Objective: To examine the clinical factors that influence medical decision making in children with oropharyngeal trauma.
Design: Retrospective chart review (spanning 6 years).
Setting: Tertiary care children's hospital.
Patients: One hundred seven consecutive children with traumatic oropharyngeal injuries.
Interventions: Computed tomographic angiography (CTA) (n = 52), surgical therapy (n = 16), inpatient admission (n = 44), and antibiotic administration (n = 77).
Main outcome measures: The likelihood of a patient undergoing each of the 4 interventions and having positive radiographic findings or clinical complications was assessed with respect to the following clinical factors: (1) age, (2) sex, (3) mechanism of injury, (4) site of injury, (5) wound severity (3-point scale), and (6) otolaryngology consultation.
Results: The following factors were significantly associated with an increased likelihood of a patient undergoing CTA to rule out occult internal carotid artery damage: (1) injury to the lateral soft palate, (2) high wound severity score, and (3) otolaryngology consultation. Radiographic abnormalities (including free air, parapharyngeal edema, and hematoma) were present in 16 (31%) of 52 CTAs but were not associated with any specific clinical factors. Patients with more severe wounds were more likely to undergo CTA, go to the operating room, receive antibiotics, and be admitted to the hospital but were not more likely to have positive CTA findings or an adverse clinical outcome.
Conclusions: We were unable to identify any clinical factors that would help predict which children with oropharyngeal trauma are at high risk of developing neurologic sequelae. Radiographic screening for vascular injury in children with oropharyngeal trauma remains controversial.