatric penetrating trauma patients with and without Urgent VATS Non-VATS Urgent VATS Outcome (n=360) (n=360) p-value LOS, days, Median (IQR) 2 (2) 6 (5) <0.001 ICU LOS, days, Median (IQR) 2 (2) 3 (3) 0.015 Major Complication, n (%) 1 (0.3%) 21 (5.8%) <0.001 Cardiac Arrest 1 (0.3%) 5 (1.4%) 0.100 CAUTI 0 1 (0.3%) 0.316 Organ Space Infection 0 2 (0.6%) 0.156 Sepsis 0 1 (0.3%) 0.317 DVT 2 (0.6%) 2 (0.6%) 0.998 Embolism 0 1 (0.3%) 0.316 Stroke or CVA 0 1 (0.3%) 0.316 Pressure Ulcer 1 (0.3%) 0 0.318 ARDS 0 (%) 3 (0.8%) 0.082 Unplanned Intubation 0 3 (0.8%) 0.082 Ventilator Associated Pneumonia 0 0 1.000 Unplanned ICU admission 0 4 (1.1%) 0.045 Unplanned Return to OR 0 8 (2.2%) 0.004 Mortality, n (%) 3 (0.8%) 20 (5.6%) <0.001 VATS = Video-assisted thoracoscopic surgery; LOS = Length of Stay; IQR = Interquartile Range; ICU = Intensive Care Unit; CAUTI = Catheter Associated Urinary Tract Infection; CLABSI = Central Line Associated Blood Stream Infection; DVT = Deep Vein Thrombosis; CVA = Cerebrovascular accident Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6542458","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":453458944,"identity":"6b2b8a87-0d5a-4dac-8ea8-db5e13cb4811","order_by":0,"name":"Daniel Mangan","email":"","orcid":"","institution":"University of California, Irvine","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Mangan","suffix":""},{"id":453458945,"identity":"680ec8ea-2dbb-4d5c-9c7b-6007b5811e41","order_by":1,"name":"Jeffry Nahmias","email":"","orcid":"","institution":"University of California, Irvine","correspondingAuthor":false,"prefix":"","firstName":"Jeffry","middleName":"","lastName":"Nahmias","suffix":""},{"id":453458946,"identity":"1b803334-a663-40ae-8910-9a2c9f091c48","order_by":2,"name":"Peter Nguyen","email":"","orcid":"","institution":"University of California, Irvine","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"","lastName":"Nguyen","suffix":""},{"id":453458947,"identity":"1e13dc80-31f8-44e6-907d-e3ebd7ccdd49","order_by":3,"name":"Matthew Dolich","email":"","orcid":"","institution":"University of California, Irvine","correspondingAuthor":false,"prefix":"","firstName":"Matthew","middleName":"","lastName":"Dolich","suffix":""},{"id":453458948,"identity":"7d87e4ad-1975-4f5d-9657-15f9a2ded91c","order_by":4,"name":"Sebastian Schubl","email":"","orcid":"","institution":"University of California, Irvine","correspondingAuthor":false,"prefix":"","firstName":"Sebastian","middleName":"","lastName":"Schubl","suffix":""},{"id":453458949,"identity":"5b4d08a3-30dd-4be4-91ed-bf7d0fbc6126","order_by":5,"name":"Kenji Inaba","email":"","orcid":"","institution":"University of Southern California","correspondingAuthor":false,"prefix":"","firstName":"Kenji","middleName":"","lastName":"Inaba","suffix":""},{"id":453458950,"identity":"fe9ba4a9-3bd2-47ed-8721-dc0f5fb80926","order_by":6,"name":"Morgan Schellenberg","email":"","orcid":"","institution":"University of Southern California","correspondingAuthor":false,"prefix":"","firstName":"Morgan","middleName":"","lastName":"Schellenberg","suffix":""},{"id":453458951,"identity":"5f39d719-cbde-4ff9-b7eb-f1a989f506a6","order_by":7,"name":"Areg 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21:23:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6542458/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6542458/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84344777,"identity":"0feb8e27-7879-4ce8-84db-d2cb760f145e","added_by":"auto","created_at":"2025-06-10 19:53:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":650962,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6542458/v1/171ff18f-a278-4350-9bf2-379f0db5bbbc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Urgent Video-Assisted Thoracoscopic Surgery After Penetrating Pediatric Trauma: A Propensity- Matched Analysis","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eNearly 60% of all pediatric deaths are related to traumatic injury with the most common mechanism being firearm related injury, which surpassed motor vehicle collisions in 2020.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Up to 8% of pediatric trauma patients will present with an injury to the thorax which has an estimated mortality between 14\u0026ndash;50%.\u003csup\u003e3,4\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn adults, Video-Assisted Thoracoscopic Surgery (VATS) has become the standard of care for a wide array of thoracic conditions and its use has expanded to include thoracic trauma.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e It has been previously estimated that VATS can replace thoracotomy in up to 60% of adult thoracic trauma patients.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e In infants and children, VATS has been safely used for a variety of conditions and it\u0026rsquo;s been postulated that it may be associated with less complications and a shorter hospital length of stay (LOS), compared to open surgery.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e In penetrating pediatric trauma, VATS has been successfully used to manage retained hemothorax with only a 15% conversion rate to a thoracotomy.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e However, clinical outcomes following urgent VATS after penetrating trauma in the pediatric population have not been previously reported and therefore it is difficult to prognosticate outcomes for patients and parents.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to evaluate clinical outcomes after urgent VATS in the pediatric population to better define the risk of morbidity and mortality compared to similarly matched patients who did not undergo VATS. Our hypothesis was that patients undergoing urgent VATS would have a higher rate and risk of in-hospital mortality and complications compared to patients not undergoing VATS.