j o u r n a l o f s u r g i c a l r e s e a r c h x x x ( 2 0 1 5 ) 1 e7
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Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Pediatric vascular injury: experience of a level 1 trauma center Casey J. Allen, MD,a Richard J. Straker, BS,a Jun Tashiro, MD, MPH,b Laura F. Teisch, BS,a Jonathan P. Meizoso, MD,a Juliet J. Ray, MD,a Nicholas Namias, MD,a and Juan E. Sola, MDb,* a
Division of Trauma Surgery, University of Miami Miller School of Medicine, Miami, Florida Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
b
article info
abstract
Article history:
Background: Our purpose was to analyze modern major vascular injury (MVI) patterns in
Received 9 December 2014
pediatric trauma, interventions performed, and outcomes at a level 1 trauma center.
Received in revised form
Materials and methods: From January 2000eDecember 2012, all pediatric admissions (17 y)
27 January 2015
were reviewed.
Accepted 12 February 2015
Results: Of 1928 pediatric admissions, 103 (5.3%) sustained MVI. This cohort was 85% male,
Available online xxx
age 15 3 y, 55% black, 58% penetrating, injury severity score of 23 15, with a length of stay of 8 (5) days. Firearm-related injury (47%) was the most common mechanism. Location
Keywords:
of injuries included the extremities (50.5%), abdomen/pelvis (29.1%), and chest/neck
Children
(20.4%). Operative procedures included repair/bypass (75.3%), ligation (12.7%), amputation
Firearms
(10.8%), or temporary shunt (2.9%). Only three injuries (2.4%) were treated endovascularly.
Mortality
MVI patients had a mortality rate of 19.4%, higher than the overall pediatric trauma pop-
Injury patterns
ulation of 3.5% (P < 0.001). After logistic regression, independent risk factors of mortality
Outcomes
were vascular injury to the neck (odds ratio [OR]: 6.5; confidence interval (CI): 1.1e39.3), abdomen/pelvis (OR: 16.3; CI: 3.13e80.2), and chest (OR: 49.0; CI: 3.0e794.5). Conclusions: MVI in children more commonly results from firearm-related injury. The mortality rate associated with MVI is profoundly higher than that of the overall pediatric trauma population. These findings underscore the major public health concern of firearmrelated injury in children. ª 2015 Elsevier Inc. All rights reserved.
1.
Introduction
Trauma remains the leading cause of death and morbidity in children after the age of 1 [1]. Vascular injury, although rare, contributes significantly to morbidity and mortality in children [2e4]. Exsanguination from such injuries is the most
common cause of early mortality in trauma across all age groups [5]. Because vascular disease is so rare in children, one of the most common indications for vascular surgery in this population is traumatic injury [6e8]. Because of the infrequency of these cases, intervention in pediatric vascular injury has traditionally been extrapolated
Portions of the data were presented at the 2014 Florida Vascular Society Conference, West Palm Beach, Florida, May 1e4, 2014 and 2015 Academic Surgical Congress, Las Vegas, Nevada, February 8e10, 2015. * Corresponding author. Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 450K, Miami, FL 33136. Tel.: þ1 305 243 5072; fax: þ1 305 243 5731. E-mail address: [email protected] (J.E. Sola). 0022-4804/$ e see front matter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2015.02.023
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2
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j o u r n a l o f s u r g i c a l r e s e a r c h x x x ( 2 0 1 5 ) 1 e7
from the experience with adult trauma patients. However, pediatric vascular injury varies significantly in certain aspects from that of adults. The rarity of these injuries in children has resulted in imprecise and ambiguous management strategies [9]. Currently only a few series exist describing the occurrence, injury patterns, initial management, and outcomes associated with pediatric trauma vascular injuries. The purpose of this study was to analyze modern vascular injury patterns in pediatric trauma, the interventions performed, and subsequent outcomes at a high-volume level 1 trauma center.
2.
