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Pediatric cardiac and great vessel injuries: Recent experience at two pediatric trauma centers
Marina L Reppucci1, Jenny Stevens1, Kaci Pickett2
1Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Insights
Pediatric cardiac and great vessel injuries are rare but highly lethal, with great vessel injuries having the highest mortality. Despite interventions, these traumatic injuries remain a significant challenge in pediatric trauma care.
Area of Science:
- Pediatric Trauma Surgery
- Cardiovascular Surgery
- Emergency Medicine
Background:
- Cardiac and great vessel injuries are infrequent in pediatric trauma patients.
- Limited data exists on traumatic great vessel injuries in children.
- This study reviews experiences from two major pediatric trauma centers.
Purpose of the Study:
- To examine and summarize recent experiences with pediatric cardiac and great vessel injuries.
- To analyze demographic and clinical characteristics of affected patients.
- To report on outcomes, including mortality rates.
Main Methods:
- Retrospective review of pediatric patients (<18 years) from January 2010 to June 2020.
- Inclusion criteria: management of cardiac or great vessel injuries at Level 1 or Level 2 trauma centers.
- Statistical comparisons using t-tests, Wilcoxon Rank-Sum, Fisher's exact, and chi-squared tests.
Main Results:
- 53 pediatric patients sustained cardiac and/or great vessel injuries.
- Most common injuries: cardiac (70%), great vessel (17%), both (13%).
- Median age 14.9 years, 74% male; median Injury Severity Score (ISS) 36.0; blunt mechanism in 58%.
Conclusions:
- Cardiac and great vessel injuries in pediatric trauma exhibit significant heterogeneity.
- These injuries are associated with substantial morbidity and high mortality rates.
- Outcomes remain poor despite aggressive surgical and catheter-based interventions.
Background:
Cardiac injuries are rare in pediatric trauma patients and data regarding this type of injury is limited. There is even less data on traumatic great vessel injuries. This study sought to examine and summarize our recent experience at two pediatric trauma centers, which serve a major metropolitan area and large geographic region.
Methods:
This is a retrospective review of pediatric (<18 years) patients who sustained cardiac or great vessel injuries and were managed at a Level 1 or Level 2 pediatric trauma center between January 1, 2010 and June 30, 2020. Demographic and clinical characteristics were compared using two-sample t-tests, Wilcoxon Rank-Sum tests, Fisher's exact tests and chi-squared tests for continuous, non-normally distributed continuous, and categorical variables, respectively.
Results:
A total of 53 patients sustained cardiac and/or great vessel injuries. Of these, 37 (70%) sustained cardiac, 9 (17%) sustained great vessel, and 7 (13%) sustained both types of injuries. The median age was 14.9 years and 74% (n = 39) were male. The median injury severity score (ISS) was 36.0 and the injury mechanism was blunt in 31 (58%) patients. The most common cardiac and great vessel injury locations were left ventricle (n = 9) and thoracic aorta (n = 11), respectively. The overall mortality rate was 53% (n = 28). Mortality was highest among those who sustained great vessel injuries (89%).
Conclusions:
There is substantial heterogeneity in cardiac and great vessel injuries. Regardless, they are highly morbid and lethal, despite aggressive surgical and catheter-based interventions.
