Management of Pediatric Lower Extremity Vascular Trauma: Adult vs Pediatric Level I Trauma Centers.

BACKGROUND:Pediatric lower extremity vascular injury (PLEVI) is uncommon. Though epidemiologic studies exist, the availability of granular data is sparse. Additionally, few studies compare the management between adult (ATC) and pediatric (PTC) trauma centers. The objective of this study was to analyze the surgical management of PLEVIs between a Level I ATC and a Level 1 PTCs in our metropolitan area. METHODS:We performed a retrospective review of all PLEVIs (age < 18 years) managed surgically between 01/2009-12/2022. Demographics, clinical and outcome data were obtained and compared between centers. Primary outcomes included amputation and fasciotomy rates. Secondary outcomes included type of vessel repair, mortality, and intensive care unit (ICU) and hospital length of stay. RESULTS:Seventy-nine patients were identified, 41 at the ATC and 38 at the PTC totaling 111 vessels injured. Overall, 84.8% were male. ATC patients were older (median 16.0 vs 12.5) and almost exclusively (97.6% vs 29.0%) gunshot wounds. There was no difference in ISS. The popliteal artery was the most injured vessel, ATC (50%) and PTC (40%). Vascular surgeons managed 50% of injuries at ATC vs 60.5% of injuries at the PTC (p = 0.35). Rates of arterial or venous repair, ligation, or grafting were not significantly different. Amputations were uncommon at both centers and not significantly different. Seventeen patients (44.7%) required fasciotomies at the PTC vs 21 (51.2%) at the ATC (p = 0.56). There was no significant difference in mortality, ICU, or hospital length of stay. CONCLUSIONS:PLEVI have acceptable outcomes (low amputation and/or fasciotomy rates, low mortality) and are managed uniformly between ATCs and PTCs. This data adds important context to the management of PLEVI. LEVEL OF EVIDENCE:Retrospective Chart Review, Level IV.