Use of angioembolization in pediatric polytrauma patients

Swendiman, Robert A.; Abramov, Alexey; Fenton, Stephen J.; Russell, Katie W.; Nance, Michael L.; Nace, Gary W.; Allukian, Myron

doi:10.1016/j.jpedsurg.2021.04.014

Cited by 6 publications

(17 citation statements)

References 27 publications

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“…Among 6860 records identified in the databases, 5369 titles and abstracts were screened, and 212 manuscripts were assessed for eligibility, of which 56, with 286 051 total participants, were included in the review (eFigure 1 in eAppendix 2 in Supplement 1). Forty-four studies (79%) were published after 2010 (eTable 5 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

Pediatric vs Adult or Mixed Trauma Centers in Children Admitted to Hospitals Following Trauma

Moore,

Freire,

Turgeon

et al. 2023

JAMA Netw Open

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ImportanceAdult trauma centers (ATCs) have been shown to decrease injury mortality and morbidity in major trauma, but a synthesis of evidence for pediatric trauma centers (PTCs) is lacking.ObjectiveTo assess the effectiveness of PTCs compared with ATCs, combined trauma centers (CTCs), or nondesignated hospitals in reducing mortality and morbidity among children admitted to hospitals following trauma.Data SourcesMEDLINE, Embase, and Web of Science through March 2023.Study SelectionStudies comparing PTCs with ATCs, CTCs, or nondesignated hospitals for pediatric trauma populations (aged ≤19 years).Data Extraction and SynthesisThis systematic review and meta-analysis was performed following the Preferred Reporting Items for Systematic Review and Meta-analysis and Meta-analysis of Observational Studies in Epidemiology guidelines. Pairs of reviewers independently extracted data and evaluated risk of bias using the Risk of Bias in Nonrandomized Studies of Interventions tool. A meta-analysis was conducted if more than 2 studies evaluated the same intervention-comparator-outcome and controlled minimally for age and injury severity. Subgroup analyses were planned for age, injury type and severity, trauma center designation level and verification body, country, and year of conduct. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess certainty of evidence.Main Outcome(s) and Measure(s)Primary outcomes were mortality, complications, functional status, discharge destination, and quality of life. Secondary outcomes were resource use and processes of care, including computed tomography (CT) and operative management of blunt solid organ injury (SOI).ResultsA total of 56 studies with 286 051 participants were included overall, and 34 were included in the meta-analysis. When compared with ATCs, PTCs were associated with a 41% lower risk of mortality (OR, 0.59; 95% CI, 0.46-0.76), a 52% lower risk of CT use (OR, 0.48; 95% CI, 0.26-0.89) and a 64% lower risk of operative management for blunt SOI (OR, 0.36; 95% CI, 0.23-0.57). The OR for complications was 0.80 (95% CI, 0.41-1.56). There was no association for mortality for older children (OR, 0.71; 95% CI, 0.47-1.06), and the association was closer to the null when PTCs were compared with CTCs (OR, 0.73; 95% CI, 0.53-0.99). Results remained similar for other subgroup analyses. GRADE certainty of evidence was very low for all outcomes.Conclusions and RelevanceIn this systematic review and meta-analysis, results suggested that PTCs were associated with lower odds of mortality, CT use, and operative management for SOI than ATCs for children admitted to hospitals following trauma, but certainty of evidence was very low. Future studies should strive to address selection and confounding biases.

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Section: Resultsmentioning

confidence: 99%

Pediatric vs Adult or Mixed Trauma Centers in Children Admitted to Hospitals Following Trauma

Moore,

Freire,

Turgeon

et al. 2023

JAMA Netw Open

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“…The decreased trend in the use of splenectomy at ATCs and MTCs might be due to an increased adoption of the APSA guidelines for the management of pediatric patients with BSI. 9,10 The results of the subgroup analysis suggest that the decreased trend in the use of splenectomy was more prominent in patients aged >14 years. This might be due to an increased use of SAE in this age group, particularly at ATCs and MTCs.…”

Section: Discussionmentioning

confidence: 99%

“…was more commonly used by pediatric trauma surgeons 6 and at designated pediatric trauma centers (PTCs) compared to adult trauma surgeons at adult trauma centers (ATCs) or mixed adult/pediatric trauma centers (MTCs). [7][8][9][10] Given the significant disparity in the management of pediatric BSI, the American Pediatric Surgical Association (APSA) published the first management guideline in 2000. 11 Some data suggested significant trends toward an increased use of NOM in pediatric BSI including low-grade injuries following the publication of the APSA guideline.…”

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confidence: 99%

“…11 Some data suggested significant trends toward an increased use of NOM in pediatric BSI including low-grade injuries following the publication of the APSA guideline. 9,10 However, there has been little analysis of disparities between trauma center types in the management of high-grade BSI for which the rates of splenectomy and splenic angioembolization (SAE) can be significantly different from those in low-grade BSI. Furthermore, a recent study showed that an increased use of NOM in adult patients with high-grade NOM over the last decade 12 ; thus, it is anticipated that the use of NOM would have been increased for pediatric high-grade BSI at ATCs and MTCs in more recent years.…”

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confidence: 99%

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Persistent disparities between trauma center types in the management of children with high‐grade blunt splenic injuries

Aoki,

Katsura,

Matsumoto

et al. 2024

World j. surg.

