The anatomical distribution of penetrating junctional injuries and their resource implications: A retrospective cohort study

Background: There is no standardised definition of what constitutes a junctional injury. Although well described in military literature, this is not the case in the civilian setting. This study aims to characterise the epidemiology of the civilian penetrating junctional injuries in our centre. Methods: A retrospective study of all adult and paediatric patients with penetrating injuries to a junctional area presenting to an urban Major Trauma Centre over one year. Data on site of injury, imaging, theatre utilisation, management, and cost was extracted. Differences between patients with injuries to the neck, axillae, diaphragm, groins, buttocks, and multiple injuries, were tested using chi-squared, Kruskal-Wallis and Mann-Whitney-U tests. Results: Penetrating junctional injuries represented 27 % of all penetrating injuries (132/487). Most patients were young males presenting outside of the hours of 0800-1700. Injuries to the buttocks were most common (n = 50, 38 %) but carried the lowest median ISS of 8. Junctional injuries were very resource intensive utilising 384 images and 183 blood products in just 132 patients. 60 patients required surgical management. In one year, 418 ward-days and 50 ITU-days were required, with an approximated total cost of 914,076 pound. Statistically: significant findings include that the youngest patients presented 1700 - 2000 (p < 0.001). Patients with diaphragm injuries had significantly higher ISS (p < 0.001), received more operations (p < 0.001), stayed on the ward longer (p = 0.002) and were more costly than the other anatomical areas (p < 0.001). Of the areas found adjoining an extremity to the torso, patients with groin injuries had significantly higher ISS (p = 0.025) and were more costly (p = 0.018). Conclusion: Junctional injuries are common and carry a high resource burden. Patients with injuries to the neck, axillae, groin, and buttocks were similar in demographics, resource requirement and cost, although groin injured patients had higher median ISS and cost. Diaphragmatic injuries share some characteristics of junctional injuries, but had significantly higher ISS, blood product use, number of operations, ward length of stay, and cost. The authors support a narrower definition of 'junctional' to exclude diaphragm, such as 'locations adjoining the extremities to the torso'.