Let’s Be Blunt - Cervical Vascular Injury In Pediatric Trauma
*Robert J McLoughlin, *Avina Joshi, Max D Hazeltine, Jonathan Green, Michael P Hirsh, Jeremy T Aidlen, *Muriel A Cleary
University of Massachusetts Medical School, Worcester, MA
Title: Let’s Be Blunt - Cervical Vascular Injury In Pediatric Trauma
1.ObjectiveDescribe hospitalized pediatric population with injuries to the vasculature of the neck after blunt trauma
2.DesignPatients ≤18 years old with an ICD-10 diagnosis of a cervical blunt vascular injury in the 2016 Kids’ Inpatient Database. Patient characteristics were analyzed using ICD-10 codes. Multivariable logistic regression was performed.
3.SettingAll hospitalized pediatric patients in 47 states across the US.
4.Patients Patients ≤18 years old with an ICD-10 diagnosis of cervical blunt vascular injury
6.Main Outcome Measure(s)In-hospital mortality, injury mechanism, demographics, discharge disposition
7.ResultsWe identified 143,857 admissions for blunt trauma. The prevalence of cervical blunt vascular injury was 0.07% (n=105). Children with cervical blunt vascular injury were predominantly male, non-Hispanic white, with a mean age of 13.5 years. Nearly half (47.5%) of injuries occurred on the weekend. Three-quarters of children required a major surgical procedure, and in-hospital mortality was 11.5%. Half of patients were discharged home, and 29% required a short-term hospital or rehab. The most common mechanism was occupancy in a motor-vehicle collision (55%). Hanging, the least common mechanism, had the highest rate of blunt vascular injury (1%). In children with blunt trauma, 0.02% ≤ 5 years had a vascular injury of the neck, but this increased four-fold in those aged 12-18 years. After multivariable logistic regression, children ≤5 years old had 78% lower odds of having a blunt cervical vascular injury than children 12-18 years old.
8.ConclusionsBlunt cervical vascular injuries are rare but are associated with high in-hospital mortality. Motor vehicle collisions and hangings are mechanisms associated with injuries to the vessels of the neck in the adolescent population.
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