New England Surgical Society

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National Trends in the Management of Traumatic Pediatric Abdominal Vascular Injury
*Katharine R. Bittner, *Erica D. Kane, *Jane Garb, *Ashwini S. Poola, David B. Tashjian, *Briana Leung, Gregory T. Banever, Kevin P. Moriarty, Michael V. Tirabassi
Baystate Medical Center, Springfield, MA

Objective: Due to the dearth of literature directing optimal management of potentially life-threatening pediatric abdominal vascular injury, treatment has followed that of adults. We assessed national trends regarding the intervention and outcomes of children presenting with these injuries.
Design: Retrospective comparison from the National Trauma DataBank.
Setting: Level I trauma center.
Patients: All patients under eighteen years who sustained blunt or penetrating injury to at least one named intraperitoneal vessel (dcode902-902.9). Patients were separated into arterial, venous, and combined arterial and venous injury; then stratified by intervention. Admission year, age, sex, mechanism, and injury severity score identified for covariate analysis.
Results: Between 2007-2011, 1799 patients sustained abdominal vascular injuries. Mean age 14.84.3 years. ISS was similar across all groups. Length of stay, ICU stay, ventilator days, and number of complications were similar across injury groups. Patients with combined vascular injuries had the highest incidence of complications (51% v. 41% arterial and 43% venous; p=0.012) and highest mortality (42%; p<0.0001). When analyzed by intervention, patients with arterial injury who underwent interventional radiology had the lowest mortality (6.2%, p=0.028; Table). Patients who had no intervention with either isolated venous injuries, or mixed arterial and venous injuries had the highest mortality rates 37%(p=0.002) and 61%(p=0.011), respectively.
Conclusion: Children presenting with both arterial and venous abdominal injuries have very high morbidity and mortality, particularly those who do not undergo operative intervention. Further study is imperative to determine if there are any opportunities to improve the current management strategies of pediatric abdominal vascular injuries.
Outcomes by Injury and Intervention
# Total
injuries
LOSComplicationsDisposition homeDisposition SNFMortality
ArterialNo intervention (Ref)7.6 6.011.5 15.840.2% (0.6 0.9)58.2%21.3%19.3%
IR12.7 35.115.7 15.041.3% (1.0 1.4)69.3%23.2%6.2%*
OR6.8 5.314.0 17.643.0% (0.8 1.3)61.7%23.4%15.4%
Both IR and OR9.8 6.015.5 13.752.8% (1.2 1.6)*20.7%**41.3%38.2%
VenousNo intervention (Ref)7.1 5.98.0 11.739% (0.6 1.1)51%9%37%
OR5.7 4.016.1 20.148% (1.0 1.3)*60%16%*24%**
BothNo intervention (Ref)7.2 5.36.8 12.651% (0.8 1.0)32%5%61%
OR5.7 4.2 13.9 19.850% (0.8 1.1)45%13%41%*
*p<0.05, **p<0.01 on multivariable analysis


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