The optimal management of blunt aortic injury in the young

IF 2.7 3区医学 Q1 SURGERY American journal of surgery Pub Date : 2024-08-30 DOI:10.1016/j.amjsurg.2024.115943

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Abstract

Background

Blunt aortic injury (BAI) is relatively uncommon in the pediatric population. The goal of this study was to examine the management of BAI in both children and adolescents, using a large national dataset.

Methods

Patients (1–19 years of age) with BAI were identified from the Trauma Quality Improvement Program (TQIP) database over 14-years. Patients were stratified by age group (children [ages 1–9] and adolescents [ages 10–19]) and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of mortality in adolescents with BAI.

Results

Adolescents undergoing TEVAR had similar morbidity (16.8 vs 12.6 %, p = 0.057) and significantly reduced mortality (2.1 vs 14.4 %, p < 0.0001) compared to those adolescents managed non-operatively. MLR identified use of TEVAR as the only modifiable risk factor significantly associated with reduced mortality (OR 0.138; 95%CI 0.059–0.324, p < 0.0001).

Conclusions

BAI leads to significant morbidity and mortality for both children and adolescents. For pediatric patients with BAI, children may be safely managed non-operatively, while an endovascular repair may improve outcomes for adolescents.

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年轻人主动脉钝挫伤的最佳治疗方法

背景钝性主动脉损伤（BAI）在儿科人群中相对少见。本研究的目的是利用一个大型全国性数据集，对儿童和青少年的 BAI 处理情况进行研究。方法从创伤质量改进计划 (TQIP) 数据库中找出 14 年来的 BAI 患者（1-19 岁）。按年龄组（儿童[1-9 岁]和青少年[10-19 岁]）对患者进行分层并进行比较。结果与接受非手术治疗的青少年相比，接受TEVAR治疗的青少年发病率相似（16.8% vs 12.6%，p = 0.057），死亡率显著降低（2.1% vs 14.4%，p < 0.0001）。MLR发现，使用TEVAR是唯一与死亡率降低显著相关的可调整风险因素（OR 0.138; 95%CI 0.059-0.324, p < 0.0001）。对于患有 BAI 的儿童患者，非手术治疗可以安全地控制病情，而血管内修复术可以改善青少年的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.