title: Pediatric vascular injury: experience of a level 1 trauma center.
abstract: BACKGROUND
  Our purpose was to analyze modern major vascular injury (MVI) patterns in pediatric trauma, interventions performed, and outcomes at a level 1 trauma center.
  
  
  METHODS
  From January 2000-December 2012, all pediatric admissions (≤17 y) were reviewed.
  
  
  RESULTS
  Of 1928 pediatric admissions, 103 (5.3%) sustained MVI. This cohort was 85% male, age 15 ± 3 y, 55% black, 58% penetrating, injury severity score of 23 ± 15, with a length of stay of 8 (5) days. Firearm-related injury (47%) was the most common mechanism. Location of injuries included the extremities (50.5%), abdomen/pelvis (29.1%), and chest/neck (20.4%). Operative procedures included repair/bypass (71.4%), ligation (12.4%), amputation (10.5%), or temporary shunt (2.9%). Only three injuries (2.9%) were treated endovascularly. MVI patients had a mortality rate of 19.4%, higher than the overall pediatric trauma population of 3.5% (P < 0.001). After logistic regression, independent risk factors of mortality were vascular injury to the neck (odds ratio [OR]: 6.5; confidence interval (CI): 1.1-39.3), abdomen/pelvis (OR: 16.3; CI: 3.13-80.2), and chest (OR: 49.0; CI: 3.0-794.5).
  
  
  CONCLUSIONS
  MVI in children more commonly results from firearm-related injury. The mortality rate associated with MVI is profoundly higher than that of the overall pediatric trauma population. These findings underscore the major public health concern of firearm-related injury in children.
authors: Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors: Casey J
authors: CJ
authors: Allen
authors: Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors: Richard J
authors: RJ
authors: Straker
authors: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors: Jun
authors: J
authors: Tashiro
authors: Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors: Laura F
authors: LF
authors: Teisch
authors: Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors: Jonathan P
authors: JP
authors: Meizoso
authors: Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors: Juliet J
authors: JJ
authors: Ray
authors: Division of Trauma Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors: Nicholas
authors: N
authors: Namias
authors: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: jsola@med.miami.edu.
authors: Juan E
authors: JE
authors: Sola
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D014656:Vascular Surgical Procedures; D057772:Vascular System Injuries / Q000401:mortality / Q000601:surgery*
keywords: Children; Firearms; Injury patterns; Mortality; Outcomes