C. J. Allen3, R. J. Straker3, J. Tashiro1, J. P. Meizoso3, J. J. Ray3, M. Hanna3, C. I. Schulman3, N. Namias3, K. G. Proctor3, J. Rey2, J. E. Sola1 1University Of Miami,Pediatric Surgery,Miami, FL, USA 2University Of Miami,Vascular Surgery,Miami, FL, USA 3University Of Miami,Trauma And Critical Care,Miami, FL, USA
Introduction: Trauma is the leading cause of death and morbidity in children. Youth firearm related injuries are rising and traumatic injury is the most common indication for pediatric vascular surgery. Our purpose is to analyze modern vascular injury patterns in pediatric trauma, interventions performed, and outcomes at a high volume level 1 trauma center.
Methods: From January 2000 to December 2012, all pediatric admissions (≤17y) at a level 1 trauma center were reviewed for demographics, mechanisms of injury (MOI), injury severity score (ISS), vascular injury, surgeries performed, length of stay (LOS), and survival. Parametric data is expressed as mean±standard deviation and non-parametric data as median(interquartile range). Univariate analysis determined significant factors of mortality. Multivariate analysis with logistic regression determined the injury locations with independent mortality risk.
Results: Of 1,928 pediatric admissions, 103 (5.3%) sustained a major vascular injury (MVI). This cohort was 85% male, age 15±3y, 55% black, 58% penetrating, ISS of 23±15, with a LOS of 8(5)d. The most common MOI were GSW (47%) and MVC (17%). Injury by location includes the extremities (50.5%), abdomen/pelvis (29.1%), and chest/neck (20.4%). Surgeries performed included repairs/bypasses (75.3%), ligation (12.7%), limb amputation (10.8%), or with temporary shunt (2.9%). The most common vessels requiring operative intervention were the superficial femoral artery (11.7%), common femoral artery (9.8%), and brachial artery (6.9%). The vessel most commonly repaired by a vascular specialist was the popliteal artery (55.6%). 3 injuries (2.4%) were treated endovascularly, 2 injuries required embolization of a branch of the internal iliac artery, and 1 injury to the thoracic aorta required endovascular stent grafting. MVI patients had a mortality rate of 19.4%, significantly increased when compared to the total pediatric trauma population mortality rate of 3.5% (p<0.001). Mortality rate also varied according to injury location (chest: 67%, abdomen/pelvis: 40%, neck: 21%, extremity: 4% (p<0.001)). Following multivariate analysis with logistic regression, significant independent risk factors of mortality were vascular injury to the neck (odds ratio (OR): 6.5; confidence interval (CI): 1.1-39.3), abdomen/pelvis (OR: 16.3; CI: 3.13-80.2), and chest (OR: 49.0; CI: 3.0-794.5).
Conclusion: 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 firearm related injury in children and to the importance of improving management and prevention of these lethal injuries.