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Pseudoaneurysm Screening after Pediatric High Grade Solid Organ Injury
Morgan Schellenberg1, Brent Emigh1, Chance Nichols1
1Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
Insights
Pseudoaneurysm screening is infrequent in pediatric high-grade solid organ injuries. Delayed CT angiography (dCTA) and contrast-enhanced ultrasound (CEUS) yield requires further study to optimize diagnosis.
Area of Science:
- Pediatric Trauma Surgery
- Diagnostic Imaging
- Vascular Surgery
Background:
- High-grade solid organ injuries in children can lead to pseudoaneurysms (PSA).
- Optimal screening strategies for pediatric PSA remain undefined.
- Delayed CT angiography (dCTA) and contrast-enhanced ultrasound (CEUS) are potential screening tools.
Purpose of the Study:
- To determine the yield of dCTA and CEUS in diagnosing pseudoaneurysms (PSA) in pediatric patients with high-grade solid organ injuries.
- To evaluate the current practices and outcomes of PSA screening in this population.
Main Methods:
- Retrospective review of patients under 18 with AAST grade ≥3 abdominal solid organ injury (01/2017-10/2021).
- Exclusion criteria included transfers, death within 48 hours, and immediate organ removal.
- Selective PSA screening using dCTA or CEUS based on attending physician discretion.
Main Results:
- Forty-two patients met inclusion criteria; 26% underwent PSA screening.
- Delayed CT angiography (dCTA) was used in 21% and contrast-enhanced ultrasound (CEUS) in 5% of patients.
- One pseudoaneurysm was diagnosed via dCTA following splenic injury; CEUS identified no PSAs.
Conclusions:
- Pseudoaneurysm screening is infrequently performed in pediatric high-grade solid organ injuries.
- Concerns regarding radiation from dCTA may influence screening choices, favoring CEUS.
- Further research is needed to establish PSA incidence and the diagnostic accuracy of dCTA and CEUS.
Background:
High grade solid organ injuries carry risk of complications, including pseudoaneurysms (PSA). The optimal approach to PSA screening among pediatric patients is unknown and may include delayed Computed Tomography Angiography (dCTA) and/or contrast-enhanced ultrasound (CEUS). This study endeavored to define dCTA/CEUS yield in PSA diagnosis after pediatric high grade solid organ injury.
Methods:
Patients <18y presenting to our ACS-verified Level 1 trauma center with ≥1 AAST grade ≥3 abdominal solid organ injury (kidney, liver, and spleen) were included (01/2017-10/2021). Transfers in, death <48h, and immediate nephrectomy/splenectomy were exclusions. PSA screening was pursued selectively based on attending discretion. Demographics, clinical/injury data, and outcomes were collected. Primary outcome was performance of dCTA or CEUS.
Results:
Forty-two patients satisfied criteria, with median age 12.5y and ISS 22. Liver injuries were most frequent (48%), followed by spleen (33%) and kidney (19%). Initial management strategy was most commonly nonoperative (liver 60%, spleen 64%, kidney 75%). Overall, 26% underwent PSA screening at a median of hospital day 4, with dCTA (21%) or CEUS (5%). CEUS was only used among liver injuries (10%), with no PSA identified. One PSA was diagnosed on dCTA after splenic injury and was managed with observation.
Conclusion:
PSA screening occurs infrequently after pediatric high grade solid organ injury, potentially due to concerns about radiation exposure from dCTA which would be mitigated with CEUS. Further delineation of PSA incidence and yield of screening investigations are needed to avoid missing this important diagnosis and to determine the diagnostic accuracy of dCTA and CEUS.
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