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e This study was deemed exempt by our institutional review board as it utilizes a national deidentified database. The 2017\u0026ndash;2019 Trauma Quality Improvement Program database was queried for patients\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;17-years of age presenting after isolated penetrating trauma to the thorax. An isolated thoracic injury was defined by an abbreviated injury scale (AIS)\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;1 for the head, neck, and abdomen. Patients that died in the emergency department or were transferred from another hospital were excluded. Patients undergoing VATS within 6-hours were compared to those not undergoing VATS.\u003c/p\u003e \u003cp\u003eDue to the observed imbalances of pediatric trauma patients who did and did not undergo VATS within 6-hours of arrival, a propensity-matched analysis was performed using a 1:1 model. We chose to match patients based on demographics and not the injury profile as the injuries and vitals on admission likely influenced the decision to proceed with VATS. This would allow us to determine clinical outcomes for patients that presented with injuries severe enough to warrant an urgent VATS. Patients were matched based on pre-hospital variables including age, sex, race, and comorbidities. The comorbidities matched for included attention-deficit hyperactivity disorder, hypertension, diabetes, smoking, mental personality disorder and substance abuse. The only cases that were entered into our analysis were within 0.001 of the estimated logit, defined as caliper matching. This is a validated method of emulating randomization in observational studies.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWe then preformed a Mann-Whitney U test for all continuous variables and a chi-squared test for all categorical variables. These bivariate analyses were performed for all pre-hospital variables to confirm a successfully matched cohort. The primary outcome was mortality. The secondary outcome was major complications defined as cardiac arrest, unplanned intubation, myocardial infarction (MI), acute respiratory distress syndrome (ARDS), unplanned return to OR, and stroke. Additional outcomes evaluated included unplanned intensive care unit (ICU) admission, length of stay (LOS) and ICU LOS. We additionally performed a univariable logistic regression analysis to identify the odds of mortality or major complication. All p-values were two-sided, with a statistical significance level of \u0026lt;\u0026thinsp;0.05. All Analysis were performed with IBM SPSS Statistics for Windows, Version 28 (Armonk, NY: IBM corp).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003ch2\u003e\u003cem\u003eDemographics of pediatric VATS patients and non-VATS patients\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eFrom 18,596 pediatric isolated penetrating thoracic trauma patients, 369 (2.0%) underwent urgent VATS within six hours. Of these, 360 (97.6%) patients undergoing VATS were successfully matched to 360 patients not undergoing VATS. There was no difference in age, sex, race, and comorbidities between the two groups (all p\u0026gt;0.05). The most common mechanism of injury in both groups was a gunshot wound (VATS, 61.9% vs. non-VATS, 57.2%, p=0.20). The VATS group had a higher rate of hypotension on admission (10.8% vs. 2.6%, p\u0026lt;0.001) and more often required blood transfusions within the first 4-hours (22.0% vs. 9.4%, p\u0026lt;0.001). The VATS group also had a higher rate of injuries to the lung (26.1% vs. 11.4%, p\u0026lt;0.001), diaphragm (11.7% vs. 0.6%, p\u0026lt;0.001), spine (10.0% vs. 3.3%, p\u0026lt;0.001), and heart (5.3% vs. 0.6%, p\u0026lt;0.001) (\u003cstrong\u003eTable 1\u003c/strong\u003e). VATS patients underwent lung resection in 9% of cases and diaphragm repair in 6.4% of cases.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003ePrimary and Secondary Outcomes\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe overall rate and associated risk of major complications were higher in the VATS group (5.8% vs. 0.3%, p\u0026lt;0.001; OR 22.24, CI 2.98-166.24, p=0.003), as was the rate and associated risk of death (5.8% vs. 0.3%, p\u0026lt;0.001; OR 7.00 CI 2.06-23.77, p=0.002). Notably, 85% of deaths occurred \u003cu\u003e\u0026gt;\u003c/u\u003e24-hours from arrival. The most common complication in the VATS group was cardiac arrest (1.4%) (\u003cstrong\u003eTable 2\u003c/strong\u003e).\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003ePatients in the VATS cohort had a longer median LOS (6 vs. 2 days, p\u0026lt;0.002) and ICU LOS (3 vs. 2 days, p=0.015), compared to the non-VATS cohort. They also were more likely to have an unplanned ICU admission (1.1% vs. 0%, p=0.045) and more likely to have an unplanned return to the OR (2.2% vs. 0%, p=0.004) (\u003cstrong\u003eTable 3\u003c/strong\u003e).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe use of minimally invasive surgery including VATS has increased exponentially in both the elective and more emergent setting for both adult and pediatric patients.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e To our knowledge, this is the first national study to compare similarly matched penetrating pediatric trauma patients who did or did not undergo urgent VATS. Although the pre-hospital demographics were the same between the two groups, the injuries they presented with were expectedly different. The VATS group had a larger injury burden which undoubtedly led to the decision to undergo surgical intervention and the substantially higher risk of mortality and complications compared to patients not undergoing VATS. In turn this led to a four day longer hospital LOS as well.\u003c/p\u003e \u003cp\u003ePenetrating thoracic trauma can cause significant injury requiring surgical intervention. In our study population, over 60% of VATS patients presented after a firearm injury. This is significantly higher than the general pediatric trauma population which has a penetrating trauma rate of 10\u0026ndash;20%.