Blunt Abdominal Solid Organ Injury Research Articles

National Analysis of Clinical Outcomes Associated With Cirrhotic Blunt Trauma Patients Undergoing Emergency Laparotomy Versus Non-operative Management: A Propensity Case-Matched Analysis.

This study aims to evaluate clinical outcomes among severely injured trauma patients presenting with isolated blunt abdominal solid organ injuries with a pre-diagnosis of liver cirrhosis (LC) undergoing emergency laparotomy vs nonoperative management (NOM). This retrospective cohort study utilized the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) dataset from 2017 to 2021. Adults (≥18years) with a pre-existing diagnosis of LC who presented with severe blunt (ISS ≥ 16) isolated solid organ abdominal injuries and underwent laparotomy or NOM were included. Outcomes of interest included in-hospital mortality, intensive care unit length of stay (ICU-LOS), and in-hospital complications such as acute renal failure and deep vein thrombosis. 929 patients were included in this analysis, with 355 undergoing laparotomy and 574 managed nonoperatively. Laparotomy patients suffered greater in-hospital mortality (n = 186, 52.3% vs n = 115, 20.0%; P < .01), required significantly more blood within 4hours (8.9 units vs 4.3 units, P < .01), and had a significantly longer ICU-LOS (10.2days vs 6.7days, P < .01). In the 1:1 propensity score matched analysis of 556 matched patients, in-hospital mortality was greater for laparotomy patients (52.3% vs 20.0%, P < .01). Laparotomy was associated with significantly higher in-hospital mortality in propensity-matched trauma patients, longer ICU-LOS, and more blood products given at 4hours compared to NOM. These findings illustrate that NOM may be a safe approach in managing severely injured trauma patients with isolated blunt abdominal solid organ injuries and a pre-diagnosis of LC.

Analysis of Blunt Abdominal Solid Organ Injury in Children: A Single Centre Study

Aim: To determine the management of solid organ injuries in blunt trauma abdomen (BTA) in children whether to conserve or operate. Study design: Descriptive case series. Place and duration of study: Department of Paediatric Surgery Sahiwal Teaching Hospital and Sahiwal Medical College Sahiwal from 1st January 2020 to 31st March 2022. Methodology: Fifty eight patients with blunt abdominal trauma due to any cause, the medical records of all patients with trauma of any kind age upto 13 years were carefully reviewed. Initial resuscitation was done according to ATLS protocol. Ultimate management decision was based on stability of patients after resuscitation. Results: The mean age was 5.34 years. Most of the patients suffered from road traffic accident, 50(86.2%). Fifty two (89.65%) patients showed free fluid in the abdomen. Organ injury in 27(46.55%) patients. CT abdomen with intravenous contrast confirmed findings of ultra sonography. Despite resuscitation, 17(43.9%) patients remained unstable and were operated. Forty one patients were kept on conservative treatment. Hospital stay ranged from 1-19 days. Conclusion: Although non-operative management is the treatment of choice in blunt trauma abdomen with solid organ injury but stability of the injured child is the central pivot around which the whole management revolves. Delay in presentation and failure of timely resuscitation results into high operative intervention. Keywords: Blunt trauma, solid, Liver, Spleen, children

Thromboprophylaxis Timing After Blunt Solid Organ Injury: A Systematic Review and Meta-analysis

IntroductionTrauma patients with blunt abdominal solid organ injuries are at high risk for venous thromboembolism (VTE), but the optimal time to safely administer chemical thromboprophylaxis is controversial, especially for patients who are managed nonoperatively due to increased risk of hemorrhage. We sought to compare failure of nonoperative management (NOM) and VTE events based on timing of chemical thromboprophylaxis initiation. MethodsA systematic review was conducted in PubMed and Embase databases. Studies were included if they evaluated timing of initiation of chemical thromboprophylaxis in trauma patients who underwent NOM of blunt solid organ injuries. Outcomes included failure of NOM and incidence of VTE. A random-effects meta-analysis was performed comparing patients who received late (>48 h) versus early thromboprophylaxis initiation. ResultsTwelve retrospective cohort studies, comprising 21,909 patients, were included. Three studies, including 6375 patients, provided data on adjusted outcomes. Pooled adjusted analysis demonstrated no difference in failure of NOM in patients receiving late versus early thromboprophylaxis (odds ratio [OR] 0.92, 95% confidence interval [CI]:0.4-2.14). When including all unadjusted studies, even those at high risk of bias, there remained no difference in failure of NOM (OR 1.16, 95% CI:0.72-1.86). In the adjusted analysis for VTE events, which had 6259 patients between two studies, patients receiving late chemical thromboprophylaxis had a higher risk of VTE compared with those who received early thromboprophylaxis (OR 1.89, 95% CI:1.15-3.12). ConclusionsBased on current observational evidence, initiation of prophylaxis before 48 h is associated with lower VTE rates without higher risk of failure of NOM.

