Management of pediatric lower extremity vascular trauma: adult vs pediatric level I trauma centers
link.springer.com shows its articles on its own site.
Read the article on link.springer.com ↗Article · Sep 2024 · 1 min read
In brief
In brief
This retrospective study compares surgical outcomes for pediatric lower extremity vascular injuries treated at adult versus pediatric Level I trauma centers over 14 years. Despite differences in patient age and injury mechanism, both center types achieved similar amputation rates, fasciotomy needs, and overall outcomes, suggesting PLEVIs can be safely managed at either facility type with appropriate surgical expertise.
- Pediatric lower extremity vascular injuries can be safely managed at both adult and pediatric Level I trauma centers with similar outcomes.
- Amputation rates were low and comparable between adult and pediatric trauma centers despite different injury mechanisms and patient ages.
- Vascular surgeons managed a higher proportion of cases at pediatric centers (73.7%) compared to adult centers (50%).
- Fasciotomy rates were similar between centers (44.7% PTC vs 51.2% ATC), suggesting comparable compartment syndrome management.
- Adult trauma centers predominantly treated older adolescents with gunshot wounds while pediatric centers saw younger patients with varied mechanisms.
Written by the GCMD Library team from the article.
Abstract
Background
Pediatric lower extremity vascular injury (PLEVI) is uncommon and the availability of granular data is sparse. This study evaluated the surgical management of PLEVIs between a Level I adult (ATC) vs pediatric (PTC) trauma center.
Methods
We performed a retrospective review of PLEVIs (< 18 years) managed surgically between 01/2009–12/2022. Demographics and outcome data were obtained. Primary outcomes included amputation and fasciotomy rates. Secondary outcomes included type of vessel repair, mortality, and hospital length of stay.
Results
Seventy-nine patients were identified, 41 at the ATC and 38 at the PTC, totaling 112 vessels injured. ATC patients were older (median years 16.0 vs 12.5) and almost exclusively (97.6% vs 29.0%) gunshot wounds. Vascular surgeons managed 50% of injuries at the ATC vs 73.7% at the PTC (p = 0.10). Amputations were uncommon and not significantly different between centers. Seventeen patients (44.7%) required fasciotomies at the PTC vs 21 (51.2%) at the ATC (p = 0.56). Rates of vessel repair, ligation, grafting, mortality, and hospital length of stay were not significantly different.
Conclusions
PLEVI can be managed safely at ATCs and PTCs with acceptable outcomes. However, important nuances in patient triage and management need to be considered. Multi-institutional comprehensive datasets are needed.
Level of Evidence: Level III.