A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Purpose: The purpose of this study is to analyze patterns of injury, management, and outcomes associated with blunt and penetrating vascular injuries in the extremities of pediatric trauma patients.
Methods: A retrospective review of data on pediatric patients between 2008 and 2014 was conducted within an institutional electronic medical records system at Phoenix Children’s Hospital. Patients were identified by ICD-9 codes for having received a diagnosis of non-iatrogenic extremity arterial vascular trauma with an associated attempt at restoring flow.
Results: Forty-four patients with arterial injuries and repairs were identified and evaluated. Twenty-seven were male and 19 had a blunt mechanism. The average age of the male patients was 8.8 years and that of the female patients was 6.8 years, with a combined range of 1.3-16 years. The ICU was utilized more than twice as much and hospital stays were three times longer with blunt wounds. The average length of stay in the hospital was 6.4 days (range 1-68 days), while average ICU stays lasted 6.9 days. The distribution of extremity injuries included 48% in the right upper, 34% in the left upper, 9% in the right lower, and 7% in the left lower. An associated fracture was present in 100% of blunt injuries, and 4% of penetrating injuries. The greatest vascular risk was to the digital artery (63.2%) after blunt trauma. Primary anastomosis was used in 68% of penetrating injuries, while grafting was required in 64% of blunt wounds. Fasciotomy risk was not a function of trauma mechanism. Amputation risk was 16% in blunt trauma and 0% in penetrating trauma. There were no mortalities during the study period.
Conclusions: Pediatric vascular injuries of the extremities are a rare but potentially serious subset of trauma that can be subdivided based on mechanisms, particular patterns of injury, and treatment modalities. Penetrating trauma is more common and typically managed by primary repair, and blunt trauma is associated with fractures, longer ICU stays, and carries a higher risk of amputation. Outcomes are usually very positive with a high rate of extremity salvage and no mortalities.
| Identifer | oai:union.ndltd.org:arizona.edu/oai:arizona.openrepository.com:10150/315928 |
| Date | 04 1900 |
| Creators | Stivers, John |
| Contributors | The University of Arizona College of Medicine - Phoenix, Graziano, Kathleen MD |
| Publisher | The University of Arizona. |
| Source Sets | University of Arizona |
| Language | en_US |
| Detected Language | English |
| Type | Thesis |
| Rights | Copyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. |
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