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Editor's Choice - International Perspective on Extremity Vascular Trauma in Children: A Scoping Review
N Moody1, A Walter1, Davina Daudu2
1Queen Elizabeth University Hospital, Glasgow, UK.
Insights
Pediatric extremity vascular trauma is uncommon, with penetrating injuries and upper limb damage most frequent. Most studies focus on operative interventions, highlighting a need for prospective research on long-term outcomes.
Area of Science:
- Pediatric vascular surgery
- Trauma surgery
- Scoping review methodology
Background:
- Extremity vascular trauma in children poses significant risks.
- Existing research primarily addresses supracondylar humeral fracture injuries.
- A comprehensive understanding of other pediatric vascular injuries is lacking.
Purpose of the Study:
- To conduct a scoping review of pediatric vascular injuries in the limbs.
- To synthesize current knowledge on epidemiology, diagnosis, management, and outcomes.
- To exclude injuries related to supracondylar humeral fractures.
Main Methods:
- Searched MEDLINE, PubMed, Web of Science, and Cochrane databases.
- Included studies on pediatric upper and lower limb vascular trauma (age < 18).
- Adhered to PRISMA extension for Scoping Reviews, excluding supracondylar humeral fracture studies.
Main Results:
- 39 retrospective studies analyzed; 74% from North America/Europe.
- Vascular trauma accounts for 0.6-4.4% of pediatric trauma admissions; penetrating injuries and upper limb trauma are most common.
- Operative intervention (80-100%) favored primary repair; low rates of fasciotomies/amputations; low mortality (0-4%).
Conclusions:
- Pediatric extremity vascular trauma is infrequent, predominantly caused by penetrating injuries to the upper extremities.
- Studies are largely from high-income nations, potentially biased towards operative management.
- Prospective research is crucial for understanding injury patterns, intervention rates, and long-term outcomes.
Objective:
Extremity vascular trauma in children can result in significant morbidity and mortality. Most published studies have focused on supracondylar humeral fracture related injuries, with little focus on other injuries. This scoping review describes the current state of knowledge on paediatric vascular injuries in the upper and lower limbs, excluding injuries related to supracondylar humeral fractures.
Methods:
MEDLINE, PubMed, Web of Science, and Cochrane databases were searched for relevant studies evaluating the epidemiology, diagnosis, management, and outcomes of upper and lower limb vascular trauma in those aged under 18 years. Studies related to supracondylar humeral fractures were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews was used.
Results:
A total of 39 studies was included, all of which were retrospective, and 74% of which were based in North America or Europe. Extremity vascular trauma was reported to cause 0.6 - 4.4% of all paediatric trauma admissions, with penetrating mechanisms and upper limb injuries being the most common. Operative intervention was reported in 80 - 100% of children in the included studies. Primary repair was the most commonly reported operative intervention, followed by interposition graft and bypass graft. Synthetic graft use was less commonly reported (incidence range 0.5 - 33%). Lower limb fasciotomies and amputations were not commonly reported (incidence range 0 - 23% and 0 - 13%, respectively). The mortality rate appeared low, with 23 studies reporting no deaths (incidence range 0 - 4%). Complications were reported inconsistently, with no uniform outcome or follow up measures used.
Conclusion:
The incidence of extremity vascular trauma appears low in children, with penetrating mechanisms and upper extremity injuries appearing to dominate. Most studies are from high income countries, with probable selection bias towards those treated by operative intervention. Prospective studies are required focusing on patterns of injury, rates of operative and endovascular intervention, and long term outcomes.
