Abdominal and Renal Trauma

Stylianos, Steven; Hicks, Barry

doi:10.1016/b978-1-4160-6127-4.00016-1

Cited by 2 publications

(4 citation statements)

References 162 publications

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“…Additionally, recent evidence suggests that excessive crystalloid volume resuscitation is associated with poor outcomes, including prolonged ventilation and hospital LOS, in pediatric trauma patients, and over half of patients who receive multiple crystalloid boluses still ultimately require transfusion [ 27 ]. Crystalloid infusion should therefore be limited to a 20 mL/kg bolus, with persistent hemodynamic instability necessitating transfusion [ 5 , 13 ]. The transfusion of packed red blood cells is recommended for hemoglobin levels of less than 7.0 g/dL or for patients with signs of ongoing or recent bleeding (GRADE 1A recommendation, strong recommendation and high-quality evidence) [ 13 , 28 ].…”

Section: Initial Resuscitationmentioning

confidence: 99%

“…Like liver trauma, operative splenic trauma is initially managed with hemorrhage control and packing of the abdomen. Packing may be left in place in order to pursue management with angiography, the use of which is further detailed below [ 5 ]. Otherwise, operative management options include splenectomy or splenorrhaphy.…”

Section: Nonoperative and Operative Managementmentioning

confidence: 99%

“…Children are at higher risk of intra-abdominal injuries due to their smaller size, less soft tissue to “pad” the transferred energy from a traumatic impact, and incompletely ossified bones leading to less protection of the underlying viscera [ 3 ]. Solid organ injury (SOI) refers to intra-abdominal organ injuries excluding hollow viscus organs and is estimated to occur in approximately 8800 children annually [ 5 ]. The most commonly injured solid organ in children is the liver, representing 44% of solid organ injuries, followed by the spleen (32%), kidney (18%), and pancreas (6%) [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Management of Pediatric Solid Organ Injuries

Lyttle,

Williams,

Stylianos

2024

Children

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Solid organ injury (SOI) is common in children who experience abdominal trauma, and the management of such injuries has evolved significantly over the past several decades. In 2000, the American Pediatric Surgical Association (APSA) published the first societal guidelines for the management of blunt spleen and/or liver injury (BLSI), advocating for optimized resource utilization while maintaining patient safety. Nonoperative management (NOM) has become the mainstay of treatment for SOI, and since the publication of the APSA guidelines, numerous groups have evaluated how invasive procedures, hospitalization, and activity restrictions may be safely minimized in children with SOI. Here, we review the current evidence-based management guidelines in place for the treatment of injuries to the spleen, liver, kidney, and pancreas in children, including initial evaluation, inpatient management, and long-term care, as well as gaps that exist in the current literature that may be targeted for further optimization of protocols for pediatric SOI.

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Section: Initial Resuscitationmentioning

confidence: 99%

Section: Nonoperative and Operative Managementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of Pediatric Solid Organ Injuries

Lyttle,

Williams,

Stylianos

2024

Children

Self Cite

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“…Ultrasonography also has been used but it's sensitivity for renal injury is ranging 25-70%. 4 The criteria of American Association for Surgery in Trauma (AAST) is well-known radiological grading system of renal injuries. In this grading scale injuries graded 1 to5 (grade 1=contusion / limited subcapsular perirenal hematoma; grade 2= <1 cm depth superficial laceration, no evidence of the collecting system involvement; grade 3= laceration >1 cm without extension into the collecting system or renal pelvis; grade 4= extravasation of urine, widening subcapsular hematoma, injured renal artery or vein to result hemorrhage; grade 5= renal hilum or ureteropelvik avulsion, shattered kidney, complete laceration or thrombus of renal artery or vein).…”

Section: Introductionmentioning

confidence: 99%

Renal traumas in childhood: a five years experience of tertiary care hospital in Turkey

et al. 2018

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Background: In this study, the experiences of kidney trauma of a third step hospital in a city at the junction of the road will be discussed with the current literature.Methods: Pediatric trauma patients admitted to Afyon Kocatepe University Hospital between 1 January 2012 and 31 December 2017 were retrospectively examined. Thirty patients with renal injuries were included in the study. Patients with renal injury were examined in terms of age, gender, type of trauma, degree of renal injury, additional organ damage, treatment method, duration of hospitalization, cost and mortality. Statistical analysis was performed with the SPSS program. The p >0.05 was considered as significant.Results: A total of 30 patients (m:23, f:7) were included in the study. The mean age of the patients was 12.10±5.70. The mean duration of hospitalization was 10.23±17.067 days. The reasons of kidney injury were determined as; traffic accident outside of the vehicle (n=9), fall (n=8), traffic accident inside the vehicle (n=6), bicycle-motorcycle accident (n=5), and firearm injury (n=2). Hematuria (n=8), grade 1 (n=12), grade 2 (n=2), grade 4 (n=5), and grade 5 (n=3) kidney injuries were detected in the patients. Isolated renal injuries were found in 7 patients. Additional organ injuries were found as lung injury (n=3), head injury (N=5), pelvic injury (n=5), spleen injury (n=8), spine injury (n=7), liver injury (n=7), intestinal injury (n=7), and extremity injury (n=7). The average cost was 4948.37 ± 10198.51 TL. One patient had nephrectomy and JJ catheter was placed to one patient due to the development of urinoma and hematoma. All other patients were treated conservatively. The cost and duration of hospitalization of patients with shock status at the time of admission to the hospital were statistically higher than those without shock status (p=0.001; p=0.025). Morbidity and cost of patients with high grades (grade 4 or 5) were higher than those with low grades (p=0.008 and p=0.027, respectively). There was no mortality except for a patient who underwent splenectomy and had concomitant brain parenchymal damage.Conclusions: Conservative treatment of kidney injuries for children is effective and safe. Additional injuries, shock status and high-grade cause morbidity, mortality and cost increases.

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Abdominal and Renal Trauma

Cited by 2 publications

References 162 publications

Management of Pediatric Solid Organ Injuries

Management of Pediatric Solid Organ Injuries

Renal traumas in childhood: a five years experience of tertiary care hospital in Turkey

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