title: Observation and surgery are associated with low risk of amputation for blunt brachial artery injury in pediatric patients.
abstract: BACKGROUND
  The ideal treatment for blunt brachial artery (BBA) injury in pediatric patients is controversial. We compared outcomes of surgical and nonsurgical management of BBA injury using the National Trauma Data Bank.
  
  
  METHODS
  All patients younger than 18 years who had suffered BBA injury were identified in the pediatric National Trauma Data Bank (2002-2010) by Current Procedural Terminology code. Patients with a penetrating mechanism of injury were excluded. By the International Classification of Diseases, Ninth Revision procedure codes, patients were stratified on the basis of treatment modality: observation vs arterial surgery. Outcomes including upper extremity amputation, mortality, and intensive care unit length of stay were compared between the two groups by two-sample t-test or χ(2) test as appropriate.
  
  
  RESULTS
  Among 119 patients with BBA injury, 49 patients (41.2%) underwent arterial surgery and 70 patients (58.8%) were observed. Patients treated with observation were significantly younger, whereas other characteristics including gender and Injury Severity Score were similar. There was no difference in the type of hospital (academic vs nonacademic) or trauma center category between the groups. Two amputations were identified in the database, and both were in the 13- to 17-year age group of the observation cohort (vs arterial surgery; P = .22). There were eight fasciotomies identified; five were in the arterial surgery group (10.2% vs observation, 4.3%; P = .20). No amputation or fasciotomy was required in the 0- to 6-year age group. Length of stay was similar between groups.
  
  
  CONCLUSIONS
  Despite slightly lower adverse outcomes, arterial surgery does not appear to confer a significant advantage over nonoperative treatment in pediatric patients with BBA injury. In patients younger than 6 years, both modalities appear to be equality effective.
authors.affiliation: Division of Vascular and Endovascular Surgery, Louisiana State University Health Shreveport, Shreveport, La.
authors.forename: Tze-Woei
authors.initials: TW
authors.lastname: Tan
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, Mass.
authors.forename: Denis
authors.initials: D
authors.lastname: Rybin
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, Mass.
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, Mass.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kalish
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, Mass.
authors.forename: Alik
authors.initials: A
authors.lastname: Farber
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston University Medical Center, Boston, Mass. Electronic address: mohammad.eslami@bmc.org.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Eslami
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000671:Amputation, Surgical; D001916:Brachial Artery / Q000293:injuries / Q000601:surgery*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D016489:Head Injuries, Closed / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay; D023821:Limb Salvage; D008297:Male; D015999:Multivariate Analysis; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D057772:Vascular System Injuries / Q000175:diagnosis / Q000601:surgery*