The optimal management of blunt aortic injury in the young.

Autor: Zambetti BR; Division of Vascular Surgery, University of Maryland, Baltimore, MD, USA., Nelson AC; Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA., Hosseinpour H; Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA., Anand T; Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA., Colosimo C; Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA., Spencer AL; Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA., Stewart C; Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA., Bhogadi SK; Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA., Hejazi O; Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA., Joseph B; Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA., Magnotti LJ; Division of Trauma and Acute Care Surgery, University of Arizona, Tucson, AZ, USA. Electronic address: lmagnotti@arizona.edu.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2024 Nov; Vol. 237, pp. 115943. Date of Electronic Publication: 2024 Aug 30.
DOI: 10.1016/j.amjsurg.2024.115943
Abstrakt: Background: Blunt aortic injury (BAI) is relatively uncommon in the pediatric population. The goal of this study was to examine the management of BAI in both children and adolescents, using a large national dataset.
Methods: Patients (1-19 years of age) with BAI were identified from the Trauma Quality Improvement Program (TQIP) database over 14-years. Patients were stratified by age group (children [ages 1-9] and adolescents [ages 10-19]) and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of mortality in adolescents with BAI.
Results: Adolescents undergoing TEVAR had similar morbidity (16.8 vs 12.6 ​%, p ​= ​0.057) and significantly reduced mortality (2.1 vs 14.4 ​%, p ​< ​0.0001) compared to those adolescents managed non-operatively. MLR identified use of TEVAR as the only modifiable risk factor significantly associated with reduced mortality (OR 0.138; 95%CI 0.059-0.324, p ​< ​0.0001).
Conclusions: BAI leads to significant morbidity and mortality for both children and adolescents. For pediatric patients with BAI, children may be safely managed non-operatively, while an endovascular repair may improve outcomes for adolescents.
Competing Interests: Declaration of competing interest None of the authors have received funding or have a conflict of interest associated with this work.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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