Abstract
BackgroundIt remains unclear whether transcatheter arterial embolisation (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. The study aimed to compare the efficacy and safety of TAE performed in paediatric (age ≤ 15 years) and adult patients with blunt torso trauma.MethodsThis was a single-centre, retrospective chart review study that included blunt torso trauma patients who underwent TAE in the trauma centre from 2012 to 2017. The comparative study was carried out between a ‘paediatric patient group’ and an ‘adult patient group’. The outcome measures for TAE were the success of haemorrhage control and complications and standardised mortality ratio (SMR).ResultsA total of 504 patients with blunt torso trauma were transported to the trauma centre, out of which 23% (N = 114) with blunt torso trauma underwent TAE, including 15 paediatric and 99 adult patients. There was no significant difference between the use of TAE in paediatric and adult patients with blunt torso trauma (29% vs 22%, P = .221). The paediatric patients’ median age was 11 years (interquartile ranges 7–14). The predicted mortality rate and SMR for paediatric patients were lower than those for adult patients (18.3% vs 25.9%, P = .026, and 0.37 vs 0.54). The rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% in paediatric patients, which was similar to that in adult patients (88%). There were no complications in paediatric patients at our centre. There were no significant differences in the proportion of paediatric patients who underwent surgery before TAE or urgent blood transfusion (33% vs 26%, P = .566, or 67% vs 85%, P = .084).ConclusionsIt is possible to provide an equal level of care related to TAE for paediatric and adult patients as it relates to TAE for blunt torso trauma with haemorrhage in the trauma centre. Alternative haemorrhage control procedures should be established as soon as possible whenever the patients reach a haemodynamically unstable state.
Highlights
It remains unclear whether transcatheter arterial embolisation (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports
There was not a significant difference between the incident rate of TAE for paediatric and adult patients with blunt torso trauma (29% vs 22%, P = .221; Fig. 1)
67% of all the paediatric patients who underwent TAE were transferred from another hospital and the transfer time from injury to arrival at our hospital was longer for these patients than that for patients transported to our hospital directly from the site of injury
Summary
It remains unclear whether transcatheter arterial embolisation (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. A previous study on children cohort reported that non-operative management for haemodynamically stable paediatric patients with blunt torso trauma was the gold standard of trauma care [7, 9]. To the best of our knowledge, there is no research that evaluates the best management strategy, including nonoperative and operative interventions, for haemodynamically unstable paediatric patients with blunt torso trauma. It remains unclear whether TAE for paediatric patients with blunt torso trauma is as effective and safe as that for adults, due to the relatively few trauma centres and sporadic case reports [10, 11]. The aim of this study was to evaluate the efficacy and safety of TAE for paediatric patients with blunt torso trauma by comparing them with adult patients in Yokohama City University Medical Centre (Yokohama, Japan), which has adapted the same therapeutic algorithm in blunt torso patients with haemorrhage regardless of age
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