Department of Surgery, Emory University, Atlanta, Georgia.
Morehouse School of Medicine, Morehouse University, Atlanta, Georgia.
J Surg Res. 2024 Jan;293:561-569. doi: 10.1016/j.jss.2023.08.039. Epub 2023 Oct 11.
Angiography has been widely accepted as an adjunct in the management of blunt abdominal trauma in adults. However, the role of angiography with or without angioembolization (AE) is still being defined in pediatric solid organ injury. We sought to compare the use of angiography in solid organ injury (SOI) at pediatric trauma centers (PTCs) versus an adult trauma center (ATC) in a large metropolitan city.
Data were drawn from a collaborative effort of three Trauma centers (one adult and two pediatric) in Atlanta, GA. All pediatric patients (ages 1-18) treated for SOI between January 1, 2016 and December 31, 2021 were included (n = 350). Registry data obtained included demographics, mechanism of injury, injury grade, injury severity score (ISS), procedures performed, and transfusions. Multivariate regression analysis was used to identify factors associated with angiography.
A total of 350 patients were identified during the study period with 101 treated at ATC and 249 treated at the two PTCs. The median age at the ATC was 17 y (IQR 16, 18) compared to nine (6, 13) at the PTCs. ISS was significantly higher at the ATC 22 (14, 34) compared to 16 (9, 22) at PTCs (P < 0.001). At the ATC, 11 (10.9%) patients underwent angiography, 4 (4.9%) of which underwent AE compared to seven (2.8%) patients who underwent angiography and AE at PTCs. In the multivariate analysis, factors associated with angiography use included age (OR 1.44, 95% CI 1.09-1.90, P = 0.010) and ISS (OR 1.05, 95% CI 1.02-1.09, P = 0.004). Through setting, ATC versus PTC was significant on univariable analysis, it did not remain a significant predictor of angiography on multivariable regression.
Our study demonstrated increased utilization of angiography for the management of SOI in pediatric patients treated at ATCs versus PTCs. On regression analysis, age and ISS remained significant predictors for angiography utilization, while setting (ATC versus PTC) was notably not a significant predictor. This data would suggest that differences in angiography utilization for pediatric SOI at PTCs and ATCs are influenced by differing patient populations (older and higher ISS), with otherwise uniform use. These findings provide a basis for future treatment algorithm revisions for pediatric blunt abdominal trauma that include angiography and provide support for the development of formal guidelines.
血管造影术已被广泛接受为成人钝性腹部创伤管理的辅助手段。然而，血管造影术（伴或不伴血管栓塞术）在儿科实体器官损伤中的作用仍在确定中。我们旨在比较在大型都市的一家儿科创伤中心（PTC）和一家成人创伤中心（ATC）中，血管造影术在实体器官损伤（SOI）中的应用。
数据来自佐治亚州亚特兰大的三个创伤中心（一个成人和两个儿科）的合作努力。纳入 2016 年 1 月 1 日至 2021 年 12 月 31 日期间接受 SOI 治疗的所有年龄在 1-18 岁的儿科患者（n=350）。获得的登记数据包括人口统计学、损伤机制、损伤等级、损伤严重程度评分（ISS）、实施的程序和输血。使用多变量回归分析确定与血管造影术相关的因素。
在研究期间共确定了 350 例患者，其中 101 例在 ATC 治疗，249 例在两个 PTC 治疗。ATC 的中位年龄为 17 岁（IQR 16，18），而 PTC 的中位年龄为 9 岁（6，13）。ATC 的 ISS 显著更高，为 22（14，34），而 PTC 的 ISS 为 16（9，22）（P<0.001）。在 ATC，11（10.9%）例患者接受了血管造影术，其中 4（4.9%）例接受了血管栓塞术，而在 PTC 则有 7（2.8%）例患者接受了血管造影术和血管栓塞术。在多变量分析中，与血管造影术使用相关的因素包括年龄（OR 1.44，95%CI 1.09-1.90，P=0.010）和 ISS（OR 1.05，95%CI 1.02-1.09，P=0.004）。通过单变量分析，设置（ATC 与 PTC）是有意义的，但在多变量回归中，它不是血管造影术的显著预测因素。
我们的研究表明，与 PTC 相比，ATC 治疗的儿科患者中，SOI 管理中血管造影术的应用更为广泛。在回归分析中，年龄和 ISS 仍然是血管造影术使用的显著预测因素，而设置（ATC 与 PTC）则不是显著的预测因素。这些数据表明，PTC 和 ATC 中儿科 SOI 血管造影术使用的差异受不同患者人群（年龄较大和 ISS 较高）的影响，否则使用是一致的。这些发现为包括血管造影术在内的儿科钝性腹部创伤的未来治疗算法修订提供了依据，并为制定正式指南提供了支持。
