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Acute procedural interventions after pediatric blunt abdominal trauma: A prospective multicenter evaluation.

Authors :
Arbra CA
Vogel AM
Zhang J
Mauldin PD
Huang EY
Savoie KB
Santore MT
Tsao K
Ostovar-Kermani TG
Falcone RA
Dassinger MS
Recicar J
Haynes JH
Blakely ML
Russell RT
Naik-Mathuria BJ
St Peter SD
Mooney DP
Onwubiko C
Upperman JS
Streck CJ
Source :
The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2017 Oct; Vol. 83 (4), pp. 597-602.
Publication Year :
2017

Abstract

Background: Pediatric intra-abdominal injuries (IAI) from blunt abdominal trauma (BAT) rarely require emergent intervention. For those children undergoing procedural intervention, our aim was to understand the timing and indications for operation and angiographic embolization.<br />Methods: We prospectively enrolled children younger than 16 years after BAT at 14 Level I Pediatric Trauma Centers over a 1-year period. Patients with IAI who received an intervention (IAI-I) were compared with those who did not receive an intervention using descriptive statistics and univariate analysis; p less than 0.05 was considered significant.<br />Results: Two hundred sixty-one (11.9%) of 2,188 patients had IAI. Forty-five (17.2%) IAI patients received an acute procedural intervention (38 operations, seven angiographic embolization). The mean age for patients requiring intervention was 7.1 ± 4.1 years and not different from the population. Most patients (88.9%) with IAI-I were normotensive. IAI-I patients were significantly more likely to have a mechanism of motor vehicle collision (66.7% vs. 38.9%), more likely to present as a Level I activation (44.4% vs. 26.9%), more likely to have a Glascow Coma Scale less than 14 (31.1% vs. 15.5%), and more likely to have an abnormal abdominal physical examination (93.3% vs. 65.7%) than patients that did not require acute intervention. All patients underwent computed tomography scan before intervention. Operations consisted of laparotomy (n = 21), laparoscopy converted to open (n = 11), and laparoscopy alone (n = 6). The most common surgical indications were hollow viscus injury (HVI) (11 small bowel, 10 colon, 6 small bowel/colon, 2 duodenum). All interventions for solid organ injury, including seven angioembolic procedures, occurred within 8 hours of arrival; many had hypotension and received a transfusion. Procedural interventions were more common for HVI than for solid organ injury (59.2% vs. 7.6%). Postoperative mortality from IAI was 2.6%.<br />Conclusion: Acute procedural interventions for children with IAI from BAT are rare, predominantly for HVI, are performed early in the hospital course and have excellent clinical outcomes.<br />Level of Evidence: Prognostic/epidemiologic study, level III; therapeutic study, level IV.

Details

Language :
English
ISSN :
2163-0763
Volume :
83
Issue :
4
Database :
MEDLINE
Journal :
The journal of trauma and acute care surgery
Publication Type :
Academic Journal
Accession number :
28930954
Full Text :
https://doi.org/10.1097/TA.0000000000001533