Pediatric vascular injuries: patterns of injury, morbidity, and mortality

The purpose of this study was to identify the patterns of injury and associated morbidity/mortality related to pediatric vascular trauma.

A retrospective review of children and adolescents treated between 1993 and 2005 was performed. Patients were identified by International Classification of Diseases, Ninth Revision codes within an institutional pediatric trauma registry.

One hundred seventy-six patients with vascular injury were identified. Those with injuries isolated to the digits and unspecified vessels were excluded (n = 73). The remaining 103 patients were evaluable and are the basis for subsequent comparisons. Seventy-four percent of injuries occurred in male patients. The average age of the male patients was 11.3 years and that of the female patients was 9.1 years (range, 1-18 years; overall, 10.7 years). Penetrating wounds caused 68% of the injuries, followed by blunt trauma (31%) and burns (0.97%). Anatomical locations of injury included the head/neck (19.4%), torso (13.5%), and extremities (67%). Amputation was required in 11 (10.7%) patients. The average hospital length of stay of the patients was 12.1 days (range, 1-155 days). The overall mortality was 9.7%. Nonoperative management was given to 9.7% of the patients; one death caused by carotid injury occurred. Overall, 24 patients underwent arteriography, with 1 patient receiving definitive treatment in interventional radiology. Of the 103 patients, 29.1% were managed by pediatric surgeons, 38.8% were managed by extremity specialists, 17% were managed by vascular surgeons, 5.8% were managed by neurosurgeons, and 9.3% were managed by others.

Despite the available multidisciplinary diagnostic and treatment modalities at tertiary care pediatric trauma centers, traumatic vascular injuries in children and adolescents are associated with significant morbidity and mortality in contemporary surgical practice.