BREAST TRAUMA: AN ANALYSIS OF THE NATIONAL TRAUMA DATABASE

Objectives: Breast trauma is often under recognized injury especially in female polytrauma patients. Although not well studied, breast trauma can be a clinically relevant source of bleeding leading to significant morbidity such as hemorrhagic shock. It has been reported that 17% of patients with breast hematomas require interventions ranging from multiple blood transfusions to angioembolizations. There has also been evidence from a single center trauma center study indicating an association between female blunt breast trauma with an elevated injury severity score (ISS). The purpose of this study was to conduct a retrospective review of the national trauma database (NTDB) to assess the prevalence of breast injuries and their association with ISS in trauma patients.

Methods: All statistical analysis was performed using R statistical software version 4.1.3. A retrospective review was performed from the NTDB from years 2016 to 2019 using all applicable ICD codes for 3 outlined subgroups (abrasions, contusions, open wounds/punctures/lacerations) with minors excluded. All continuous variables tested as non-normally distributed, so all test results for continuous variables used Kruskal-Wallis test. All categorical variables were tested using chi-squared test.

Results: Patients with abrasions and contusions had a higher incidence of ICU stays (23.8% and 25.3%, respectively) compared to patients with open wounds/punctures/lacerations (13.6%). Additionally, patients with abrasions and contusions to the breast are more likely to have a significantly higher ISS score compared to those with visible open wounds/punctures/lacerations (9.00 vs 5.00, p < 0.001).

Conclusion: Patients who have multiple injuries, especially those in the ICU and those with high ISS, have the potential for missed injuries including breast hematomas. Therefore, all patients with clinically relevant mechanisms should be evaluated for breast trauma on tertiary survey to minimize missed injuries and subsequent increased morbidity.