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Extravasation injury management for neonates and children: A systematic review and aggregated case series
Mitchell Dufficy1,2, Mari Takashima1,2, Jacqueline Cunninghame1,2
1School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.
Insights
Pediatric extravasation injuries require better management guidelines. This review found limited research and no treatment consensus for these common healthcare-associated injuries in children.
Area of Science:
- Pediatric Healthcare
- Medical Injury Management
- Evidence-Based Practice
Background:
- Pediatric extravasation injuries are common healthcare-associated injuries with potential for severe complications.
- There is a need for evidence-based guidance to prevent permanent injury in children.
Purpose of the Study:
- To conduct a systematic review of literature on the management of extravasation injuries in hospitalized pediatric patients.
- To identify current research trends and gaps in the management of pediatric extravasation injuries.
Main Methods:
- Systematic literature search of PubMed, CINAHL, and EMBASE databases (up to December 13, 2021).
- Inclusion of primary research on pediatric extravasation injury management (patients ≤18 years) published from 2010 onwards.
- Data extraction and synthesis by independent reviewers with arbitration.
Main Results:
- 27 studies were included, with 18 reporting case data (33 cases), primarily case studies (52%) of neonates (67%).
- Common outcomes included scarring (45%) and necrosis (30%).
- Diverse treatments were identified, categorized into first aid, medical, surgical, and dressings.
Conclusions:
- Pediatric extravasation injury management is under-researched, characterized by low-quality studies.
- There is a lack of consensus on effective treatments and outcome measures for pediatric extravasation injuries.
Background:
Pediatric extravasation injuries are significant healthcare-associated injuries, with sometimes significant sequelae. Evidence-based guidance on management is necessary to prevent permanent injury.
Purpose:
A systematic review of the literature, including aggregated case series, investigating extravasation injury management of hospitalized pediatric patients.
Data Sources:
PubMed, Cummulative Index to Nursing and Allied Health Literature (CINAHL), and Excerpta Medica database (EMBASE) were searched on December 13, 2021.
Study Selection:
Primary research investigating extravasation injury management of hospitalized pediatric patients (to 18 years), published from 2010 onwards and in English, independently screened by two authors, with arbitration from a third author.
Data Extraction:
Data regarding the study, patient (age, primary diagnosis), extravasation (site, presentation, outcome), and treatment (first aid, wound management) were extracted by two authors, with arbitration from a third author.
Data Synthesis:
From an initial 1769 articles, 27 studies were included with extractable case data reported in 18 studies, resulting in 33 cases. No clinical trials were identified, instead, studies were primarily case studies (52%) of neonates (67%), with varied extravasation symptoms. Studies had good selection and ascertainment, but few met the causality and reporting requirements for quality assessments. Signs and symptoms varied, with scarring (45%) and necrosis (30%) commonly described. Diverse treatments were categorized into first aid, medical, surgical, and dressings.
Conclusions:
Despite infiltration and extravasation injuries being common within pediatric healthcare, management interventions are under-researched, with low-quality studies and no consensus on treatments or outcomes.
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