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Angiography and the pediatric trauma patient: a 10-year review
Devin Puapong1, Carlos V R Brown, Michael Katz
1Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90033, USA.
Insights
Angiography in pediatric trauma patients revealed abnormal findings in nearly half of cases, often leading to necessary therapeutic interventions. This diagnostic tool is safe and effective for injured children.
Area of Science:
- Pediatric Trauma Care
- Interventional Radiology
- Diagnostic Imaging
Background:
- Interventional radiology is increasingly used in adult trauma management.
- Limited data exists on its application in pediatric trauma care.
- This study addresses the role of angiography in injured children.
Purpose of the Study:
- To analyze the indications for angiography in pediatric trauma patients.
- To evaluate the results and complications of angiography in this population.
- To determine the utility of angiography in pediatric trauma management.
Main Methods:
- Retrospective review of pediatric patients (≤14 years) at a level I trauma center (1993-2003).
- Data collected from hospital records, trauma registry, and medical records.
- Analysis of angiographic indications, findings, interventions, and complications.
Main Results:
- Twenty-five pediatric trauma patients underwent angiography.
- Indications included suspected limb ischemia, pelvic/solid organ bleeding, aortic injury, and expanding hematoma.
- 44% had abnormal findings, with 10 undergoing therapeutic intervention; 1 minor complication, no mortality.
Conclusions:
- Angiography is infrequently used but reveals significant findings in pediatric trauma.
- Abnormal results frequently prompt necessary therapeutic interventions.
- Angiography is a safe and useful adjunct in the care of injured children.
Background/Purpose:
Although interventional radiology has played an increasing role in the management of adult trauma patients, little has been written regarding its application in the care of the injured child. This study analyzed the indications, results, and complications for angiography in pediatric trauma patients.
Methods:
A retrospective review of pediatric patients (14 years or younger) admitted to Los Angeles County-University of Southern California Medical Center, Los Angeles, Calif (an urban level I trauma center), over a 10-year period (1993-2003) was performed. Patients who underwent angiography were identified using hospital angiography records, and further information was recorded from the trauma registry and medical records. Variables collected included age, sex, mechanism of injury, and injury severity score (ISS). Angiographic data analyzed included indications, results, therapeutic interventions, and procedure-related complications.
Results:
Twenty-five pediatric trauma patients who underwent angiography were identified (18 boys, 7 girls). The average age was 11 years (range, 1-14 years), with an ISS of 16 +/- 10. Indications for angiography included suspected limb ischemia (n = 9), suspected pelvic (n = 8) or solid organ bleeding (n = 8), suspected aortic injury (n = 6), and expanding hematoma (n = 1). Eleven patients (44%) had an abnormal finding, and 10 of 11 underwent a subsequent therapeutic intervention. There was 1 minor procedure-related complication and no procedure-related mortality.
Conclusions:
Though used infrequently in pediatric trauma patients, the result of the angiography was abnormal in almost half of the children in this series. An abnormal finding prompted further therapeutic intervention in most cases. Angiography was associated with minimal morbidity and should be considered as a useful and safe adjunct when caring for injured children.
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