\u003csup\u003e11\u003c/sup\u003e The most common injury found in patients undergoing urgent VATS was to the lung. In cases of peripheral lung lacerations, VATS can be used in conjunction with surgical stapling devices to effectively control hemorrhage or an air leak. In adult populations, about 25% of patients undergoing VATS for lung injury ultimately require a wedge resection.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e We found the rate in pediatric thoracic trauma to be much lower at just under 10%. The second most common injury in our study population of pediatric patients undergoing urgent VATS was to the diaphragm. VATS has an invaluable role in the diagnosis of diaphragm injuries with a sensitivity rate of up to 100%.\u003csup\u003e13\u003c/sup\u003e Additionally, VATS has the added benefit of allowing for repair of smaller diaphragm injuries. Our study found that about 6% of pediatric patients undergoing urgent VATS also had a concurrent diaphragm repair. This is in contrast to the 9% of adult patients that undergo diaphragm repair with VATS.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eUrgent VATS may be associated with a higher risk of mortality in trauma patients. In adult trauma patients, the mortality rate attributed to VATS is \u0026lt;\u0026thinsp;2%.\u003csup\u003e12,14\u0026ndash;17\u003c/sup\u003e However, these studies do not specifically differentiate mortality risk between patients undergoing emergent, urgent, early, or delayed VATS.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Our study is the first to report the mortality rate and risk for pediatric trauma patients undergoing urgent VATS. We found that the risk of death is over 7-fold higher compared to patients not undergoing urgent VATS. This may be a result of unsalvageable injuries or the inappropriate selection of VATS as the initial intervention. Most deaths occurred after 24-hours suggesting patients did not die intraoperatively or from immediate hemorrhage, which would have likely necessitated an open thoracotomy approach. Unfortunately the TQIP database is not granular enough to include the indication(s) for operation or intraoperative findings. Future prospective research is needed to determine the ideal pediatric trauma population for urgent VATS, which should also include a comparison of patients undergoing VATS versus thoracotomy.\u003c/p\u003e \u003cp\u003eIn addition to mortality there has come to be increased focus on other metrics of hospital performance such as LOS. This study found children undergoing urgent VATS after trauma had an increased LOS compared to children not undergoing VATS by a median of 4 days. In comparison Goodman et al. demonstrated adult patients undergoing VATS within 24 hours had a LOS of less than 6 days, however this definition of within 24 hours is different than our urgent definition of within 6 hours and thus may include patients with less substantial injury burden (e.g., early VATS for retained hemothorax).\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e As there is an association between LOS and timing of VATS, this may help explain the discrepancy between our pediatric and previous adult data.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Future studies are needed to define the relationship between LOS and timing of VATS for pediatric trauma patients.\u003c/p\u003e \u003cp\u003eThis study has multiple limitations, most of which are expected with this type of retrospective database study. These limitations include coding errors, misclassification, and selection bias. Also, as previously mentioned the indication(s) for VATS and granular operative data including precise procedures performed, intraoperative findings, and hemodynamic stability of the patient during the operation are all unknown. Also, the cause of morbidity and mortality and their relationship to the VATS procedure are not available within TQIP. Additionally, although our study was able to demonstrate increased morbidity and mortality for patients undergoing VATS, it was not sufficiently powered to analyze which specific complications are more common in VATS patients. However, our study is strengthened by a large national sample that matched patients based on pre-hospital demographics, and is the first to report clinical outcomes for pediatric patients requiring urgent VATS.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis propensity-matched analysis of 360 isolated thoracic penetrating pediatric trauma patients undergoing urgent VATS demonstrated a 22-fold increased risk of major complications and a 7-fold increased risk of death compared to similarly matched patients not undergoing VATS. This information can help inform the consent process, prognosticate expected postoperative outcomes and aid in family discussions. Future studies should look to further evaluate the proximate causes of increased hospitalization and mortality in this population and determine the ideal population of pediatric trauma patients for urgent VATS, including direct comparisons of patients undergoing VATS versus thoracotomy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no funding to report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthics Approval was not required. The above research relies on the Trauma Quality Improvement Program (TQIP) database, an anonymous multicenter database.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interests\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInformed consent was not required. The above research relies on the Trauma Quality Improvement Program (TQIP) database, an anonymous multicenter database.