SP6.14 - The Burden of Penetrating Junctional Injuries in a UK Major Trauma Centre: a Retrospective Cohort Study

Abstract Background Junctional injuries occur at the join of ‘anatomically distinct zones’. The emergence of junctional injuries in trauma care has been a consequence of recent battlefield casualties; accounting for 21% of potentially survivable deaths from haemorrhage. Although well described in military literature, there are no civilian studies into junctional injuries. This study aims to examine the epidemiology and resource burden of junctional penetrating injuries. Methods Retrospective study of adult and paediatric patients with penetrating injuries to a junctional zone presenting to an urban MTC in one year. Electronic patient records were searched and data on anatomical distribution of injury, imaging and theatre utilisation, inpatient stay, and discharge codes extracted. Discharge codes were referenced with the National Schedule of NHS costs to produce a cost. Results In 132 patients 92.4% (n=122) were male with median age 27.5 and in hospital mortality 1.6% (n=2). Saturday and Sunday were most frequent 37.9% (n=50) and 81.8% (n=108) attended after 1700 and before 0800. 37.9% (n=50) of injuries were buttock; 22% (n=29) neck; 18.9% (n=25) multiply-injured; 8.3% (n=11) axilla; 6.8% (n=9) diaphragm; and 6.1% (n=8) groin. Median Injury Severity Score (ISS) 8. 46.2% (n=61) underwent surgery; 50.8% (n=67) were admitted, 7.6% (n=10) to ITU. Median length of ward stay was 3 days. 15.9% (n=21) received blood products. The overall cost was £914,076. Conclusion Junctional injuries are a significant resource burden. Buttock wounds were the most common but had the lowest median ISS and cost. Diaphragmatic injuries appear distinct from junctional wounds in terms of ISS and cost, and may be separate to other junctional zones.