Blunt Trauma in Pediatric Patients- Experience from Small Center (original) (raw)
Related papers
Trauma is one of the leading causes of mortality at all age group. Blunt trauma to abdomen is one of the leading cause of death in young. BAT can remain silent after initial injury only to present later with clinical deterioration and can be almost always fatal if not intervened. Liver and spleen are the commonly injured solid organs. Over the past few decades, there is a transition of trend in management from operative procedures to non-operative management as the former carried more mortality and morbidity. NOM has become the widely accepted standard practice of management for BAT. This case series is our institutional experience in the NOM of hemodynamically stable blunt liver, spleen and pancreatic trauma patients irrespective of the severity of a single / multiple solid organ injury or other associated injuries.
Feasibility of selective non-operative management for penetrating abdominal trauma in France
Journal of Visceral Surgery, 2017
Introduction: In France, non-operative management (NOM) is not the widely accepted treatment for penetrating wounds. The aim of our study was to evaluate the feasibility of NOM for the treatment of penetrating abdominal traumas at 3 hospitals in the Southeast of France. Methodology: Our study was multicentric and retroprospective from January, 2010 to September, 2013. Patients presenting with a penetrating abdominal stab wound (SW) or gunshot wound (GSW) were included in the study. Those with signs of acute abdomen or hemodynamic instability had immediate surgery. Patients who were hemodynamically stable had a CT scan with contrast. If no intra-abdominal injury requiring surgery was evident, patients were observed. Criteria evaluated were failed NOM and its morbidity, rate of non-therapeutic procedures (NTP) and their morbidity, length of hospital stay and cost analysis. Results: One hundred patients were included in the study. One patient died at admission. Twenty-seven were selected for NOM (20 SW and 7 GSW). Morbidity rate was 18%. Failure rate was 7.4% (2 patients) and there were no mortality. Seventy-two patients required operation of which 22 were NTP. In this subgroup , the morbidity rate was 9%. There were no mortality. Median length of hospital stay was 4 days for the NOM group and 5.5 days for group requiring surgery. Cost analysis showed an economic advantage to NOM. Conclusion: Implementation of NOM of penetrating trauma is feasible and safe in France. Indications may be extended even for some GSW. Clinical criteria are clearly defined but CT scan criteria should be better described to improve patient selection. NOM reduced costs and length of hospital stay.
Nonoperative Management of Solid Organ Injuries in Children Is it Safe?
Annals of Surgery, 1994
Purpose: The American Pediatric Surgical Association (APSA) guidelines for the treatment of isolated solid organ injury (SOI) in children were published in 2000 and have been widely adopted. The aim of this systematic review by the APSA Outcomes and Evidence Based Practice Committee was to evaluate the published evidence regarding treatment of solid organ injuries in children. Methods: A comprehensive search strategy was crafted and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Four principal questions were examined based upon the previously published consensus APSA guidelines regarding length of stay (LOS), activity level, interventional radiologic procedures, and follow-up imaging. A literature search was performed including multiple databases from 1996 to 2016. Results: LOS for children with isolated solid organ injuries should be based upon clinical findings and may not be related to grade of injury. Total LOS may be less than recommended by the previously published APSA guidelines. Restricting activity to grade of injury plus two weeks is safe but shorter periods of activity restriction have not been adequately studied. Prophylactic embolization of SOI in stable patients with image-confirmed arterial extravasation is not indicated and should be reserved for patients with evidence of ongoing bleeding. Routine follow-up imaging for asymptomatic, uncomplicated, low-grade injured children with abdominal blunt trauma is not warranted. Limited data are available to support the need for follow-up imaging for high grade injuries. Conclusion: Based upon review of the recent literature, we recommend an update to the current APSA guidelines that includes: hospital length of stay based on physiology, shorter activity restrictions may be safe, minimizing post-injury imaging for lower injury grades and embolization only in patients with evidence of ongoing hemorrhage.
Non operative management of abdominal trauma -- a 10 years review
World Journal of Emergency Surgery, 2013
Introduction: Due to high rate of operative mortality and morbidity non-operative management of blunt liver and spleen trauma was widely accepted in stable pediatric patients, but the general surgeons were skeptical to adopt it for adults. The current study is analysis of so far largest sample (1071) of hemodynamically stable blunt liver, spleen, kidney and pancreatic trauma patients managed non operatively irrespective of severity of a single /multiple solid organ injury or other associated injuries with high rate of success.
