Subjective and Objective Evaluation of Pediatric Vascular Injuries
*Regan F Williams, Laura Veras, *Ankush Gosain
University of Tennessee Health Science Center, Memphis, TN
Background:Vascular trauma is much more common in adults than children and often requires endovascular and/or operative repair. We hypothesized that the availability of resources for the management of pediatric vascular injuries and outcomes would differ based on hospital type. Methods:Following IRB approval, the Pediatric Trauma Society(PTS) membership was surveyed to determine current practice patterns for pediatric vascular trauma. The National Trauma Data Bank(NTDB-2014) was queried to compare time to intervention and outcomes for children treated at adult(ATC), a pediatric(PTC) or combined trauma centers(CTC). Continuous variables were compared with linear regression while categorical variables were compared with Chi-square analyses.
Results:60 physician PTS members completed the survey(20% response). Most(78%) worked at an academic, university-affiliated center with half practicing at a PTC and 43% at a CTC. The majority(85%) manage pediatric vascular trauma at their center with variable access to resources(Vascular Surgery-75%, Pediatric-trained Interventional Radiology-57%). By report, pediatric vascular injuries are managed by Pediatric Surgery in consultation with Vascular Surgery(47%), Vascular Surgery only(32%), or Pediatric Surgery only(12%). For 473 children in the NTDB, time to intervention, length of stay and mortality were better at ATC(Table).
Conclusions:In PTC, Pediatric Surgeons collaborate with Vascular Surgeons to manage vascular injuries and access to optimal resources is limited. Children with vascular injuries have improved outcomes at ATC, which may be due to faster initial intervention. Work to align resources with patient needs is required to improve outcomes for children with vascular injuries.
|PTC, n=145||CTC, n=192||ATC, n=136||p-value|
|Time to intervention (median hours, range)||3 (1-24)||3 (1-24)||2 (1-24)||0.0214|
|Length of stay (median days, range)||18 (1-61)||21 (3-72)||12 (1-81)||0.0224|
|Complications||43 (30%)||62 (32%)||52 (38%)||0.2940|
|Mortality||11 (8%)||2 (1%)||8 (6%)||0.0097|
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