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Characteristics and Validation of Pediatric Extremity Vascular Trauma in Dedicated Pediatric and Adult Trauma
Christos Argyriou1, Vasiliki Varlami2, Katerina Kambouri3
1Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Thrace, Greece.
Insights
Pediatric extremity vascular injuries are rare but serious. Early diagnosis and treatment are crucial for reducing complications and improving outcomes, though dedicated pediatric centers are often unavailable.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Pediatric Emergency Medicine
Background:
- Pediatric extremity vascular injuries are uncommon but can lead to severe complications if not promptly diagnosed and managed.
- Effective management strategies in pediatric versus combined adult trauma centers (ATCs) require further evaluation.
Purpose of the Study:
- To analyze the characteristics and outcomes of pediatric extremity vascular injuries.
- To compare the effectiveness of dedicated pediatric ATCs versus combined ATCs in managing these injuries.
- To identify unique diagnostic and management features of pediatric vascular disease.
Main Methods:
- A scoping review following PRISMA-extension guidelines.
- Analysis of 12 studies involving 2,124 pediatric patients with vascular extremity injuries.
- Inclusion of records identified using MeSH terms from PubMed/MEDLINE.
Main Results:
- Incidence of pediatric extremity vascular injury is 0.5%, with upper extremity injuries being most common (63%).
- Blunt injuries (58%) were more frequent than penetrating injuries (42%).
- High limb-salvage rates (92%-99%) were observed, with in-hospital mortality (0.9%-13.2%) and morbidity (13%-30%).
Conclusions:
- Dedicated pediatric trauma centers offer theoretical advantages for complex cases requiring vascular reconstruction.
- Resource limitations and economic factors often make dedicated centers inaccessible.
- A high index of clinical suspicion for early diagnosis is paramount for superior patient outcomes.
Background:
Pediatric extremity vascular injuries constitute a rare yet serious entity that can lead to serious complications especially if left untreated or become late diagnosed. In our scoping review, we sought to evaluate different characteristics and outcomes of pediatric and combined adult trauma centers (ATCs) in the management of pediatric extremity vascular injury.
Methods:
We sought to analyze various characteristics and parameters that differentiate a dedicated pediatric and a combined pediatric ATC in terms of effectiveness and quality of care in the acute setting and to describe special features and characteristics of an acute vascular disease that constitute pediatric population unique from the aspect of diagnosis and management. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews guidelines to conduct the study.
Results:
The search identified 8,815 records in title using MeSH terms from PubMed/MEDLINE database among which 12 studies reporting a total of 2,124 pediatric patients with vascular extremity injuries were included for analysis. Incidence of pediatric extremity vascular injury was 0.5%. Upper extremity injuries were the most frequent presenting in 63% of cases followed by lower extremity injuries in 37% of cases. Blunt injuries were marginally more common than penetrating injuries (58% vs. 42%). In-hospital mortality and morbidity ranged from 13.2% to 0.9% and 13% to 30%, respectively. Limb-salvage rates were high, ranging from 92% to 99%. Furthermore, there are no clearly defined clinical guidelines involving the mode of imaging and diagnosis, the surgical specialties involved and the competency of nursing or medical staff overall.
Conclusions:
Dedicated children trauma centers theoretically represent the optimal path for acute pediatric trauma admission, especially in complex trauma necessitating vascular reconstruction. However, in the current setting of rapidly increasing health costs and economic crisis worldwide, regional or resource-related factors make this option rather unavailable. In any case, it is imperative the clinicians have a high index of suspicion when confronting with these types of injuries because early diagnosis is highly related with reduced morbidity and superior outcomes.