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJ.N. and A.G. contributed to the conceptualization of the study design. A.G. contributed to the data acquisition. D.M., J.N., and A.G. contributed to the data analysis and interpretation. D.M. wrote the original draft of the manuscript and all authors contributed revisions to produce the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCunningham RM, Walton MA, Carter PM. The Major Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2018 Dec 20;379(25):2468-2475.\u003c/li\u003e\n \u003cli\u003eGoldstick JE, Cunningham RM, Carter PM. Current Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2022 May 19;386(20):1955-1956. doi: 10.1056/NEJMc2201761. Epub 2022 Apr 20.\u003c/li\u003e\n \u003cli\u003ePeclet MH, Newman KD, Eichelberger MR, Gotschall CS, Garcia VF, Bowman LM. Thoracic trauma in children: an indicator of increased mortality. J Pediatr Surg. 1990 Sep;25(9):961-5; discussion 965-6.\u003c/li\u003e\n \u003cli\u003eCooper A, Barlow B, DiScala C, String D. Mortality and truncal injury: the pediatric perspective. J Pediatr Surg. 1994 Jan;29(1):33-8.\u003c/li\u003e\n \u003cli\u003eAhmed N, Jones D. Video-assisted thoracic surgery: state of the art in trauma care. Injury. 2004 May;35(5):479-89.\u003c/li\u003e\n \u003cli\u003eManlulu AV, Lee TW, Thung KH, Wong R, Yim AP. Current indications and results of VATS in the evaluation and management of hemodynamically stable thoracic injuries. Eur J Cardiothorac Surg. 2004 Jun;25(6):1048-53.\u003c/li\u003e\n \u003cli\u003eUre BM, Schmidt AI, Jesch NK. Thoracoscopic surgery in infants and children. Eur J Pediatr Surg. 2005 Oct;15(5):314-8.\u003c/li\u003e\n \u003cli\u003eGrant HM, Knee A, Coulter AP, Tirabassi MV. Factors Associated With Successful Video-Assisted Thoracoscopic Surgery for Traumatic Hemothorax in Children: A Cross-Sectional Study. J Surg Res. 2022 Nov;279:748-754.\u003c/li\u003e\n \u003cli\u003eAustin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 2011;10(2)15061\u003c/li\u003e\n \u003cli\u003eSmith JW, Franklin GA, Harbrecht BG, Richardson JD. Early VATS for blunt chest trauma: a management technique underutilized by acute care surgeons. J Trauma. 2011 Jul;71(1):102-5; discussion 105-7.\u003c/li\u003e\n \u003cli\u003eCotton BA, Nance ML. Penetrating trauma in children. Semin Pediatr Surg. 2004 May;13(2):87-97.\u003c/li\u003e\n \u003cli\u003eGoodman M, Lewis J, Guitron J, et al. Video-assisted thoracoscopic surgery for acute thoracic trauma. J Emerg Trauma Shock 2013;6:106-9.\u003c/li\u003e\n \u003cli\u003ePaci M, Ferrari G, Annessi V, et al. The role of diagnostic VATS in penetrating thoracic injuries. World J Emerg Surg 2006;1:30.\u003c/li\u003e\n \u003cli\u003eAlwatari Y, Simmonds A, Ayalew D, Khoraki J, Wolfe L, Leichtle SW, Aboutanos MB, Rodas EB. Early video-assisted thoracoscopic surgery (VATS) for non-emergent thoracic trauma remains underutilized in trauma accredited centers despite evidence of improved patient outcomes. Eur J Trauma Emerg Surg. 2022 Aug;48(4):3211-3219. Doi: 10.1007/s00068-022-01881-7. Epub 2022 Jan 27.\u003c/li\u003e\n \u003cli\u003eLiu, Dah-Wei MD; Liu, Hui-Ping MD; Lin, Pyng Jing MD; Chang, Chau-Hsiung MD. Video-assisted Thoracic Surgery in Treatment of Chest Trauma. The Journal of Trauma: Injury, Infection, and Critical Care 42(4):p 670-674, April 1997.\u003c/li\u003e\n \u003cli\u003eSmith, Jason W. MD; Franklin, Glen A. MD; Harbrecht, Brian G. MD; Richardson, J. David MD. Early VATS For Blunt Chest Trauma: A Management Technique Underutilized By Acute Care Surgeons. The Journal of Trauma: Injury, Infection, and Critical Care 71(1):p 102-107, July 2011.\u003c/li\u003e\n \u003cli\u003eMeyer DM, Jessen ME, Wait MA, Estrera AS. Early evacuation of traumatic retained hemothoraces using thoracoscopy: A prospective, randomized trial. Ann Thorac Surg. 1997;64:1396\u0026ndash;400.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Demographics of pediatric penetrating trauma patients with and without Urgent VATS\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"552\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-VATS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrgent VATS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(n=360)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(n=360)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003eAge, year, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e16 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e16 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003eISS, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e4 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e5 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003eRace, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;White\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e111 (30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e106 (29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e0.685\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Black\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e187 (62.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e189 (64.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e0.739\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Asian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e3 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e4 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003eComorbidities, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;ADHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e15 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e15 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mental Personality Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e17 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e18 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e0.862\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Smoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e41 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e41 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Substance Abuse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e27 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e27 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003eMechanism, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;GSW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e206 (57.