International Journal of Emergency Medicine, 2011
Background: In recent years there has been increasing interest shown in the nonoperative management (NOM) of blunt traumatic injury. The growing use of NOM for blunt abdominal organ injury has been made possible because of the progress made in the quality and availability of the multidetector computed tomography (MDCT) scan and the development of minimally invasive intervention options such as angioembolization. Aim: The purpose of this review is to describe the changes that have been made over the past decades in the management of blunt trauma to the liver, spleen and kidney.
The Journal of Trauma: Injury, Infection, and Critical Care, 2005
Background: Nonoperative management (NOM) is the accepted treatment of most pediatric solid organ injuries (SOI) and, is typically successful. We sought to elucidate predictors of, and the time course to, failure in the subset of children suffering SOI who required operative intervention. Methods: A retrospective analysis was performed from January 1997 through December 2002 of all pediatric patients (age 0-20 years) with a SOI (liver, spleen, kidney, pancreas) from the trauma registries of seven designated, level I pediatric trauma centers. Failure of NOM was defined as the need for intraabdominal operative intervention. Data reviewed included demographics, injury mechanism, injury severity (ISS, AIS, SOI grade, and GCS), and outcome. For the failures of NOM, time to operation and relevant clinical variables were also abstracted. A summary AIS (sAIS) was calculated for each patient by summing the AIS values for each SOI, to account for multiple SOI in the same patient. Univariate and multivariate analyses were employed, and significance was set at p < 0.05. Results: A total of 1,880 children were identified. Of these, 62 sustained nonsurvivable head injuries that precluded assessment of NOM outcome and were thus excluded. The remaining 1,818 patients comprised the overall study population. There were 1,729 successful NOM patients (controls-C) and 89 failures (F), for an overall NOM failure rate of 5%. For isolated organ injuries, the failure rates were: kidney 3%, liver 3%, spleen 4%, and pancreas 18%. There were 14 deaths in the failure group from nonsalvageable injuries (mean ISS ؍ 54 ؎ 15). The two groups did not differ with respect to mean age or gender. An MVC was the most common injury mechanism in both groups. Only bicycle crashes were associated with a significantly increased risk of failing NOM (RR ؍ 1.76, 95% CI ؍ 1.02-3.04, p < 0.05). Injury severity and organ specific injuries were associated with NOM failure (Table). When controlling for ISS and GCS, multivariate regression analysis confirmed that a sAIS > 4, isolated pancreatic injury, and >1 organ injured were significantly associated with NOM failure (p < 0.01). The median time to failure was 3 hours (range, 0.5-144 hours) with 38% having failed by 2 hours, 59% by 4 hours, and 76% by 12 hours. Conclusions: Failure of NOM is un common (5%) and typically occurs within the first 12 hours after injury. Failure is associated with injury severity and multiplicity, as well as isolated pancreatic injuries.
Which Treatment for Abdominal Trauma in Pediatric Age
Abdominal trauma are present in 40% of multiple trauma patients and in relation to the position of damaged tissues are classified into superficial (bruises) and deep (affecting vessels, parenchyma and viscera) the purpose Of this work is to propose a valid diagnostic algorithm effective and safe. Materials and Methods From January 1997 to December 2000 were seen at the Surgical Clinic III of the University Hospital of Catania No 11 patients aged 8-13 years average age 10.5, with blunt abdominal blunt trauma. N 9 pts. (81%) were male, the remaining n 2 cases (19%) were female, the causes of trauma were accidental and contusion, the most affected organs were: spleen (52%) the liver (31%), kidney and ileum (18%). Results In abdominal trauma in children most frequently was found to parenchymatous organs (spleen and liver, kidney) The diagnostic approach is made by clinical examination based on a history that collects information that guide immediately to the affected organ from trauma for the purposes of defining what the exam is the most appropriate therapy. .Discussion In patients with hemodynamic istabilità after evaluation of CT eco investigations, with the presence of peritoneal fluid proceed to invasive intervention after laparoscopic evaluation. In cases where we have a hemodynamically stable patient in whom the CT and echo tests show small and medium-sized lesions treatment is not implemented invasivo.La tab 1 summarizes the algorithmic Conclusions Conclusions The secondary blunt trauma to domestic traumatic causes or falls frequent accidental in children require special attention not only has specifics kills. Index Terms— Pediatric Trauma Treatment.