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Blunt brachial artery injury among pediatric patients: Surgery or not?
Mohammad H. Eslami, MD1, Tze Woei Tan, MD1, Kaveh Shahmohammadi, MD1, Denis Rybin, PhD2, Gheorghe Doros, PhD2, Jeffery Kalish, MD1, Alik Farber, MD1.
1Division of Vascular Surgery, Boston University School of Medicine, Boston, MA, USA, 2Division of Biostatistics, Boston University School of Medicine, Boston, MA, USA.
Introduction: The ideal treatment for blunt brachial artery injury (BBA) in pediatric patients is controversial. In this study we strived to compare the outcomes among the two treatment modalities- surgical or non-surgical- using National Trauma Data Bank (NTDB).
Methods: Pediatric NTDB was queried and all pediatric patients (age <18) with BBA from 2002-2010 were identified using CPT code (903.1). Patients with penetrating mechanism of injury were excluded. Patients were stratified based on the treatment modality (no arterial surgery: NAS versus arterial surgery: AS) using ICD-9 procedure codes. Outcomes (upper extremity amputation [UEA], mortality and ICU length of stay [LOS]) were compared between the groups using two sample t-Test or Chi Sqaure test as appropriate.
Results: Table summarizes some of the characteristics of the 119 patients identified with isolated BBA. NAS compromised of significantly higher percentage of younger patients. Other characteristics reviewed were similar. Type of hospital (Academic/non or trauma level I/not) did not significantly differed among the two treatment groups. In the entire patient population, we identified only two UEAs. These were in the 13-17 years age group of the NAS cohort (vs. AS p=.22); no UAE was observed among the 0-6 year age group. Of eight fasciotomies identified, 5 were in the AS (10.2% vs. NAS: 4.3%; p=.20). LOS was similar among the two groups with no mortality observed among either group.
Conclusions: Despite slightly lower adverse outcomes, arterial surgery does not appear to confer a significant advantage over non operative modality. Among the very young, both modalities appear to be equality effective. | Overall | Arterial surgery (AS) | No arterial surgery (NAS) | p | Age (yr):
Mean
Median ( Range) | 10.6±4.7
10 (3-17) | 11.9±4.3
12 (4-17) | 9.7±4.7
8 (3-17) | 0.011* | Age Group:
0-6
7-12
7-13 | 35 (29.4%)
36 (30.3%)
48 (40.3%) | 8 (16.3%)
18 (36.7%)
23 (46.9%) | 27 (38.6%)
18 (25.7%)
25 (35.7%) | 0.032* | Gender:
Male
Female | 79 (66.4%)
40 (33.6%) | 32 (65.3%)
17 (34.7%) | 47 (67.1%)
23 (32.9%) | 0.835 | Race:
White
African-American
Hispanic
Other | 92 (77.3%)
8 (6.7%)
11 (9.2)
8 (6.7%) | 33 (67.3%)
5 (10.2%)
6 (12.2%)
5 (10.2%) | 59 (84.3%)
3 (4.3%)
5 (7.1%)
3 (4.3%) | 0.180 | Injury Severity Score (ISS):
Mean
Median(Range) | 8.7±4.3
9 (1-34) | 8.7±3.3
9 (1-19) | 8.7±5
9 (1-34) | 0.925 |
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