Current Trends of Conservative Management of Blunt Abdominal Solid Organ Injury

Introduction: Bangladesh is one of the most densely inhabited countries in the world. Road traffic accidents are one of the leading causes of morbidity, and the incidence of blunt abdominal injuries is on the rise. Over the last several years, the treatment of blunt abdominal injury (BAI) has changed dramatically. Conservative or non-operative treatment (NOM) of liver, spleen, and kidney injuries has proven to be quite effective. Methods of study: A prospective observational study was done in Dhaka medical college with 50 consecutive patients included from January 2010 to June 2010. Results: Within the 50 consecutive patients 88% were male, and 64% were motor vehicular crashes. 26 patients (52%) had a liver injury; 5 (10%) had a renal injury; 7 (14%) had a splenic injury and 3 (6%) had a pancreatic injury; 9(18%), 2 patients (4%) had both liver and spleen injury, 3 patients (6%) had both spleen and kidney injury. 39 (78%) patients were managed successfully by a conservative approach. Compared with these patients who underwent non-operative management (NOM) initially, patients in the operative group had a higher injury severity score. (p &lt; 0.001). Twenty-seven patients (high risk) were successfully treated without surgery. No serious complication was found on routine image follow-up. Conclusion: Conservative or non-operative management of blunt abdominal solid organ injury in hemodynamically stable patients is highly successful in many fields when compared with the operative group, including the outcomes of morbidity, mortality, and length of hospital stay.

Nonoperative management of blunt abdominal solid organ injury: Are we paying enough attention to patients on preinjury anticoagulation?

BackgroundThis study aims to assess the impact of pre-injury anticoagulant use on outcomes of isolated blunt abdominal SOI patients who underwent NOM. MethodsA 1-year(2017) analysis of the ACS-TQIP. We included all ≥18yrs trauma patients with isolated blunt abdominal-SOI who underwent NOM. Patients were stratified into two groups based on their history of pre-injury anticoagulant use. Propensity score matching was performed. ResultsA matched cohort of 2709 patients (AC, 903; No-AC,1806) was analyzed. Compared to the No-AC group, the AC group had higher rates of failure of NOM(2.6% vs. 4.5%, p = 0.03), cardiac arrest (1.2%vs. 3.1%, p = 0.02), acute kidney injury (2.4% vs. 4.2%, p < 0.01), myocardial infarction (0.6% vs. 1.4%,p = 0.03), and mortality (5.1%vs. 7.6%,p = 0.01), and longer hospital LOS (17[10–24]vs.17[12–26]days,p = 0.04) and ICU LOS (11[6–17]vs.11[7–18]days,p = 0.01). ConclusionAmong nonoperatively managed blunt abdominal SOI patients, preinjury use of anticoagulants negatively impacts outcomes. Extra surveillance is required while managing patients with blunt abdominal SOI on pre-injury anticoagulants. Level of evidenceLevel III. Study typeTherapeutic/care management.

