Defining the role of angioembolization in pediatric isolated blunt solid organ injury

Abstract

Purpose: To determine the incidence and outcomes of angiography in pediatric patients with blunt solid organ injury (SOI).

Methods: The National Trauma Data Bank (2010-2014) was queried for patients ≤19 years who experienced isolated blunt SOI. Multivariate logistic regression was used to evaluate characteristics associated with radiological and surgical intervention.

Results: Patients with isolated blunt injuries to the spleen (n = 7542), liver (n = 4549), and kidney (n = 2640) were identified. Use of angiography increased yearly from 1.6% to 3.1% of cases (p = 0.001) and was associated with older age (OR 2.61 [CI: 1.94-3.50], p < 0.001) and grade III or higher injury (OR 4.63 [CI: 3.11-6.90], p < 0.001). Odds of angiography were 4.9 times higher at adult trauma centers (TCs) than pediatric TCs overall, and almost 9 times higher for isolated splenic trauma (p < 0.001 for each). There was no improvement in splenic salvage after angiography for high grade injuries (3.5% vs. 4.8%, p = NS). Only 1.8% of cases began within 30 min of arrival (median time = 3.6 h).

Conclusion: Variability exists in the utilization of angiography in pediatric blunt SOI between adult and pediatric TCs, with no improvement in splenic salvage.

Level of evidence: Level III - Treatment study.

Keywords: Angiography; Blunt trauma; Non-operative management; Solid organ injury.