Resource utilization and national demographics of laryngotracheal trauma in children.

Abstract

Pediatric laryngotracheal trauma is rare but can carry considerable morbidity and health care resource expenditure. However, the true cost of these injuries has not been thoroughly investigated. To use a national administrative pediatric database to identify normative data on pediatric laryngotracheal trauma, specifically with regard to cost and resource utilization. Retrospective medical record review using the Kids' Inpatient Database (KID) 2009. Inclusion criteria were admissions with International Classification of Diseases, Ninth Revision, Clinical Modification, codes for fractures or open wounds of the larynx and trachea. Among many data analyzed were demographic information and admission characteristics, including length of stay, diagnoses, procedures performed, and total charges. There were 106 admissions that met inclusion criteria. Patient mean (SE) age was 15.9 (0.45) years, and 79% were males. The mean (SE) length of stay (LOS) was 8.4 (1.1) days; more than 50% of patients had a LOS longer than 4 days. The mean number of diagnoses per patient was 6.9 (0.6); other traumatic injuries included pneumothorax (n = 18). More than 75% of patients underwent more than 2 procedures during their admission; 60.2% underwent a major operative procedure. The most common procedures performed were laryngoscopy (n = 54) and operative repair of the larynx and/or trachea (n = 32). Tracheostomy was performed in only 30 patients. The mean (SE) total charge was $90,879 ($11,419), and one-third of patients had total charges more than $100,000. Pediatric laryngotracheal trauma remains a relatively rare clinical entity. These injuries primarily affect older children and are associated with long hospitalizations, multiple procedures, and high resource utilization.