Professor of Surgery Louisiana State University Health Sciences Center New Orleans, Louisiana
Objectives: Although pediatric vascular trauma is rare, it can result in severe functional deficits or death. The purpose of this study is to evaluate the demographics, injuries, and outcomes of the pediatric vascular trauma population and identify any risk factors associated with complications or death.
Methods: The authors conducted a retrospective cohort study that included all patients with penetrating and blunt trauma age 18 and under that presented to a large urban level 1 trauma center from January 2016 to August 2021. Demographic, injury, treatment, and outcome variables were recorded. The primary outcome variable was the presence of a vascular complication. The secondary outcome variable was mortality. Descriptive statistics were calculated and chi square, logistic regression and t-tests were used to analyze relationships between study variables and the outcomes.
Results: From January 2016 to August 2021, there were 2,168 pediatric trauma patients of which 3.41% presented with a major vascular injury. A retrospective chart review was performed for these 74 patients. The mean age for the study population was 15 [1-18] and 78% were male. Penetrating trauma represented 70.2% (52/74) of the cohort and more specifically 60.8% (45/74) of injuries seen were secondary to gunshots. Arterial injuries were the most common (67/74, 90%). In 55.2% (32/58) of the patients who underwent surgery, the vascular repair was performed by a vascular surgeon, the remaining (44.8%, 26/58) were conducted by trauma surgeons. Involvement by a vascular surgeon was associated with a higher likelihood of vessel repair rather than ligations (P <.01). Over the study period, 20.3% (15/74) of patients re-presented with additional trauma requiring evaluation. Hospital mortality was 18.9% (14/74) and 9.5% (7/74) of patients suffered a major complication. Mortality was associated with low blood pressure on arrival (P=0.0011), low heart rate on arrival (p=0.0095), a lower GCS on arrival (P < 0.0001), higher injury severity score (P=0.0002), and the lack of an antiplatelet used (p=0.003). Complications were associated with anticoagulation use (P=0.0371).
Conclusions: Pediatric trauma is a leading cause of death in patients under 18 years of age. While vascular trauma is uncommon in pediatric patients, it is associated with high morbidity and mortality. Additionally, a large percentage of pediatric trauma patients will re-present with additional traumatic injuries.
