Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Thrace, Greece.
Neonatal Intensive Care Unit, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Thrace, Greece.
Ann Vasc Surg. 2024 Aug;105:189-200. doi: 10.1016/j.avsg.2024.02.020. Epub 2024 Apr 6.
Pediatric extremity vascular injuries constitute a rare yet serious entity that can lead to serious complications especially if left untreated or become late diagnosed. In our scoping review, we sought to evaluate different characteristics and outcomes of pediatric and combined adult trauma centers (ATCs) in the management of pediatric extremity vascular injury.
We sought to analyze various characteristics and parameters that differentiate a dedicated pediatric and a combined pediatric ATC in terms of effectiveness and quality of care in the acute setting and to describe special features and characteristics of an acute vascular disease that constitute pediatric population unique from the aspect of diagnosis and management. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews guidelines to conduct the study.
The search identified 8,815 records in title using MeSH terms from PubMed/MEDLINE database among which 12 studies reporting a total of 2,124 pediatric patients with vascular extremity injuries were included for analysis. Incidence of pediatric extremity vascular injury was 0.5%. Upper extremity injuries were the most frequent presenting in 63% of cases followed by lower extremity injuries in 37% of cases. Blunt injuries were marginally more common than penetrating injuries (58% vs. 42%). In-hospital mortality and morbidity ranged from 13.2% to 0.9% and 13% to 30%, respectively. Limb-salvage rates were high, ranging from 92% to 99%. Furthermore, there are no clearly defined clinical guidelines involving the mode of imaging and diagnosis, the surgical specialties involved and the competency of nursing or medical staff overall.
Dedicated children trauma centers theoretically represent the optimal path for acute pediatric trauma admission, especially in complex trauma necessitating vascular reconstruction. However, in the current setting of rapidly increasing health costs and economic crisis worldwide, regional or resource-related factors make this option rather unavailable. In any case, it is imperative the clinicians have a high index of suspicion when confronting with these types of injuries because early diagnosis is highly related with reduced morbidity and superior outcomes.
小儿肢体血管损伤是一种罕见但严重的疾病，如果不及时治疗或诊断延迟，可能会导致严重并发症。在本范围综述中，我们旨在评估小儿创伤中心（ATC）与成人创伤中心（ATC）在治疗小儿肢体血管损伤方面的不同特点和结局。
我们旨在分析在急性治疗中，专门的小儿 ATC 和合并的小儿 ATC 在有效性和护理质量方面的不同特点和参数，并描述急性血管疾病的特殊特征和特点，这些特征和特点构成了儿科人群在诊断和管理方面的独特之处。我们遵循系统评价和荟萃分析扩展范围综述指南，开展了这项研究。
通过使用 PubMed/MEDLINE 数据库中的 MeSH 术语进行标题搜索，共确定了 8815 条记录，其中纳入了 12 项研究，共分析了 2124 例小儿肢体血管损伤患者。小儿肢体血管损伤的发生率为 0.5%。上肢损伤最常见，占 63%，其次是下肢损伤，占 37%。钝性损伤比穿透性损伤略多见（58%比 42%）。住院期间死亡率和发病率分别为 13.2%至 0.9%和 13%至 30%。保肢率高，范围为 92%至 99%。此外，目前尚无明确的临床指南涉及成像和诊断方式、涉及的外科专业以及护理或医务人员的整体能力。
专门的儿童创伤中心理论上代表了急性儿科创伤患者入院的最佳途径，特别是在需要血管重建的复杂创伤中。然而，在全球范围内，医疗费用迅速增加和经济危机的当前背景下，区域或资源相关因素使得这种选择变得不太可行。在任何情况下，临床医生在遇到这些类型的损伤时都必须高度怀疑，因为早期诊断与降低发病率和更好的结果密切相关。
