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Mechanism matters for major vascular injury in children: A Trauma Quality Improvement Program analysis
Micaela K Gomez1, Maximilian Peter Forssten, Elizabeth C Wood
1From the Department of Vascular Surgery (M.K.G.), Wake Forest University, Winston-Salem, North Carolina; Department of General Surgery (M.K.G.), University of Arizona, Tucson, Arizona; Department of Orthopedic Surgery (M.P.F.), Orebro University Hospital, Sweden, School of Medical Sciences, Orebro University, Sweden; Department of Surgery (E.C.W.), Department of Vascular and Endovascular Surgery (T.K.W.), Wake Forest School of Medicine, Winston Salem, North Carolina; Department of Orthopedic Surgery (S.P.F.), Orebro University Hospital, Orebro, Sweden; Center of Trauma and Critical Care (B.S.), George Washington University, Washington, District of Columbia; Department of Pediatric Surgery, Wake Forest School of Medicine (L.P.N.), Winston-Salem, North Carolina; and Consultant Trauma & Emergency Surgeon (S.M.), School of Medical Sciences, Orebro University, Sweden.
Background:
Trauma is the leading cause of death in pediatric patients, with major vascular injuries significantly worsening outcomes. This study aimed to evaluate the mortality and complication profile of pediatric trauma patients suffering from major vascular injuries as a result of gunshot wounds (GSWs) compared with blunt mechanisms.
Methods:
We queried the American College of Surgeons Trauma Quality Improvement Program database from 2013 to 2021 for pediatric (≤12 years old) trauma patients who suffered a major vascular injury as a result of either blunt trauma or a GSW. Patients were excluded if they had a head or face Abbreviated Injury Scale ≥2 or an Abbreviated Injury Scale of 6 in any other region. These groups were examined regarding demographics, clinical characteristics, and in-hospital outcomes. In order to adjust for confounding, Poisson regression models with robust standard errors were employed.
Results:
After applying the inclusion and exclusion criteria 1,605 patients remained for further analysis. Of these, 18.1% patients (n = 292) suffered a GSW. GSW patients were significantly more injured than blunt trauma patients (Injury Severity Score ≥ 16: 59.6% vs. 33.6%, p < 0.001). GSW patients had significantly higher rates of major intrathoracic as well as femoral vascular injuries, whereas intraabdominal aortic and renal vascular injuries were more common in blunt trauma patients. GSW patients accordingly demonstrated significantly higher rates of in-hospital mortality (21.2% vs. 5.3%, p < 0.001) and overall complications (13.7% vs. 8.4%, p = 0.007). After adjusting for potential confounding, suffering a major vascular injury due to a GSW was associated with an 80% higher rate of mortality ( p = 0.013).
Conclusion:
The overall lethality and complication rate for major vascular injury is greater after GSWs than blunt trauma. These findings underscore the importance of firearm injury prevention and provide further insight into the new leading cause of death in children.
Level Of Evidence:
Therapeutic/Care Management; Level IV.