Timing of pharmacologic venous thromboembolism prophylaxis initiation for trauma patients with nonoperatively managed blunt abdominal solid organ injury: a systematic review and meta-analysis

BackgroundBlunt abdominal solid organ injury is common and is often managed nonoperatively. Clinicians must balance risk of both hemorrhage and thrombosis. The optimal timing of pharmacologic venous thromboembolism prophylaxis (VTEp) initiation in this population is unclear. The objective was to evaluate early (< 48 h) compared to late initiation of VTEp in adult trauma patients with blunt abdominal solid organ injury managed nonoperatively.MethodsEmbase, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched from inception to March 2021. Studies comparing timeframes of VTEp initiation were considered. The primary outcome was failure of nonoperative management (NOM) after VTEp initiation. Secondary outcomes included risk of transfusion, other bleeding complications, risk of deep vein thrombosis (DVT) and pulmonary embolism, and mortality.ResultsTen cohort studies met inclusion criteria, with a total of 4642 patients. Meta-analysis revealed a statistically significant increase in the risk of failure of NOM among patients receiving early VTEp (OR 1.76, 95% CI 1.01–3.05, p = 0.05). There was no significant difference in risk of transfusion. Odds of DVT were significantly lower in the early group (OR 0.36, 95% CI 0.22–0.59, p < 0.0001). There was no difference in mortality (OR 1.50, 95% CI 0.82–2.75, p = 0.19). All studies were at serious risk of bias due to confounding.ConclusionsInitiation of VTEp earlier than 48 h following hospitalization is associated with an increased risk of failure of NOM but a decreased risk of DVT. Absolute failure rates of NOM are low. Initiation of VTEp at 48 h may balance the risks of bleeding and VTE.

Interventional radiology and open surgery: An effective partnership for solid organ trauma

BackgroundManagement algorithms of paediatric blunt abdominal solid organ injury (BASOI) are evolving to include interventional radiology, but there are few studies documenting the application and clinical outcomes of cases in children. MethodsA retrospective case note review of all paediatric BASOI at a single Paediatric Major Trauma Centre was completed. CT scans and injuries have been retrospectively graded according to AAST guidelines. ResultsIn the period February 2012 - October 2019, there were 106 children (median age 10.6 years (range 10 days – 16 years)) with BASOI. Of these, 71% (n = 75) suffered liver injuries, 29% (n = 31) spleen, and 27% (n = 29) renal. 95 children (89.6%) were treated with non-operative management, of which 15% (n = 14) went on to require secondary operative management (surgery, n = 1 & interventional radiology, n = 14). There were no deaths or loss of organ in the group which required secondary operative management, regardless of the grade of injury. ConclusionThe majority of BASOI can be successfully treated conservatively, but IR is a useful additional tool in management for all grades of injury and is complementary to open surgery. Level of EvidenceLevel IV Case Series

Fragmentation of care in the blunt abdominal trauma patient: Capturing our true outcomes and impact on care.

Trauma care is associated with unplanned readmissions, which may occur at facilities other than the index treatment facility. This "fragmentation of care" may be associated with adverse outcomes. We evaluated a statewide database that includes readmissions to analyze the incidence and impact of FC. The California Office of Statewide Health Planning and Development patient discharge data set was evaluated for calendar years 2016 to 2018. Patients 15 years or older diagnosed with blunt abdominal solid organ injury during the index admission were identified. Readmissions were evaluated postdischarge at 1, 3, and 6 months. Patients readmitted within 6 months to a facility other than the index admission facility (fragmented care [FC]) were compared with those readmitted to their index admission facility (non-FC). Logistic regression modeling was used to evaluate risk of FC. Of the total 1,580 patients, there were 752 FC (47.6%) and 828 (52.4%) non-FC. Readmissions representing FC at months 1, 3, and 6 were 40.3%, 49.3%, and 53.4%, respectively. At index admission, the groups were demographically and clinically similar, with similar rates of abdominal operations and complications. Non-FC patients had a higher rate of abdominal reoperation at readmission (5.8% non-FC vs. 2.9% FC, p = 0.006). In an adjusted model, multiple readmissions (odds ratio [OR] 1.11, p = 0.014), readmission >30 days after index facility discharge (OR, 1.98; p < 0.001), and discharge to a nonmedical facility (OR, 2.46; p < 0.0001) were associated with increased odds of FC. Operative intervention at index admission was associated with lower odds of FC (OR, 0.77; p = 0.039). However, FC was not independently associated with demographic or insurance characteristics. The rate of FC among patients with blunt abdominal injury is high. The risk of FC is mitigated when patients are managed operatively during the index admission. Trauma systems should implement measures to ensure that these patients are followed postdischarge. Prognostic and epidemiological, level III; Care management, level IV.

