Journal of Trauma and Acute Care Surgery. 83(4):597–602, OCTOBER 2017

DOI: 10.1097/TA.0000000000001533

,  

PMID: 28930954

Issn Print: 2163-0755

Publication Date: October 2017


Share this on facebook   Share this on Twitter   Share this on LinkedIn   Email this article  



Print

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

Chase Arbra;Adam Vogel;Jingwen Zhang;Patrick Mauldin;Eunice Huang;Kate Savoie;Matthew Santore;KuoJen Tsao;Tiffany Ostovar-Kermani;Richard Falcone;M. Dassinger;John Recicar;Jeffrey Haynes;Martin Blakely;Robert Russell;Bindi Naik-Mathuria;Shawn St. Peter;David Mooney;Chinwendu Onwubiko;Jeffrey Upperman;Christian Streck;

+ Author Information


    loading  Checking for direct PDF access through Ovid

Abstract

BACKGROUNDPediatric 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.METHODSWe 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.RESULTSTwo 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%.CONCLUSIONAcute 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.LEVEL OF EVIDENCEPrognostic/epidemiologic study, level III; therapeutic study, level IV.

Related Topics

    Related Articles

        loading  Loading Related Articles