Management of pediatric brachial plexus injuries: A cohort study utilizing the trauma quality improvement program (TQIP) database.

Abstract

Purpose: Pediatric brachial plexus injuries (BPI) are uncommon, representing about 10% of BPIs overall and 0.1% of pediatric trauma cases. These injuries often result from high-energy trauma and are unique to neonatal and adult cases. This study aims to provide a contemporary, large-scale analysis of pediatric BPI mechanisms and management patterns.

Methods: The Trauma Quality Improvement Program (TQIP) database was used to identify pediatric BPI cases from 2017 to 2020. Mechanisms of injury (MOI), concomitant injuries, imaging, and treatment intervention were determined. Pediatric age groups were defined as children (0-9 years), young adolescents (10-14), and older adolescents (15-17).

Results: Of the 746,817 recorded pediatric trauma cases in TQIP, 285 BPI cases were identified (0.038%), with the majority (55%) in older adolescents. Firearm injuries accounted for 23% of cases, surpassing sports (22%) and MVAs (21%) as the leading mechanisms. Children under 10 years were most affected by MVAs (20%), young adolescents by sports (32%), and older adolescents by firearms (30%). Associated injuries included orthopedic (44%), head (40%), and vascular (24%) injuries. Imaging was performed in 82% of cases, with CT (57%) and MRI (50%) being the most common. Immediate BPI repair was rare (4.3%), mainly occurring in cases with concurrent vascular injuries (91%).

Discussion: Pediatric BPIs are increasingly linked to firearms and often present alongside complex polytrauma, requiring specialized care. Immediate repair is rare, typically reserved for cases with vascular injury. These findings emphasize the need for further research to refine management, particularly in high-energy and firearm-related BPIs.