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The Utilization of Angiography In Pediatric Blunt Trauma Patients
Stephen J. Fenton, MD, Kristin Sandoval, MA, Austin M. Stevens, RN, BSN and Eric R. Scaife, MD, University of Utah School of Medicine, Salt Lake City UT

Abstract: Background: Angiography is a common treatment used in adults with blunt abdominal trauma (BAT) and/or severe pelvic fractures. The American College of Surgeons has recently advocated for this resource to be urgently available at pediatric trauma centers, however, its usefulness in the pediatric setting is unclear. The purpose of this study is to determine the incidence of angiography in the treatment of BAT amongst injured children. Methods: A secondary analysis was performed using an established public use dataset of children (<18 years) treated at established trauma centers for intra-abdominal injuries through the Pediatric Emergency Care Applied Research Network (PCARN). Patients who underwent angiography of the abdomen or pelvis were identified and analyzed. Results: Of the 12,044 children with BAT included within the dataset, only 26 (0.22%) underwent angiography. The mean age was 15 years, 64% male, with a mortality rate of 19%. Overall, 29 angiographic procedures were performed: 21 abdominal, 8 pelvic, with 3 patients undergoing both abdominal and pelvic. 11 patients underwent embolization of a bleeding vessel, all of which were related to the spleen. No pelvic vessels required embolization. The mean time to angiography from emergency department was 11.1 hours. 50% required surgical intervention, of which 31% underwent a laparotomy. 9 patients required blood product transfusion. 42% required admission to the intensive care unit. Conclusion: The use of angiography with embolization is extremely uncommon in pediatric patients with blunt abdominal injuries. The requirement that pediatric trauma centers have access to interventional radiology within 30 minutes may be unnecessary.

Objective: At the end of this activity, the learner will be able to explain the need for angiography in the treatment of traumatic intra-abdominal injuries in pediatric patients.

Objective Content: The need for angiography by interventional radiology is pediatric patients with intra-abdominal injuries is very uncommon. The need for urgent interventional radiology access maybe unnecessary.

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