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e223 (61.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Stab Wound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e127 (35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e134 (37.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003eVitals on Admission, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Tachypnea (\u0026gt;22/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e80 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e130 (37.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Tachycardic (\u0026gt;120/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e49 (14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e65 (18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Hypotension (SBP \u0026lt;90 mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e9 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e38 (10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;PRBC Transfusion, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e33 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e75 (20.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003eInjuries, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Thoracic Cord\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e7 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.033\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Thoracic Vessels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e9 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e15 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Heart\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e2 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e19 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Rib Fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e17 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e30 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.050\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Single Rib Fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e12 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e19 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e0.199\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Multiple Rib Fractures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e5 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e11 (3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Lung Injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e41 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e94 (26.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Pneumothorax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e15 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e33 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Hemothorax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e5 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e19 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Hemopneumothorax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e15 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e39 (10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Lung Injury NOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e19 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e49 (13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Diaphragm\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e2 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e42 (11.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Esophagus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e2 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.3913%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Spinal Fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e12 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8261%;\"\u003e\n \u003cp\u003e36 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.9565%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cem\u003eVATS = Video-assisted thoracoscopic surgery; IQR = Interquartile Range; ISS = Injury Severity Score\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eADHD = Attention Deficit/Hyperactivity Disorder GSW = Gunshot Wound; SBP = Systolic Blood Pressure; PRBC = Packed Red Blood Cells\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Risk of Death and Major Complication for Urgent VATS\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"468\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk factor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9487%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7949%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5128%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7436%;\"\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9487%;\"\u003e\n \u003cp\u003e7.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7949%;\"\u003e\n \u003cp\u003e2.06-23.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5128%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7436%;\"\u003e\n \u003cp\u003eMajor Complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.9487%;\"\u003e\n \u003cp\u003e22.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7949%;\"\u003e\n \u003cp\u003e2.98-166.