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BackgroundIn the early 2000s, substantial variations were reported in the management of pediatric patients with blunt splenic injury (BSI). The purpose of this study was to assess the recent trends and disparities between different types of trauma centers. We hypothesized that there would be persistent disparities despite decreased trends in the rate of splenectomy.MethodsThis is a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database. We included patients (age ≤18 years) with high‐grade BSI (Abbreviated Injury Scale 3–5) between 2014 and 2021. The patients were divided into three groups based on trauma center types (adult trauma centers [ATCs], mixed trauma centers [MTCs], and pediatric trauma centers [PTCs]). The primary outcome was the splenectomy rate. Logistic regression was performed to evaluate the association between trauma center types and clinical outcomes. Additionally, the trends in the rate of splenectomy at ATCs, MTCs, and PTCs were evaluated.ResultsA total of 6601 patients with high‐grade BSI were included in the analysis. Overall splenectomy rates were 524 (17.5%), 448 (16.3%), and 32 (3.7%) in the ATC, MTC, and PTC groups, respectively. ATCs and MTCs had significantly higher splenectomy rates compared to PTCs (ATCs: OR = 5.72, 95%CI = 3.78–8.67, and p < 0.001 and MTCs: OR = 4.50, 95%CI = 2.97–6.81, and p < 0.001), while decreased trends in the splenectomy rates were observed in ATCs and MTCs (ATCs: OR = 0.92, 95%CI = 0.87–0.97, and p = 0.003 and MTCs: OR = 0.92, 95%CI = 0.87–0.98, and p = 0.013).ConclusionsThis study suggested persistent disparities between different trauma center types in the management of children with high‐grade BSI.

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“…Previously, splenectomy was routinely performed in this situation but the emergence of interventional radiology into the pediatric population has brought the possibility of splenic artery embolization (SE) as an alternative. 4 5 6 7 8 9 In addition to being a less invasive procedure than splenectomy, there is the added benefit of preservation of splenic function even with proximal SE. 10 11 The precise indications for SE remain to be established and there is likely institutional variation in its use.…”

Section: Introductionmentioning

confidence: 99%

European Pediatric Surgeons' Association Survey on the Use of Splenic Embolization in Blunt Splenic Trauma in Children

et al. 2022

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Introduction This article assesses (1) access to splenic embolization (SE), (2) indications for SE, and (3) post-embolization management in high-grade splenic trauma in children. Materials and Methods An online questionnaire was sent in 2021 to all members of European Pediatric Surgeons' Association. Results There were a total of 157 responses (50 countries, 83% academic hospitals). Among them, 68% have access to SE (SE) and 32% do not (nSE). For a hemodynamic stable patient with high-grade isolated splenic trauma without contrast extravasation (CE) on computed tomography (CT) scan, 99% SE and 95% nSE respondents use nonoperative management (NOM). In cases with CE, NOM decreases to 50% (p = 0.01) and 51% (p = 0.007) in SE and nSE centers, respectively. SE respondents report a significant reduction of NOM in stable patients with an associated spine injury requiring urgent surgery in prone position, both without and with CE (90 and 28%, respectively). For these respondents, in stable patients the association of a femur fracture only tends to decrease the NOM, both without and with CE (93 and 39%, respectively). There was no significant difference in NOM in group nSE with associated injuries with or without CE. After proximal SE with preserved spleen vascularization on ultrasound Doppler, 44% respondents prescribe antibiotics and/or immunizations. Conclusion Two-thirds of respondents have access to SE. For SE respondents, SE is used even in stable patients when CE showed on initial CT scan and its use increased with the concomitant need for spinal surgery. There is currently a variation in the use of SE and antibiotics/immunizations following SE.

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Use of angioembolization in pediatric polytrauma patients

Cited by 6 publications

References 27 publications

Pediatric vs Adult or Mixed Trauma Centers in Children Admitted to Hospitals Following Trauma

Pediatric vs Adult or Mixed Trauma Centers in Children Admitted to Hospitals Following Trauma

Persistent disparities between trauma center types in the management of children with high‐grade blunt splenic injuries

European Pediatric Surgeons' Association Survey on the Use of Splenic Embolization in Blunt Splenic Trauma in Children

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