Management of Blunt Abdominal Trauma in Children

Abstract

Surgery| July 01 2002 Management of Blunt Abdominal Trauma in Children AAP Grand Rounds (2002) 8 (1): 8–9. https://doi.org/10.1542/gr.8-1-8-a Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Management of Blunt Abdominal Trauma in Children. AAP Grand Rounds July 2002; 8 (1): 8–9. https://doi.org/10.1542/gr.8-1-8-a Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: blunt abdominal injuries, splenectomy, spleen injuries Sources: (1) Potoka DA, Schall LC, Ford HR. Risk factors for splenectomy in children with blunt splenic trauma. J Pediatr Surg. 2002;37:294–299. (2) Hackam DJ, Potoka D, Meza M, et al. Utility of radiographic hepatic injury grade in predicting outcome for children after blunt abdominal trauma. J Pediatr Surg. 2002;37:386–389. Two articles by investigators at the University of Pittsburgh and Children’s Hospital of Pittsburgh, Pennsylvania, examine issues related to blunt abdominal trauma in children. The first study reports a retrospective review of 754 children (ages 0–16) who received care for blunt splenic trauma between 1993–1997 at 1 of 2 pediatric and 24 adult trauma centers and were identified through the Pennsylvania Trauma Outcome Study registry. Factors associated with increased frequency of splenectomy were identified using multivariate logistic regression. Of the 754 children with splenic injury, 15% underwent splenectomy, 7% were managed with operative splenic repair (splenorrhaphy), and 78% of children were managed non-operatively. Factors associated with splenectomy included increased grade of splenic injury, presence of severe, nonsplenic abdominal injuries, Glasgow Coma Scale of 3–8, and age range of 15–16 years. Children treated at designated pediatric trauma centers had significantly fewer splenectomies than those treated at adult trauma centers (7.8% versus 15.7%, P<.05). Authors of the second article retrospectively reviewed 152 children with blunt hepatic injury treated from 1995–2000 at Children’s Hospital of Pittsburgh and graded liver injury severity based upon CT scan evaluation using the American Association for the Surgery of Trauma (AAST) grading system (Grades I–V). They found that AAST injury grade did not correlate with mortality, hospital length of stay or intensive care unit (ICU) length of stay. The authors conclude that the AAST radiographic liver grading system does not accurately predict outcome in the pediatric population. Both of these studies serve to underscore unique aspects of pediatric trauma management with respect to blunt abdominal injury. The nonoperative management of solid visceral injury has become increasingly accepted in the treatment of the pediatric population and is becoming more so in adult trauma management. Nonetheless, indications for operative intervention are still under refinement, as both of these articles indicate. A 15% splenectomy rate is excessive. A recent article from the American Pediatric Surgical Association Liver/Spleen Trauma Study Group found early operation (for hemorrhage) in only 1.3% of the 316 patients studied.1 While it is generally conceded that operation for solid viscus injury alone (usually identified by CT scanning) is indicated for ongoing, severe hemorrhage, the comfort level of surgeons managing children with any degree of hemorrhage varies greatly. Based on the results in the first article, children treated outside of a designated pediatric trauma center, presumably by non-pediatric surgeons, had far higher rates of splenectomy than those who were in designated pediatric trauma centers. Unfortunately, the second article does not identify a grading system for liver injuries that correlates with severity of injury and thus might serve as a safe triage tool. Based on these studies, the... You do not currently have access to this content.