Pediatric Trauma Society

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Safety and Effectiveness of Diagnostic and Therapeutic Angiography in the Acute Management of Pediatric Trauma Patients
Stephanie F. Polites1, Rachel M. Nygaard2, Mark Smith2, *Terri A. Elsbernd1, Sherrie Murphy2, *Donald D. Potter1, *Christopher R. Moir1, Donavon J. Hess3, *Denise B. Klinkner1
1Mayo Clinic, Rochester, MN;2Hennepin County Medical Center, Minneapolis, MN;3University of Minnesota, Minneapolis, MN

Background: The utility of angiography at pediatric trauma centers is disputed. The purpose of this study was to evaluate the effectiveness of angiography in caring for injured children at two level I pediatric trauma centers.
Methods: A dual-institution review of 2007-2016 pediatric trauma patients ≤14 years who underwent angiography was performed using trauma registry and medical record data.
Findings: Angiography was performed in 22 children following blunt (n=21) or penetrating (n=1) injuries. Mean (range) age was 10 (1-14) years, median (IQR) ISS was 23 (16-38), and 16 required transfusion. Mesenteric angiography was most frequent (n=12, 55%), with embolization performed in 10 patients (Table). None required additional hemorrhage control procedures. Three patients underwent pelvic angiography for bleeding (one embolization) and one underwent thoracic angiography without embolization. Diagnostic cerebral (n=5, 23%) and lower extremity (n=2, 9%) angiograms were also performed. No complications from angiography occurred and there was no increase in mean creatinine after angiography (0.6 vs 0.6, p=.73). One death occurred due to head injury.
Conclusions: Angiography appears a useful diagnostic and therapeutic tool for pediatric trauma patients that may obviate the need for more invasive procedures especially for solid organ injuries. While further studies would be helpful, these data support the safety and efficacy of angiography in pediatric trauma centers.


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