Pediatric blunt thoracic aortic injuries: Understanding the role of patient size and utilization of thoracic endovascular aortic repair.

Background: Thoracic aortic trauma management includes nonoperative observation, open repair, or thoracic endovascular aortic repair (TEVAR). While TEVAR is frequently used in adults, there is no standardized treatment for pediatric thoracic aortic trauma despite many pediatric patients with adult-equivalent height and weight. We aim to better understand the management of blunt pediatric thoracic aortic trauma by evaluating patient size and interventions as well as the utilization of TEVAR in this population.

Methods: This is a retrospective review of the American College of Surgeons Trauma Quality Improvement Participant User Files with thoracic aortic trauma identified by International Classification of Diseases, Tenth Revision, codes. Patients younger than 18 years with blunt thoracic aortic trauma from 2017 to 2022 were included. Injury mechanism, patient height/weight, blood product requirements, diagnosis/injury scoring, concomitant injuries, operative interventions, length of stay, and mortality were reviewed.

Results: We identified 346 patients with blunt thoracic aortic trauma younger than 18 years who met the inclusion criteria, 135 underwent TEVAR, 24 underwent open repair, and 187 were nonoperative. The mean ages for the open and TEVAR cohorts were 15.5 and 15.6 years, respectively. The mean height and weight were 165.1 cm and 71 kg for open repair patients, 171.7 cm and 80.5 kg for TEVAR patients, and 163.5 cm and 67.9 kg for the nonoperative patients (p < 0.01). Mortality rates for patients surviving the emergency department were 27.8% for nonoperative, 16.7% for open, and 3.7% for TEVAR (p < 0.01).

Conclusion: Despite increased critical care and prolonged hospital stays, patients undergoing TEVAR demonstrated better outcomes with lower mortality rates and higher likelihood of discharge home rather than to rehab or nursing facilities. This highlights the need for consideration of height, weight, and anatomy in addition to age for thoracic aortic trauma management and could lead to increased utilization of TEVAR in this population with improved patient outcomes.

Level of evidence: Therapeutic/Care Management; Level III.