title: Pediatric abdominal and pelvic trauma: safety and efficacy of arterial embolization.
abstract: OBJECTIVE
  Although transcatheter embolization is a well established technique to treat adults in the trauma setting, evidence is lacking in the pediatric population. This study assesses the safety and efficacy of arterial embolization for blunt abdominal and pelvic trauma in the pediatric population.
  
  
  METHODS
  A retrospective review of abdominal and pelvic angiograms in 97 pediatric patients with blunt trauma was conducted over an 11-year period. Abdominal angiography and embolization was performed for ongoing hepatic, renal, splenic, or nonvisceral retroperitoneal injury. Pelvic angiography was performed in the setting of pelvic fracture with ongoing pelvic hemorrhage. Complications and clinical success rates of these procedures were assessed.
  
  
  RESULTS
  Of the 97 pediatric patients who underwent angiography for acute abdominal or pelvic trauma, 54 (56%) required embolization involving 62 separate sites. Injury severity score greater than 15 was present in 94% of patients. Targets of embolization included the pelvis (n = 39), liver (n = 8), kidney (n = 7), spleen (n = 6), and retroperitoneum (n = 2). Effective hemorrhage control was achieved in 47 patients (87%). Overall mortality rate was 22% (12 of 54), with most deaths related to traumatic brain injury. Five complications occurred in four patients (7%), including three major complications (hepatic abscess, bile leak, and urinary incontinence).
  
  
  CONCLUSIONS
  Angiography and embolization is relatively safe and potentially effective in the setting of abdominal and pelvic trauma in the pediatric population. Angiography with embolization should be considered in the treatment algorithm for this patient population.
authors.affiliation: Department of Radiology and Section of Pediatric Interventional Radiology and Vascular and Interventional Radiology, Seattle Children's Hospital and the University of Washington, Seattle, Washington. Electronic address: nvo@chw.org.
authors.forename: Nghia-Jack
authors.initials: NJ
authors.lastname: Vo
authors.affiliation: Section of Interventional Radiology, University of Washington, Seattle, Washington; Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Morgan
authors.initials: M
authors.lastname: Althoen
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Hippe
authors.affiliation: Section of Interventional Radiology, University of Washington, Seattle, Washington; Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Somnath J
authors.initials: SJ
authors.lastname: Prabhu
authors.affiliation: Section of Interventional Radiology, University of Washington, Seattle, Washington; Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Karim
authors.initials: K
authors.lastname: Valji
authors.affiliation: Section of Interventional Radiology, University of Washington, Seattle, Washington; Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: Siddharth A
authors.initials: SA
authors.lastname: Padia
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000367:Age Factors; D000465:Algorithms; D002648:Child; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D018579:Patient Selection; D010388:Pelvis / Q000098:blood supply* / Q000293:injuries*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*
keywords: CI; ISS; PRBC; confidence interval; injury severity score; packed red blood cell