Management of pediatric lower extremity vascular trauma: adult vs pediatric level I trauma centers.

Autor: Dantes G; Department of Surgery, Emory University Hospital, Atlanta, GA, 30341, USA. gdantes@emory.edu.; Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. gdantes@emory.edu., Grady ZJ; Department of Surgery, Emory University Hospital, Atlanta, GA, 30341, USA., Weeks A; Department of Emergency Medicine, University of Washington School of Medicine, Seattle, USA., Forrester N; Emory University School of Medicine, Emory University, Atlanta, GA, USA., Trinidad JB; Emory University School of Medicine, Emory University, Atlanta, GA, USA., Stokes A; Emory University School of Medicine, Emory University, Atlanta, GA, USA., Dutreuil VL; Emory Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, USA., Cheng A; Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA., Kim P; Department of Trauma and Acute Care Surgery, Grady Memorial Health, Atlanta, GA, USA., Smith RN; Department of Surgery, Emory University Hospital, Atlanta, GA, 30341, USA.; Department of Trauma and Acute Care Surgery, Grady Memorial Health, Atlanta, GA, USA., Ramos CR; Department of Surgery, Emory University Hospital, Atlanta, GA, 30341, USA.; Department of Trauma and Acute Care Surgery, Grady Memorial Health, Atlanta, GA, USA., Todd SR; Department of Surgery, Emory University Hospital, Atlanta, GA, 30341, USA.; Department of Trauma and Acute Care Surgery, Grady Memorial Health, Atlanta, GA, USA., Smith A; Department of Surgery, Emory University Hospital, Atlanta, GA, 30341, USA.; Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA., Sciarretta JD; Department of Surgery, Emory University Hospital, Atlanta, GA, 30341, USA.; Department of Trauma and Acute Care Surgery, Grady Memorial Health, Atlanta, GA, USA.
Jazyk: angličtina
Zdroj: Pediatric surgery international [Pediatr Surg Int] 2024 Sep 28; Vol. 40 (1), pp. 256. Date of Electronic Publication: 2024 Sep 28.
DOI: 10.1007/s00383-024-05837-3
Abstrakt: 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.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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