Hospital-based intervention is rarely needed for children with low-grade blunt abdominal solid organ injury: An analysis of the Trauma Quality Improvement Program registry.

Children with low-grade blunt solid organ injury (SOI) have historically been admitted to an inpatient setting for monitoring, but the evidence supporting the necessity of this practice is lacking. The purpose of this study was to quantify the frequency and timing of intervention for hemorrhage and to describe hospital-based resource utilization for low-grade SOI in the absence of other major injuries (OMIs). A cohort of children (aged <16 years) with blunt American Association for the Surgery of Trauma grade 1 or 2 SOI from the American College of Surgeons Trauma Quality Improvement Program registry (2007-2017) was analyzed. Children were excluded if they had confounding factors associated with intervention for hemorrhage (comorbidities, OMIs, or extra-abdominal surgical procedures). Outcomes included frequency and timing of intervention (laparotomy, angiography, or transfusion) for hemorrhage, as well as hospital-based resource utilization. A total of 1,019 children were identified with low-grade blunt SOI and no OMIs. Nine hundred eighty-six (96.8%) of these children were admitted to an inpatient unit. Admitted children with low-grade SOI had a median length-of-stay of 2 days and a 23.9% intensive care unit admission rate. Only 1.7% (n = 17) of patients with low-grade SOI underwent an intervention, with the median time to intervention being the first hospital day. No child who underwent angiography was transfused or had an abnormal initial ED shock index. Children with low-grade SOI are routinely admitted to the hospital and often to the intensive care unit but rarely undergo hospital-based intervention. The most common intervention was angiography, with questionable indications in this cohort. These data question the need for inpatient admission for low-grade SOI and suggest that discharge from the emergency room may be safe. Prospective investigation into granular risk factors to identify the rare patient needing hospital-based intervention is needed, as is validation of the safety of ambulatory management. Prognostic and epidemiological, level III.

Timing of thromboprophylaxis in patients with blunt abdominal solid organ injuries undergoing nonoperative management.

Decision making regarding the optimal timing for initiating thromboprophylaxis in patients with blunt abdominal solid organ injuries (BSOIs) remains ill-defined, with no guidelines defining optimal timing. In this study, we aimed to evaluate the relationship of the timing of thromboprophylaxis with thromboembolic and bleeding complications in the setting of BSOIs. A retrospective analysis of the Trauma Quality Improvement Program database was performed between 2013 and 2016. All patients with isolated BSOIs (liver, spleen, pancreas, or kidney, Abbreviated Injury Scale score, <3 in other regions) who underwent initial nonoperative management (NOM) were included. Patients were divided into three groups (early, <48 hours; intermediate, 48-72 hours; and late, >72 hours) based on timing of thromboprophylaxis initiation. Primary outcomes were rates of thromboembolism and bleeding after thromboprophylaxis initiation. Of the 25,118 patients with isolated BSOIs, 3,223 met the inclusion criteria (age, 38.7 ± 17.3 years; males, 2.082 [64.6%]), among which 1,832 (56.8%) received early thromboprophylaxis, 703 (21.8%) received intermediate thromboprophylaxis, and 688 (21.4%) received late thromboprophylaxis. Late thromboprophylaxis initiation was independently associated with a higher likelihood of both deep vein thrombosis (odds ratio [OR], 3.15; 95% confidence interval [CI], 1.68-5.91, p < 0.001) and pulmonary embolism (OR, 4.29; 95% CI, 1.95-9.42; p < 0.001). Intermediate thromboprophylaxis initiation was independently associated with a higher likelihood of deep venous thrombosis (OR, 2.38; 95% CI, 1.20-4.74; p = 0.013), but not pulmonary embolism (p = 0.960) compared with early initiation. Early (but not intermediate) thromboprophylaxis initiation was independently associated with a higher likelihood of bleeding (OR, 2.05; 95% CI, 1.11-2.18; p = 0.023), along with a history of diabetes mellitus, splenic, and high-grade liver injuries. Early thromboprophylaxis should be considered in patients with BSOIs undergoing nonoperative management who are at low likelihood of bleeding. An intermediate delay (48-72 hours) of thromboprophylaxis should be considered for patients with diabetes mellitus, splenic injuries, and Grades 3 to 5 liver injuries. Therapeutic, Level IV.