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5128%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eVATS = Video-assisted thoracoscopic surgery; OR = Odds Ratio; CI = Confidence Interval\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. Clinical outcomes of pediatric penetrating trauma patients with and without Urgent VATS\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"547\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-VATS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrgent VATS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(n=360)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(n=360)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003eLOS, days, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e2 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e6 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003eICU LOS, days, Median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e2 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e3 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003eMajor Complication, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e21 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Cardiac Arrest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e5 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;CAUTI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Organ Space Infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e2 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Sepsis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;DVT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e2 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e2 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Embolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Stroke or CVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Pressure Ulcer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;ARDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e0 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e3 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Unplanned Intubation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e3 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Ventilator Associated Pneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Unplanned ICU admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e4 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.045\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Unplanned Return to OR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e8 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44.9726%;\"\u003e\n \u003cp\u003eMortality, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7441%;\"\u003e\n \u003cp\u003e3 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.0347%;\"\u003e\n \u003cp\u003e20 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.2486%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cem\u003eVATS = Video-assisted thoracoscopic surgery; LOS = Length of Stay; IQR = Interquartile Range;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eICU = Intensive Care Unit; CAUTI = Catheter Associated Urinary Tract Infection; CLABSI = Central Line Associated Blood Stream Infection; DVT = Deep Vein Thrombosis; CVA = Cerebrovascular accident\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Trauma, Thoracic, Video-Assisted Thoracoscopic Surgery (VATS), Pediatric","lastPublishedDoi":"10.21203/rs.3.rs-6542458/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6542458/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eINTRODUCTION\u003c/strong\u003e: Outcomes following urgent video-assisted thoracoscopic surgery (VATS) after penetrating thoracic trauma in pediatric patients is unknown. We hypothesized that patients undergoing urgent VATS would have a higher risk of in-hospital mortality and complications, compared to similarly matched patients not undergoing VATS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS\u003c/strong\u003e: The 2017-2019 Trauma Quality Improvement Program database was queried for patients \u0026lt;17-years of age presenting after isolated penetrating thoracic trauma. Patients undergoing VATS within 6-hours were compared to those not undergoing VATS using a 1:1 propensity-score model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS\u003c/strong\u003e: From 18,596 isolated penetrating trauma patients, 369 (2.0%) underwent VATS within six hours. 360 patients undergoing VATS were matched to 360 patients not undergoing VATS. There were no differences in age, sex, race, and comorbidities (all p\u0026gt;0.05). The VATS group had a higher rate of hypotension on admission (10.8% vs. 2.6%, p\u0026lt;0.001) and more often required blood transfusions within the first 4-hours (22.0% vs. 9.4%, p\u0026lt;0.001). The VATS group had a higher rate of injuries to the lung (26.1% vs. 11.4%, p\u0026lt;0.001), diaphragm (11.7% vs. 0.6%, p\u0026lt;0.001), spine (10.0% vs. 3.3%, p\u0026lt;0.001), and heart (5.3% vs. 0.6%, p\u0026lt;0.001). The overall rate and associated risk of major complications (5.8% vs. 0.3%, p\u0026lt;0.001; OR 22.24, CI 2.98-166.24, p=0.003) were higher in the VATS group, as was the risk of death (5.8% vs. 0.3%, p\u0026lt;0.001; OR 7.00 CI 2.06-23.77, p=0.002).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION\u003c/strong\u003e: Urgent pediatric VATS after isolated penetrating thoracic trauma occurs in 2% of cases. These patients have a 22-fold higher associated risk of complications and 7-fold higher risk of death.\u003c/p\u003e","manuscriptTitle":"Urgent Video-Assisted Thoracoscopic Surgery After Penetrating Pediatric Trauma: A Propensity- Matched Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-18 15:07:17","doi":"10.21203/rs.3.rs-6542458/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"251e63c8-6b75-4290-bd45-d683832d5c51","owner":[],"postedDate":"May 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-10T19:53:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-18 15:07:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6542458","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6542458","identity":"rs-6542458","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}