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Pediatric trauma and the role of the interventional radiologist

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Abstract

Purpose

While interventional radiologists occupy a critical role in adult trauma management, the role of interventionalist in pediatric trauma continues to evolve. The indications for transarterial embolization (TAE) are significantly different in pediatric patients in whom non-operative management (NOM) has a much more prominent role than in adults. Contrast extravasation on imaging may not require acute surgical or interventional management as it would in an adult. There are also areas in which pediatric interventional radiology is increasingly useful such as pelvic TAE in failed management, or splenic embolization to treat bleeding without the loss of splenic function inherent to surgical splenectomy. The rapid evolution of techniques and devices in pediatric patients is also changing what interventions are possible in pediatric trauma management which necessitates frequent reassessment of the guidelines and interventional radiology’s role in caring for these patients.

Conclusion

This review seeks to consolidate the recent literature to describe the evolving role of the interventional radiologist in pediatric trauma management.

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Authors and Affiliations

  1. Division of Pediatric Radiology, Department of Radiology, University of Colorado, Children’s Hospital Colorado, 13123 East 16th Avenue, Aurora, CO, 80045, USA

    Aparna Annam

  2. Department of Pediatric Radiology, Lucile Packard Children’s Hospital, Stanford Medicine, Palo Alto, CA, USA

    Shellie Josephs

  3. Division of Vascular and Interventional Radiology, Medical University of South Carolina, Mount Pleasant, SC, USA

    Thor Johnson

  4. Division of Pediatric Surgery, Department of Surgery, University of Colorado, Children’s Hospital Colorado, Aurora, CO, USA

    Ann M. Kulungowski

  5. Emeritus Radiologist-in-Chief at Phoenix Children’s Hospital, Phoenix, USA

    Richard B. Towbin

  6. Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Anne Marie Cahill

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  1. Aparna Annam
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  2. Shellie Josephs
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  3. Thor Johnson
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  4. Ann M. Kulungowski
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  5. Richard B. Towbin
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  6. Anne Marie Cahill
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All authors meet ICJME recommendations for authorship as referenced by the journal.

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• Drafting the work or revising it critically for important intellectual content; AND

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Correspondence to Aparna Annam.

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Highlights

• Physiologic response to resuscitation and hemodynamic status plays an important role in interventional management, when positive trauma findings are present in children.

• Non-operative management of solid organ injury is preferred in the hemodynamically stable pediatric patient with solid organ injury.

• Embolization can reduce the need for surgery in pediatric patients with signs of ongoing blood loss.

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Annam, A., Josephs, S., Johnson, T. et al. Pediatric trauma and the role of the interventional radiologist. Emerg Radiol 29, 903–914 (2022). https://doi.org/10.1007/s10140-022-02067-9

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  • DOI: https://doi.org/10.1007/s10140-022-02067-9

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