Fenton Stephen J, Sandoval Kristin N, Stevens Austin M, Scaife Eric R
From the Division of Pediatric Surgery (S.J.F., A.M.S., E.R.S.), University of Utah School of Medicine, Salt Lake City, Utah, and University of Utah School of Medicine (K.N.S.), Salt Lake City, Utah.
J Trauma Acute Care Surg. 2016 Aug;81(2):261-5. doi: 10.1097/TA.0000000000001097.
Angiography is a common treatment used in adults with blunt abdominal trauma and/or severe pelvic fractures. The Committee on Trauma of 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 was to determine the incidence of angiography in the treatment of blunt abdominal trauma among injured children.
An analysis was performed using an established public use data set of children (younger than 18 years) treated at 20 participating trauma centers for blunt torso trauma through the Pediatric Emergency Care Applied Research Network. Patients who underwent angiography of the abdomen or pelvis were identified and analyzed.
Of the 12,044 children evaluated for blunt abdominal trauma included within the data set, 973 sustained abdominopelvic injuries. Of these, only 26 (3%) underwent angiography. The median age was 14 years, 65% were males, with a mortality rate of 19%. Overall, 29 angiographic procedures were performed: 21 abdominal, 8 pelvic, with 3 patients undergoing both abdominal and pelvic. Eleven patients underwent embolization of a bleeding vessel, all of which were related to the spleen. No hepatic, renal, or pelvic vessels required embolization. The median time to angiography from emergency department evaluation was 7.3 hours. In addition to angiography, 50% also required surgical intervention, of which 31% underwent a laparotomy. Thirty-five percent of these patients required blood product transfusion, and 42% were admitted to the intensive care unit.
The emergent use of angiography with embolization is 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.
Epidemiologic study, level III; therapeutic study, level IV.
血管造影术是用于成人钝性腹部创伤和/或严重骨盆骨折的常见治疗方法。美国外科医师学会创伤委员会最近主张儿科创伤中心应紧急配备这种资源；然而，其在儿科环境中的实用性尚不清楚。本研究的目的是确定血管造影术在受伤儿童钝性腹部创伤治疗中的发生率。
通过儿科急诊应用研究网络，对在20个参与研究的创伤中心接受钝性躯干创伤治疗的儿童（18岁以下）的既定公开数据集进行分析。确定并分析接受腹部或骨盆血管造影术的患者。
在数据集中评估的12044例钝性腹部创伤儿童中，973例遭受了腹盆腔损伤。其中，只有26例（3%）接受了血管造影术。中位年龄为14岁，65%为男性，死亡率为19%。总体而言，共进行了29次血管造影手术：21次腹部手术，8次骨盆手术，3例患者同时接受了腹部和骨盆手术。11例患者接受了出血血管栓塞术，所有这些均与脾脏有关。无需对肝、肾或盆腔血管进行栓塞。从急诊科评估到血管造影术的中位时间为7.3小时。除血管造影术外，50%的患者还需要手术干预，其中31%接受了剖腹手术。这些患者中有35%需要输血，42%入住重症监护病房。
血管造影术联合栓塞术在钝性腹部损伤的儿科患者中的紧急应用并不常见。要求儿科创伤中心在30分钟内具备介入放射学条件可能没有必要。
流行病学研究，III级；治疗性研究，IV级。
