James M Prieto1, Jan Michael Van Gent2, Richard Y Calvo2, Kyle D Checchi2, Lyndsey E Wessels2, C Beth Sise2, Michael J Sise2, Vishal Bansal2, Romeo C Ignacio3. 1. Trauma Service (MER62), Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA 92103, USA; Division of Pediatric Surgery, Rady Children's Hospital, 3020 Children's Way, MC 5136, San Diego, CA 92123, USA. 2. Trauma Service (MER62), Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA 92103, USA. 3. Division of Pediatric Surgery, Rady Children's Hospital, 3020 Children's Way, MC 5136, San Diego, CA 92123, USA. Electronic address: r1ignacio@ucsd.edu.
Abstract
BACKGROUND: The purpose of this study was to evaluate the epidemiology and management of pediatric vascular extremity trauma to assess injury patterns and other factors that may contribute to poor outcomes. METHODS: Using the California Office of Statewide Health Planning and Development discharge database, we identified pediatric patients with extremity arterial trauma admitted to acute-care hospitals from 2007 to 2014. Demographics, management patterns, and outcomes were collected and analyzed. RESULTS: A total of 775 patients were treated for an extremity arterial injury. Overall, 40% were admitted to pediatric trauma centers and 39% to adult trauma centers. Management was predominantly by open surgical repair. Injury to the common femoral artery was associated with mortality (Hazard Ratio 3.9; 95% CI 1.1-14.5; p < 0.05). Popliteal artery injuries (Odds Ratio [OR] 4.8; 95% CI 1.2-19.9; p < 0.05) and anterior tibial artery injuries (OR 7.1; 95% CI 1.4-37.3; p < 0.05) had an increased risk of amputation. There was no difference in amputation or mortality rates by hospital category. CONCLUSIONS: Pediatric extremity arterial injuries are rare. In California, outcomes are similar by hospital type. Common femoral artery injuries are associated with an increased risk of mortality, while popliteal and anterior tibial artery injuries are associated with an increased risk of amputation. TYPE OF STUDY: Prognosis Study. LEVEL OF EVIDENCE: Level III.
BACKGROUND: The purpose of this study was to evaluate the epidemiology and management of pediatric vascular extremity trauma to assess injury patterns and other factors that may contribute to poor outcomes. METHODS: Using the California Office of Statewide Health Planning and Development discharge database, we identified pediatric patients with extremity arterial trauma admitted to acute-care hospitals from 2007 to 2014. Demographics, management patterns, and outcomes were collected and analyzed. RESULTS: A total of 775 patients were treated for an extremity arterial injury. Overall, 40% were admitted to pediatric trauma centers and 39% to adult trauma centers. Management was predominantly by open surgical repair. Injury to the common femoral artery was associated with mortality (Hazard Ratio 3.9; 95% CI 1.1-14.5; p < 0.05). Popliteal artery injuries (Odds Ratio [OR] 4.8; 95% CI 1.2-19.9; p < 0.05) and anterior tibial artery injuries (OR 7.1; 95% CI 1.4-37.3; p < 0.05) had an increased risk of amputation. There was no difference in amputation or mortality rates by hospital category. CONCLUSIONS: Pediatric extremity arterial injuries are rare. In California, outcomes are similar by hospital type. Common femoral artery injuries are associated with an increased risk of mortality, while popliteal and anterior tibial artery injuries are associated with an increased risk of amputation. TYPE OF STUDY: Prognosis Study. LEVEL OF EVIDENCE: Level III.