Pediatric vs adult vascular trauma: a National Trauma Databank review

Barmparas, Galinos; Inaba, Kenji; Talving, Peep; David, Jean-Stephane; Lam, Lydia; Plurad, David; Green, Donald; Demetriades, Demetrios

doi:10.1016/j.jpedsurg.2009.09.017

« Previous Next »Journal of Pediatric Surgery
Volume 45, Issue 7 , Pages 1404-1412, July 2010

Pediatric vs adult vascular trauma: a National Trauma Databank review

Galinos Barmparas
- Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
Kenji Inaba
- Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
- Corresponding author. Division of Trauma Surgery and Surgical Critical Care, University of Southern California, USC+LAC Medical Center, Los Angeles, CA 90033, USA. Tel.: +1 323 409 9597; fax: +1 323 441 9907.
Peep Talving
- Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
Jean-Stephane David
- Department of Anesthesiology and Critical Care, Lyon-Sud Hospital, Hospices Civilis de Lyon (HCL) and Claude Bernard University, Lyon, France
Lydia Lam
- Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
David Plurad
- Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
Donald Green
- Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
Demetrios Demetriades
- Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA

Received 7 August 2009; received in revised form 17 September 2009; accepted 19 September 2009.

Abstract

Introduction

The purpose of this study was to examine nationwide data on vascular injuries in children and to compare pediatric and adult patients with respect to the incidence, injury mechanisms, and outcomes.

Methods

This is a National Trauma Databank analysis based on dataset version 7.0 (spanning a 5-year period ending December 2006). Pediatric patients under the age of 16 with at least one reported diagnosis of a vascular injury were compared to the adult cohort aged 16 and greater with a vascular injury.

Results

During the study period, of 251,787 injured patients younger than 16 years, 1138 (0.6%) had a vascular injury. The incidence in patients 16 years or older was significantly higher, at 1.6% (P < .01). Compared to the adult vascular patients, pediatric patients had a significantly lower Injury Severity Score (16.8 ± 14.9 vs 26.3 ± 16.7, P < .001) and encountered less frequently penetrating injuries (41.8% vs 51.2%, P < .001). The most commonly injured vessels in the pediatric population were vessels of the upper extremity (424 patients or 37.9%). The overall incidence of thoracic aortic injuries in children was seven-fold lower compared to the incidence in adults (0.03% vs 0.21%). After adjusting for confounding factors, pediatric patients demonstrated improved survival following vascular injuries (adjusted odds ratio, 0.60; 95% CI, 0.45-0.79; P < .001). No significant difference was identified in the rate of amputation between pediatric and adult patients who had sustained upper or lower extremity vascular injuries.

Conclusion

Vascular trauma in the pediatric population is uncommon, occurring in only 0.6% of all pediatric trauma patients. Although less frequent than adults, a significant proportion was due to penetrating injury. Vessels of the upper extremity were the most commonly injured and were associated with low mortality. Injuries of the thoracic aorta are rare. Overall, pediatric patients had an improved adjusted mortality when compared to adults.

Key words: Vascular injury, Vascular trauma, Pediatric, Epidemiology, Outcomes