Blunt intraabdominal arterial injury in pediatric trauma patients: injury distribution and markers of outcome.
BACKGROUND
The epidemiology of pediatric blunt intraabdominal arterial injury is ill defined. We analyzed a multiinstitutional trauma database to better define injury patterns and predictors of outcome.


METHODS
The American College of Surgeons National Trauma Database was evaluated for all patients younger than 16 years with blunt intraabdominal arterial injury from 2000 to 2004. Injury distribution, operative treatment, and variables associated with mortality were considered.


RESULTS
One hundred twelve intraabdominal arterial injuries were identified in 103 pediatric blunt trauma patients. Single arterial injury (92.2%) occurred most frequently: renal (36.9%), mesenteric (24.3%), and iliac (23.3%). Associated injuries were present in 96.1% of patients (abdominal visceral, 75.7%; major extraabdominal skeletal/visceral, 77.7%). Arterial control was obtained operatively (n = 46, 44.7%) or by endovascular means (n = 6, 5.8%) in 52 patients. Overall mortality was 15.5%. Increased mortality was associated with multiple arterial injuries (P = .049), intraabdominal venous injury (P = .011), head injury (P = .05), Glasgow Coma Score less than 8 (P < .001), cardiac arrest (P < .001), profound base deficit (P = .007), and poor performance on multiple injured outcomes scoring systems (Revised Trauma Score [P < .001], Injury Severity Score [P = .001], and TRISS [P = .002]).


CONCLUSIONS
Blunt intraabdominal arterial injury in children usually affects a single vessel. Associated injuries appear to be nearly universal. The high mortality rate is influenced by serious associated injuries and is reflected by overall injury severity scores.
Hamner
Chad E
CE
Division of Pediatric General Surgery, Schneider Children's Hospital, New Hyde Park, NY 11040, USA.
Groner
Jonathon I
JI
Caniano
Donna A
DA
Hayes
John R
JR
Kenney
Brian D
BD
D000005:Abdomen / Q000098:blood supply*; D000007:Abdominal Injuries / Q000145:classification* / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000293:Adolescent; D001158:Arteries / Q000293:injuries*; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011647:Puerto Rico / Q000453:epidemiology; D012042:Registries; D012306:Risk; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000145:classification* / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy