Management of pediatric brachial plexus injuries: A cohort study utilizing the trauma quality improvement program
Molly F MacIsaac1, Raissa Li2, Kinsey A Rice3
1Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, 601 Fifth Street South, Suite 611, St. Petersburg, FL, 33701, USA.
Insights
Pediatric brachial plexus injuries (BPI) are increasingly caused by firearms, often with severe associated trauma. Immediate surgical repair for BPI is rare, usually reserved for cases involving vascular damage.
Area of Science:
- Trauma Surgery
- Pediatric Orthopedics
- Neurology
Background:
- Pediatric brachial plexus injuries (BPI) are uncommon, representing a small fraction of overall BPIs and pediatric trauma cases.
- These injuries typically result from high-energy trauma, presenting unique challenges in pediatric populations compared to adults.
- Understanding contemporary patterns in pediatric BPI is crucial for effective management.
Purpose of the Study:
- To conduct a large-scale analysis of pediatric BPI.
- To identify current mechanisms of injury (MOI) and management strategies for pediatric BPI.
- To stratify findings by pediatric age groups.
Main Methods:
- Utilized the Trauma Quality Improvement Program (TQIP) database (2017-2020).
- Identified pediatric BPI cases and analyzed MOI, concomitant injuries, imaging, and treatments.
- Defined pediatric age groups: children (0-9), young adolescents (10-14), and older adolescents (15-17).
Main Results:
- Firearm injuries (23%) surpassed sports (22%) and motor vehicle accidents (MVAs, 21%) as the leading MOI in pediatric BPI.
- Older adolescents predominantly sustained firearm-related BPIs, while younger children were more affected by MVAs.
- Associated injuries were common, including orthopedic (44%), head (40%), and vascular (24%); immediate BPI repair was infrequent (4.3%), primarily in vascular injury cases.
Conclusions:
- Pediatric BPIs are increasingly associated with firearm incidents and complex polytrauma.
- Specialized care is essential for managing these severe injuries.
- Immediate repair is reserved for specific scenarios, highlighting the need for refined management protocols, especially for high-energy and firearm-related BPIs.
Purpose:
Pediatric brachial plexus injuries (BPI) are uncommon, representing about 10% of BPIs overall and 0.1% of pediatric trauma cases. These injuries often result from high-energy trauma and are unique to neonatal and adult cases. This study aims to provide a contemporary, large-scale analysis of pediatric BPI mechanisms and management patterns.
Methods:
The Trauma Quality Improvement Program (TQIP) database was used to identify pediatric BPI cases from 2017 to 2020. Mechanisms of injury (MOI), concomitant injuries, imaging, and treatment intervention were determined. Pediatric age groups were defined as children (0-9 years), young adolescents (10-14), and older adolescents (15-17).
Results:
Of the 746,817 recorded pediatric trauma cases in TQIP, 285 BPI cases were identified (0.038%), with the majority (55%) in older adolescents. Firearm injuries accounted for 23% of cases, surpassing sports (22%) and MVAs (21%) as the leading mechanisms. Children under 10 years were most affected by MVAs (20%), young adolescents by sports (32%), and older adolescents by firearms (30%). Associated injuries included orthopedic (44%), head (40%), and vascular (24%) injuries. Imaging was performed in 82% of cases, with CT (57%) and MRI (50%) being the most common. Immediate BPI repair was rare (4.3%), mainly occurring in cases with concurrent vascular injuries (91%).
Discussion:
Pediatric BPIs are increasingly linked to firearms and often present alongside complex polytrauma, requiring specialized care. Immediate repair is rare, typically reserved for cases with vascular injury. These findings emphasize the need for further research to refine management, particularly in high-energy and firearm-related BPIs.