Hospital-level intensive care unit admission for patients with isolated blunt abdominal solid organ injury.

The optimal level of care for hemodynamically stable patients with isolated blunt hepatic, renal, or splenic injuries (solid organ injuries [SOIs]) is unknown. We sought to characterize interhospital variability in intensive care unit (ICU) admission of such patients and to determine whether greater hospital-level ICU use would be associated with improved outcomes. We conducted a retrospective cohort study using the 2015 and 2016 National Trauma Data Bank. We included adult patients with blunt trauma with SOIs with an Abbreviated Injury Scale score of 2 to 4. We excluded patients with other significant injuries, hypotension, or another indication for ICU admission, and hospitals with less than 10 eligible patients. We categorized hospitals into quartiles based on the proportion of eligible patients admitted to an ICU. The primary outcome was a composite of organ failure (cardiac arrest, acute lung injury/acute respiratory failure, or acute kidney injury), infection (sepsis, pneumonia, or catheter-related blood stream infection), or death during hospitalization. Among 14,312 patients at 444 facilities, 7,225 (50%), 5,050 (35%), and 3,499 (24%) had splenic, hepatic, and renal injuries, respectively. The median proportion of ICU use was 44% (interquartile range, 27-59%, range 0-95%). The composite outcome occurred in 180 patients (1.3%), with death in 76 (0.5%), organ failure in 97 (0.7%), and infection in 53 (0.4%). Relative to hospitals with the lowest ICU use (quartile 1), greater hospital-level ICU use was not associated with decreased likelihood of the composite outcome (adjusted odds ratios, 1.31; 95% confidence interval [95% CI], 0.88-1.95; 0.81; 95% CI, 0.52-1.26; and 0.94; 95% CI, 0.62-1.43 for quartiles 2-4, respectively) or its components. Unplanned ICU transfer was no more likely with lower hospital-level ICU use. Admission location of stable patients with isolated mild to moderate abdominal SOIs is variable across hospitals, but hospitalization at a facility with greater ICU use is not associated with substantially improved outcomes. Therapeutic/care management, Level IV.

Non-Operative Management of Pediatric Blunt Abdominal Solid Organ Injuries : Our Experience at Queen Rania Al-Abdullah Hospital for Children

Non-Operative Management of Pediatric Blunt Abdominal Solid Organ Injuries : Our Experience at Queen Rania Al-Abdullah Hospital for Children

Management of blunt trauma abdomen in a tertiary care teaching hospital: a surgical audit

Background: Blunt abdominal trauma is a common scenario in Emergency department and the common cause being road traffic accidents. With this study we present our experience with blunt trauma of abdominal solid organ injuries over a period of 12 months.Methods: A retrospective study was conducted among 45 blunt trauma of abdominal solid organ injuries who presented to the emergency room of Department of General Surgery of Mysore Medical College and Research Institute, Mysore from 1st January 17 to 31st December 2017.All date were retrieved from medical records and statistical analysis was performed using Epi info version 7.Results: Mean age of study population was 31.46 years. 78.2% of the patients were males. Thirty-three (73.3%) patients undergone non-operative management. Splenic injury was reported as the most common abdominal solid organ injury followed by liver.Conclusions: With the advent of newer investigative modalities like contrast enhanced computed tomography (CECT) abdomen, more and more cases of blunt trauma abdominal solid organ injury can be managed non-operatively with effective ICU care. High-grade injuries do not preclude non-operative management.

Use of angiographic embolization in trauma-induced pediatric abdominal solid organ injuries.

