RESUMO
BACKGROUND: Blunt aortic injury (BAI) is relatively uncommon in the pediatric population. The goal of this study was to examine the management of BAI in both children and adolescents, using a large national dataset. METHODS: Patients (1-19 years of age) with BAI were identified from the Trauma Quality Improvement Program (TQIP) database over 14-years. Patients were stratified by age group (children [ages 1-9] and adolescents [ages 10-19]) and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of mortality in adolescents with BAI. RESULTS: Adolescents undergoing TEVAR had similar morbidity (16.8 vs 12.6 â%, p â= â0.057) and significantly reduced mortality (2.1 vs 14.4 â%, p â< â0.0001) compared to those adolescents managed non-operatively. MLR identified use of TEVAR as the only modifiable risk factor significantly associated with reduced mortality (OR 0.138; 95%CI 0.059-0.324, p â< â0.0001). CONCLUSIONS: BAI leads to significant morbidity and mortality for both children and adolescents. For pediatric patients with BAI, children may be safely managed non-operatively, while an endovascular repair may improve outcomes for adolescents.
Assuntos
Procedimentos Endovasculares , Ferimentos não Penetrantes , Humanos , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/cirurgia , Ferimentos não Penetrantes/terapia , Ferimentos não Penetrantes/diagnóstico , Adolescente , Feminino , Masculino , Criança , Pré-Escolar , Lactente , Estudos Retrospectivos , Adulto Jovem , Aorta/lesões , Aorta/cirurgia , Lesões do Sistema Vascular/cirurgia , Lesões do Sistema Vascular/mortalidade , Fatores de RiscoRESUMO
INTRODUCTION: The aim of this study was to examine the association between the injury mechanism and repair type with outcomes in patients with traumatic inferior vena cava injuries. METHODS: This is a retrospective analysis of the ACS-TQIP database (2017-2020), including patients with traumatic IVC injuries. Patients were stratified by injury mechanism and type of repair and compared. RESULTS: Out of 1334 patients, 5 â% underwent endovascular repair while 95 â% had an open procedure. Overall, 74.7 â% sustained a penetrating injury. On multivariable regression analysis, the type of repair was not associated with mortality and morbidity for patients with penetrating injuries. However, among patients with blunt injuries, endovascular repair was associated with lower odds of in-hospital mortality (aOR:0.35, p â= â0.020) and non-venous thromboembolism (VTE) morbidity (aOR:0.41, p â= â0.015), and higher odds of VTE complications (aOR:6.74, p â< â0.001). CONCLUSIONS: Although the type of repair did not impact morbidity and mortality in patients with penetrating injuries, endovascular repair was identified as the only modifiable predictor of reduced non-VTE morbidity and mortality in patients with blunt injuries.