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Pediatric vs adult vascular trauma: a National Trauma Databank review
Galinos Barmparas1, Kenji Inaba, Peep Talving
1Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles, CA 90033, USA.
Insights
Pediatric vascular trauma is uncommon, with upper extremity injuries most frequent and low mortality. Despite lower incidence than adults, children show improved survival rates for vascular injuries.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Vascular Surgery
Background:
- Vascular injuries in children are less common than in adults.
- Understanding pediatric vascular trauma is crucial for effective treatment and outcomes.
Purpose of the Study:
- To analyze nationwide data on pediatric vascular injuries.
- To compare incidence, injury mechanisms, and outcomes of pediatric versus adult vascular trauma.
Main Methods:
- Analysis of the National Trauma Databank (dataset version 7.0).
- Comparison of pediatric patients (<16 years) with adult patients (≥16 years) diagnosed with vascular injuries.
- Data spanned a 5-year period ending December 2006.
Main Results:
- Vascular injury occurred in 0.6% of pediatric trauma patients versus 1.6% in adults.
- Pediatric patients had lower Injury Severity Scores and fewer penetrating injuries.
- Upper extremity vessels were most commonly injured in children; thoracic aortic injuries were rare.
- Pediatric patients demonstrated improved survival rates (adjusted odds ratio, 0.60).
Conclusions:
- Pediatric vascular trauma is infrequent but can result from penetrating injuries.
- Upper extremity vascular injuries in children have low mortality.
- Children with vascular injuries have better adjusted survival rates compared to adults.
Introduction:
The purpose of this study was to examine nationwide data on vascular injuries in children and to compare pediatric and adult patients with respect to the incidence, injury mechanisms, and outcomes.
Methods:
This is a National Trauma Databank analysis based on dataset version 7.0 (spanning a 5-year period ending December 2006). Pediatric patients under the age of 16 with at least one reported diagnosis of a vascular injury were compared to the adult cohort aged 16 and greater with a vascular injury.
Results:
During the study period, of 251,787 injured patients younger than 16 years, 1138 (0.6%) had a vascular injury. The incidence in patients 16 years or older was significantly higher, at 1.6% (P < .01). Compared to the adult vascular patients, pediatric patients had a significantly lower Injury Severity Score (16.8 +/- 14.9 vs 26.3 +/- 16.7, P < .001) and encountered less frequently penetrating injuries (41.8% vs 51.2%, P < .001). The most commonly injured vessels in the pediatric population were vessels of the upper extremity (424 patients or 37.9%). The overall incidence of thoracic aortic injuries in children was seven-fold lower compared to the incidence in adults (0.03% vs 0.21%). After adjusting for confounding factors, pediatric patients demonstrated improved survival following vascular injuries (adjusted odds ratio, 0.60; 95% CI, 0.45-0.79; P < .001). No significant difference was identified in the rate of amputation between pediatric and adult patients who had sustained upper or lower extremity vascular injuries.
Conclusion:
Vascular trauma in the pediatric population is uncommon, occurring in only 0.6% of all pediatric trauma patients. Although less frequent than adults, a significant proportion was due to penetrating injury. Vessels of the upper extremity were the most commonly injured and were associated with low mortality. Injuries of the thoracic aorta are rare. Overall, pediatric patients had an improved adjusted mortality when compared to adults.
