A decade of managing pediatric major traumatic vascular injuries: insights from a referral center
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In brief
In brief
This 10-year retrospective study of 30 pediatric patients with major traumatic vascular injuries found firearms as the leading cause, with lower extremity vessels most commonly affected. Surgical intervention with autologous bypass for arterial injuries and aggressive resuscitation achieved 90% survival, though optimal post-operative anticoagulation protocols remain undefined.
- Firearms caused 43% of pediatric vascular injuries; lower extremities were most affected (62.5% of injuries).
- Autologous bypass graft was preferred for arterial injuries (42%), while venous injuries were primarily managed with ligation (64%).
- Aggressive resuscitation and prompt surgery achieved 90% survival despite 57% presenting in shock and 83% having associated injuries.
- Blood transfusion was required in 83% of cases; post-op anticoagulation/antiplatelet use (41%) lacks standardized protocols.
- Mechanism of injury, anatomical location, shock on arrival, and hemoglobin level did not predict mortality in this cohort.
Written by the GCMD Library team from the article.
Abstract
Purpose
Incidence, management, and outcomes of pediatric vascular injuries secondary to non-iatrogenic trauma were reviewed over a decade in our institution.
Methods
A retrospective review of medical records (2013–2022) of major traumatic vascular injuries, focusing on injury profiles, treatment modalities, and clinical outcomes.
Results
Thirty patients with 48 vessel injuries were included. Firearms were the leading mechanism, accounting for 43.3% (n = 13) of cases. We identified 29 arterial injuries and 19 venous injuries, with 30 (62.5%) of the overall injuries occurred in the lower extremities. Shock (17; 56.7%) and associated injuries (25; 83.3%) were common. Surgery was the most common management strategy. Autologous bypass graft was the most frequently performed procedure for arterial injuries (8; 42.1%), while ligation dominated in venous injuries (9; 64.3%). Blood transfusion requirements (24; 82.7%) and post-operative prescription of anticoagulant and antiplatelet agents (12; 41.4%) were similar for arterial and venous injuries (p > 0.05). Three patients demised, resulting in a 90% survival rate. Neither the mechanism of injury, anatomical location, and presence of shock on arrival nor the baseline hemoglobin level served as predictors of mortality.
Conclusion
Intensive resuscitation with blood transfusion and prompt surgical intervention achieve favorable survival rates for pediatric traumatic vascular injuries. Optimal post-operative anticoagulant and antiplatelet regimens remain unclear.