Knowledge of the utility of angiographic embolization (AE) in pediatric cases of blunt abdominal solid organ trauma injuries is limited. The current study is an examination of AE as an effective and reliable method to control bleeding in patients with persistent bleeding due to blunt trauma-induced abdominal solid organ injury. This was a retrospective examination of patients <17 years of age who had experienced blunt abdominal solid organ injury and who presented at a single institution within 4 years. A statistical analysis of the data was performed. The mean length of intensive care unit stay was 4 days for those who underwent embolization (n=11), and the mean length of hospital stay was 12 days. The average pre-AE blood loss, as measured by the decrease in hematocrit (%) from admission to embolization, was -7.33+-5.3% (p<0.001). The average post-AE blood loss, as measured by the change in hematocrit 72 hours post AE, was 2+-0.97% (p>0.05). All of the patients were discharged with a full recovery. AE was a safe and effective method to control solid organ hemorrhage in pediatric patients with blunt abdominal injuries.

Safety of early ambulation following blunt abdominal solid organ injury: A prospective observational study

BackgroundThere is continued debate regarding the optimal period of bed-rest and in-hospital monitoring for non-operative management of solid organ injury following blunt trauma. MethodsSingle center, prospective, observational study of blunt solid organ injuries from 07/2014–02/2016, managed initially without surgical or angiographic intervention. Early ambulation was defined as ≤24 h. Results79 patients met inclusion criteria, with 36 (45.6%) in the early ambulation group and 43 (54.4%) in the late ambulation group. There were zero complications in the early ambulation group, and three complications in the late ambulation group (complications, p = 0.246; further interventions, p = 0.498). Median ICU LOS was zero days and three days for early vs. late ambulation, p = 0.001. Median total LOS was two days and five days for early vs. late ambulation, p < 0.001. ConclusionEarly ambulation is safe in patients undergoing non-operative management of their solid organ injury, and may result in a reduced length of stay.

Outcomes of an accelerated care pathway for pediatric blunt solid organ injuries in a public healthcare system

PurposeAn accelerated clinical care pathway for solid organ abdominal injuries was implemented at a level one pediatric trauma center. The impact on resource utilization and demonstration of protocol safety was assessed. MethodsData were collected retrospectively on patients admitted with blunt abdominal solid organ injuries from 2012 to 2015. Patients were subdivided into pre- and post-protocol groups. Length of hospital stay (LOS) and failure of non-operative treatment were the primary outcomes of interest. Results138 patients with solid organ injury were studied: 73 pre- (2012–2014) and 65 post-protocol (2014–2015). There were no significant differences in age, gender, injury severity score (ISS), injury grade, or mechanism (p>0.05). LOS was shorter post-protocol (mean 5.6 vs. 3.4days; median 5 .0 vs. 3.0days; p=0.0002), resulting in average savings of $5966 per patient. Patients in the protocol group mobilized faster (p<0.0001) and experienced fewer blood draws (p=0.02). On multivariate analysis, protocol group (p<0.001) and ISS (p<0.001) were independently associated with LOS. There were no differences between groups in the need for operation, embolization, or transfusion. ConclusionAn accelerated care pathway is safe and effective in the management of pediatric solid organ injuries with early mobilization, less blood draws, and decreased LOS without significant morbidity and mortality. Level of evidenceTherapeutic, cost effectiveness, level III.

Evaluation of the outcome of non-operative management in blunt abdominal solid organ injury

Background: Blunt injury to abdomen is one of the most common injuries caused by road traffic accidents. The advent of newer imaging techniques with high resolution Computerised Tomography (CT) scanners has enabled the clinicians to exactly diagnose the extent of the intra-abdominal injuries. These injuries are commonly managed by surgery, but the shift to selective non operative management (NOM) of blunt injuries to abdominal solid organs is one of the most notable trends in the care of trauma. Methods: The present study is a prospective one to evaluate the outcome of non-operative management of blunt trauma abdomen conducted at Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai from the month of April 2011 to September 2013. Results: Out of 50 cases, the most common organ to be injured was the liver (32 cases) and of which 27 cases were managed by non-operative method and it is statistically significant (p=0.008). Of the 50 patients, 15 patients got converted. 8 patients (16%) were converted due to fall in Hb, 6 patients (12%) converted due to fall in Hb and hypotension, and one patient (2%) was converted due to persistent fever and features of peritonitis. 35 patients were managed conservatively. 12 out of 15 patients (80%) who underwent laparotomy developed complications, in comparison only 5 out of 35 patients (15%) who were treated conservatively had complication. Conclusions: In our study, non-operative management was successful in 70% of the patients with good outcome.

Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury: a national trauma data bank analysis

BackgroundNonoperative management of hemodynamically stable children with Solid Organ Injury (SOI) has become standard of care. The aim of this study is to identify differences in management of children with SOI treated at Adult Trauma Centers (ATC) versus Pediatric Trauma Centers (PTC). We hypothesized that patients treated at ATC would undergo more procedures than PTC. MethodsPatients younger than 18 years old with isolated SOI (spleen, liver, kidney) who were treated at level I-II ATC or PTC were identified from the 2011–2012 National Trauma Data Bank. The primary outcome measure was the incidence of operative management. Data was analyzed using multivariate logistic regression analysis. Procedures were defined as surgery or transarterial embolization (TAE). Results6799 children with SOI (spleen: 2375, liver: 2867, kidney: 1557) were included. Spleen surgery was performed more frequently at ATC than PTC {101 (7.7%) vs. 52 (4.9%); P=0.007}. After adjusting for potential confounders (grade of injury, age, gender and injury severity score), admission at ATC was associated with higher odds of splenic surgery (OR: 1.5, 95% CI: 1.02–2.25; p=0.03). 11 and 8 children underwent kidney and liver operations respectively. TAE was performed in 17 patients with splenic, 34 with liver and 14 with kidney trauma. There was no practice variation between ATC and PTC regarding kidney and liver operations or TAE incidence. ConclusionsOperative management for SOI was more often performed at ATC. The presence of significant disparity in the management of children with splenic injuries justifies efforts to use these surgeries as a reported national quality indicator for trauma programs.

"Management of blunt renal injury: what is new?".

The diagnosis, workup and management of blunt renal injury have evolved greatly over the past decades. Evaluation and management of blunt renal injury echoes the increasing success of nonoperative management in other blunt abdominal solid organ injury, such as liver and spleen. Decision-making difficulties still remain regarding the optimal imaging, grading and degree of interventional or operative exploration used. Increasingly, initial nonoperative management has gained acceptance and appears to be applicable even high-grade injuries. Emerging techniques in highly sensitive imaging as well as interventional angiography have allowed safe nonoperative management in the appropriate patient. This review will focus on the contemporary workup and management of blunt renal injury while focusing on some of the emerging literatures in regard to refined imaging and grading of injuries as well as techniques to increase the success of nonoperative management.

The investigation of posttraumatic pseudoaneurysms in patients treated with nonoperative management for blunt abdominal solid organ injuries.

BackgroundPosttraumatic pseudoaneurysms (PAs) have been recognized as the cause of delayed hemorrhage complicated with nonoperative management (NOM), although the need for intervention in patients with small-sized PAs and the relationship between the occurrence of PAs and bed-rest has been also unclear.ObjectivesThe purpose of this study was to investigate the clinical history of small-sized PAs (less than 10 mm in diameter) which occurred in abdominal solid organs, and to analyze the relationship between the occurrence of PAs and early mobilization from bed.MethodsSixty-two patients who were successfully managed with NOM were investigated. Mobilization within three days post-injury was defined as “early mobilization” and bed-rest lasting over three days was defined as “late mobilization.” A comparison of the clinical factors, including the duration of bed-rest between patients with and without PAs detected by follow-up CT was performed. Furthermore, a multiple logistic regression model analysis on the occurrence of PAs was performed.ResultsPAs were detected in 7 of the 62 patients. The One patient with PAs measuring larger than 10 mm received trans-arterial embolization, and the remaining six patients with PAs smaller than 10 mm were managed conservatively. Consequently, no delayed hemorrhage occurred, and the PAs spontaneously disappeared in all of the six patients managed without intervention. The multiple regression model analysis revealed that early mobilization was not a significant factor predicting new-onset PAs.ConclusionsSmall PAs can be expected to disappear spontaneously. Moreover, early mobilization is not a significant risk factor for the occurrence of PAs.