Materials and methods
Data for this analysis were gathered from the trauma registry of a level I trauma center serving a large urban population of 2.6 million and the surrounding metropolitan area. Cases were identified in the period between January 2000 and December 2012 and limited to patients aged
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Q5 17 18 19 20 Q1 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Pediatric vascular injury: experience of a level 1 trauma center Casey J. Allen, MD,a Richard J. Straker, BS,a Jun Tashiro, MD, MPH,b Laura F. Teisch, BS,a Jonathan P. Meizoso, MD,a Juliet J. Ray, MD,a Nicholas Namias, MD,a and Juan E. Sola, MDb,* a
Division of Trauma Surgery, University of Miami Miller School of Medicine, Miami, Florida Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
b
article info
abstract
Article history:
Background: Our purpose was to analyze modern major vascular injury (MVI) patterns in
Received 9 December 2014
pediatric trauma, interventions performed, and outcomes at a level 1 trauma center.
Received in revised form
Materials and methods: From January 2000eDecember 2012, all pediatric admissions (17 y)
27 January 2015
were reviewed.
Accepted 12 February 2015
Results: Of 1928 pediatric admissions, 103 (5.3%) sustained MVI. This cohort was 85% male,
Available online xxx
age 15 3 y, 55% black, 58% penetrating, injury severity score of 23 15, with a length of stay of 8 (5) days. Firearm-related injury (47%) was the most common mechanism. Location
Keywords:
of injuries included the extremities (50.5%), abdomen/pelvis (29.1%), and chest/neck
Children
(20.4%). Operative procedures included repair/bypass (75.3%), ligation (12.7%), amputation
Firearms
(10.8%), or temporary shunt (2.9%). Only three injuries (2.4%) were treated endovascularly.
Mortality
MVI patients had a mortality rate of 19.4%, higher than the overall pediatric trauma pop-
Injury patterns
ulation of 3.5% (P < 0.001). After logistic regression, independent risk factors of mortality
Outcomes
were vascular injury to the neck (odds ratio [OR]: 6.5; confidence interval (CI): 1.1e39.3), abdomen/pelvis (OR: 16.3; CI: 3.13e80.2), and chest (OR: 49.0; CI: 3.0e794.5). Conclusions: MVI in children more commonly results from firearm-related injury. The mortality rate associated with MVI is profoundly higher than that of the overall pediatric trauma population. These findings underscore the major public health concern of firearmrelated injury in children. ª 2015 Elsevier Inc. All rights reserved.
1.
Introduction
Trauma remains the leading cause of death and morbidity in children after the age of 1 [1]. Vascular injury, although rare, contributes significantly to morbidity and mortality in children [2e4]. Exsanguination from such injuries is the most
common cause of early mortality in trauma across all age groups [5]. Because vascular disease is so rare in children, one of the most common indications for vascular surgery in this population is traumatic injury [6e8]. Because of the infrequency of these cases, intervention in pediatric vascular injury has traditionally been extrapolated
Portions of the data were presented at the 2014 Florida Vascular Society Conference, West Palm Beach, Florida, May 1e4, 2014 and 2015 Academic Surgical Congress, Las Vegas, Nevada, February 8e10, 2015. * Corresponding author. Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 450K, Miami, FL 33136. Tel.: þ1 305 243 5072; fax: þ1 305 243 5731. E-mail address: [email protected] (J.E. Sola). 0022-4804/$ e see front matter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2015.02.023
5.2.0 DTD YJSRE13140_proof 3 March 2015 4:44 am ce
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j o u r n a l o f s u r g i c a l r e s e a r c h x x x ( 2 0 1 5 ) 1 e7
from the experience with adult trauma patients. However, pediatric vascular injury varies significantly in certain aspects from that of adults. The rarity of these injuries in children has resulted in imprecise and ambiguous management strategies [9]. Currently only a few series exist describing the occurrence, injury patterns, initial management, and outcomes associated with pediatric trauma vascular injuries. The purpose of this study was to analyze modern vascular injury patterns in pediatric trauma, the interventions performed, and subsequent outcomes at a high-volume level 1 trauma center.
2.
Materials and methods
Data for this analysis were gathered from the trauma registry of a level I trauma center serving a large urban population of 2.6 million and the surrounding metropolitan area. Cases were identified in the period between January 2000 and December 2012 and limited to patients aged
