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Surgical intervention for paediatric infusion-related extravasation injury: a systematic review
Max Little1, Sophie Dupré2, Justin Conrad Rosen Wormald2,3
1Trauma & Orthopaedic Surgery, Whittington Hospital NHS Trust, London, UK.
Insights
This review found limited evidence for surgical interventions in pediatric extravasation injuries. More research is needed to determine optimal surgical techniques and outcomes for these injuries in children.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Evidence-Based Medicine
Background:
- Extravasation injuries in children can range from mild to severe.
- Surgical interventions are sometimes employed for significant soft tissue damage.
Purpose of the Study:
- To assess the quality of literature on surgical interventions for pediatric extravasation injuries.
- To determine if evidence supports invasive techniques in children.
Main Methods:
- Systematic review of multiple databases (MEDLINE, EMBASE, AMED, CINAHL, Cochrane) and clinicaltrials.gov.
- Inclusion criteria: pediatric population (<18 years), surgical intervention for extravasation, reported outcomes.
- Study quality assessed using NIH tools.
Main Results:
- 26 studies (728 children) included: 1 before-and-after, 25 case series.
- Most common surgical technique: multiple puncture wounds with saline/hyaluronidase.
- Severe complications noted, including amputation; functional/aesthetic outcomes often lacking.
Conclusions:
- Surgical management is frequently reported for significant soft tissue injury.
- Lack of comparative studies makes optimal surgical approach unclear.
- Further research, including a centralized register and core outcome set, is needed.
Objectives:
This systematic review aims to assess the quality of literature supporting surgical interventions for paediatric extravasation injury and to determine whether there is sufficient evidence to support invasive techniques in children.
Methods:
We performed a systematic review by searching Ovid MEDLINE and EMBASE as well as AMED, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and clinicaltrials.gov from inception to February 2019. Studies other than case reports were eligible for inclusion if the population was younger than 18 years old, if there was a surgical intervention aimed at treating extravasation injury and if they reported on outcomes. Study quality was graded according to the National Institutes of Health study quality assessment tools.
Results:
26 studies involving 728 children were included-one before-and-after study and 25 case series. Extravasation injuries were mainly confined to skin and subcutaneous tissues but severe complications were also encountered, including amputation (one toe and one below elbow). Of the surgical treatments described, the technique of multiple puncture wounds and instillation of saline and/or hyaluronidase was the most commonly used. However, there were no studies in which its effectiveness was tested against another treatment or a control and details of functional and aesthetic outcomes were generally lacking.
Conclusion:
Surgical management is commonly reported in the literature in cases where there is significant soft tissue injury but as there are no comparative studies, it is unclear whether this is optimal. Further observational and experimental research evaluating extravasation injuries, including a centralised extravasation register using a universal grading scheme and core outcome set with adequate follow-up, are required to provide evidence to guide clinician decision-making.
