Pediatric aortic trauma: National database analysis of trauma outcomes in pediatric population

Although rare, aortic injury is the second leading cause of death in pediatric trauma, highlighting its morbidity and mortality. This study investigates the demographics, treatment modalities, interventions, and outcomes of pediatric trauma patients with aortic injury over a four-year period. The National Trauma Data Bank 2017-2020 was queried, including all patients aged 1 to ≤18 with aortic injury. The primary outcome was mortality rate, while secondary outcomes included Intensive Care Unit (ICU) admission rates, injury location, and surgical repair type. Of the 524,000 pediatric trauma cases, there were a total of 955 patients (0.18 %) with aortic injuries. From this group, there were 653 patients with thoracic aortic injuries (TAI) and 302 patients with abdominal aortic injuries (AAI). TAI and AAI were primarily due to blunt trauma (66 %, 61.3 %). Most patients did not receive surgical intervention (67.3 %); 32.7 % of patients underwent surgical intervention. Aortic injuries had an overall mortality rate of 43.5 %. TAI had a mortality rate of 49.2 %, which was significantly higher than the 31.1 % mortality in AAI (p < 0.001). Aortic injuries are extremely lethal, with thoracic aortic injuries displaying a higher mortality rate. Endovascular repair is the most common intervention, suggesting its potential benefit over an open repair. These findings underscore the importance of prompt injury identification and intervention, emphasizing the need for future research to optimize treatment strategies and improve survival rates. LEVEL OF EVIDENCE: III.