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Published on: December 31, 2017
Outcomes of truncal vascular injuries in children
Nathan D Allison1, Christopher M Anderson, Shinil K Shah
1Department of Pediatric Surgery and Surgery, University of Texas Medical School at Houston, Children's Memorial Hermann Hospital, Houston, TX 77030, USA.
Insights
Pediatric truncal vascular injuries are serious, with survival depending on initial hemodynamic status. Associated injuries, particularly abdominal, increase risks for children with these rare traumas.
Area of Science:
- Pediatric Trauma Surgery
- Vascular Injury Management
- Emergency Medicine
Background:
- Pediatric truncal vascular injuries are infrequent but carry high mortality (30-50%).
- Understanding injury patterns and outcomes is crucial for improving patient care.
Purpose of the Study:
- To examine demographics, injury mechanisms, associated trauma, and outcomes.
- To analyze patient data over a 10-year period at a single institution.
Main Methods:
- Retrospective review of a pediatric trauma registry from 1997-2006.
- Analysis of 57 patients with 75 truncal vascular injuries.
Main Results:
- Penetrating injuries accounted for 37% of cases.
- Associated injuries were common: 76% abdominal, 62% thoracic, 43% neck.
- Hemodynamic instability significantly correlated with nonvascular complications and mortality, especially in thoracic injuries.
Conclusions:
- Patient's hemodynamic status at presentation is a key determinant of survival and complications.
- Abdominal vascular injuries are associated with a higher incidence of concomitant trauma.
Background:
Pediatric truncal vascular injuries occur infrequently and have a reported mortality rate of 30% to 50%. This report examines the demographics, mechanisms of injury, associated trauma, and outcome of patients presenting for the past 10 years at a single institution with truncal vascular injuries.
Methods:
A retrospective review (1997-2006) of a pediatric trauma registry at a single institution was undertaken.
Results:
Seventy-five truncal vascular injuries occurred in 57 patients (age, 12 +/- 3 years); the injury mechanisms were penetrating in 37%. Concomitant injuries occurred with 76%, 62%, and 43% of abdominal, thoracic, and neck vascular injuries, respectively. Nonvascular complications occurred more frequently in patients with abdominal vascular injuries who were hemodynamically unstable on presentation. All patients with thoracic vascular injuries presenting with hemodynamic instability died. In patients with neck vascular injuries, 1 of 2 patients who were hemodynamically unstable died, compared to 1 of 12 patients who died in those who presented hemodynamically stable. Overall survival was 75%.
Conclusions:
Survival and complications of pediatric truncal vascular injury are related to hemodynamic status at the time of presentation. Associated injuries are higher with trauma involving the abdomen.
