Pediatric Major Vascular Injuries: A 16-Year Institutional Experience From a Combined Adult and Pediatric Trauma Center.
Autor: Perea, Lindsey L.; Hazelton, Joshua P.; Fox, Nicole; Gaughan, John P.; Porter, John; Goldenberg, Anna
Publication year: 2021
Pediatric emergency care
issn:1535-1815 0749-5161
doi: 10.1097/PEC.0000000000001642
Abstract:
OBJECTIVES: Vascular injury in pediatric trauma patients is uncommon but associated with a reported mortality greater than 19% in some series. The purpose of this study was to characterize pediatric major vascular injuries (MVIs) and analyze mortality at a high-volume combined adult and pediatric trauma center. METHODS: A retrospective review (January 2000 to May 2016) was conducted of all pediatric (<18 years old) trauma patients who presented with a vascular injury. A total of 177 patients were identified, with 60 (34%) having an MVI, defined as injury in the neck, torso, or proximal extremity. Patients were then further analyzed based on location of injury, mechanism, age, and race. P ≤ 0.05 was deemed significant. RESULTS: Of the 60 patients with MVI, the mean age was 14.3 years (range, 4-17 years). Mean intensive care unit length of stay (LOS) was 5.4 days, and mean hospital LOS was 12.5 days. Blunt mechanism was more common in patients 14 years or younger; penetrating trauma was more common amongst patients older than 14 years. Overall, blunt injuries had a longer intensive care unit LOS compared with penetrating trauma (7.8 vs 3.1 days; P = 0.016). A total of 33% (n = 20) of MVIs occurred in the torso, with 50% (n = 10) of these from blunt trauma. Location of injury did correlate with mortality; 45% (n = 9) of torso MVIs resulted in death (penetrating n = 7, blunt n = 2). Overall mortality from an MVI was 15.3% (n = 9); all were torso MVIs. Higher Injury Severity Score and Glasgow Coma Scale score were found to be independently associated with mortality. CONCLUSIONS: Our experience demonstrates that MVIs are associated with a significant mortality (15.3%), with a majority of those resulting from gunshot wounds, more than 9-fold greater than the overall mortality of pediatric trauma patients at our institution (1.6%). Further research should be aimed at improving management strategies specific for MVIs in the pediatric trauma patient as gun violence continues to afflict youth in the United States. Language: eng Rights: Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. Pmid: 30335690 Tags: Humans; Adult; Retrospective Studies; Child; Adolescent; United States; Trauma Centers; Length of Stay; Injury Severity Score; *Vascular System Injuries/epidemiology/therapy; *Wounds, Gunshot Link: https://pubmed.ncbi.nlm.nih.gov/30335690/
