Benchmarks for splenectomy in pediatric trauma: How are we doing?

Polites, Stephanie F.; Zielinski, Martin D.; Zarroug, Abdalla E.; Wagie, Amy E.; Stylianos, Steven; Habermann, Elizabeth B.

doi:10.1016/j.jpedsurg.2014.09.001

Cited by 38 publications

(26 citation statements)

References 14 publications

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“…Baseline characteristics are shown in Table 1. The study group consisted of 83 (68%) males and 38 (31%) females, with a median age of 12 (8)(9)(10)(11)(12)(13)(14)(15)(16) and a median ISS of 16 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). On admission, the study group had a median SBR of 120 (108-130), a PR of 92 (80-110), and a GCS of 15 (14)(15).…”

Section: Resultsmentioning

confidence: 99%

“…Two patients with an active blush from their grade 4 liver injury and 2 patients with an active blush from their grade 4 splenic injury were treated by AE. Patients in the laparotomy group showed the highest pulse rate of 110 (89-120) and respiratory rate 21 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Furthermore, ISS was higher in patients undergoing laparotomy.…”

Section: Resultsmentioning

confidence: 99%

“…Injuries were graded based on the American Association for Surgery of Trauma organ injury grading scales. All injuries were scored according to the Abbreviated Injury Scale (AIS) by an [25] authorized registrar by analyzing the Computed tomography (CT)-scan, diagnostic abdominal ultrasound (US), or after abdominal exploration [26]. The injury severity score (ISS) was calculated per patient after dismissal.…”

Section: Patientsmentioning

confidence: 99%

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Management of pediatric blunt abdominal trauma in a Dutch level one trauma center

Spijkerman

Bulthuis

Hesselink

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Most children with intra-abdominal injuries can be managed non-operatively. However, in Europe, there are many different healthcare systems for the treatment of pediatric trauma patients. Therefore, the aim of this study was to describe the management strategies and outcomes of all pediatric patients with blunt intra-abdominal injuries in our unique dedicated pediatric trauma center with a pediatric trauma surgeon. Methods We performed a retrospective, single-center, cohort study to investigate the management of pediatric patients with blunt abdominal trauma. From the National Trauma Registration database, we retrospectively identified pediatric (≤ 18 years) patients with blunt abdominal injuries admitted to the UMCU from January 2012 till January 2018. Results A total of 121 pediatric patients were included in the study. The median [interquartile range (IQR)] age of patients was 12 (8-16) years, and the median ISS was 16 (9-25). High-grade liver injuries were found in 12 patients. Three patients had a pancreas injury grade V. Furthermore, 2 (1.6%) patients had urethra injuries and 10 (8.2%) hollow viscus injuries were found. Eighteen (14.9%) patients required a laparotomy and 4 (3.3%) patients underwent angiographic embolization. In 6 (5.0%) patients, complications were found and in 4 (3.3%) children intervention was needed for their complication. No mortality was seen in patients treated non-operatively. One patient died in the operative management group. Conclusions In conclusion, it is safe to treat most children with blunt abdominal injuries non-operatively if monitoring is adequate. These decisions should be made by the clinicians operating on these children, who should be an integral part of the entire group of treating physicians. Surgical interventions are only needed in case of hemodynamic instability or specific injuries such as bowel perforation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

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Management of pediatric blunt abdominal trauma in a Dutch level one trauma center

Spijkerman

Bulthuis

Hesselink

et al. 2020

Eur J Trauma Emerg Surg

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“…It is already known that the rate of non-operative management in pediatric trauma centers is higher compared to adult trauma centers, and the prognosis for non-operative treatment is superior to that of operative treatment. [17][18][19] At this point, we need to admit that some cases could have been managed non-operatively if patients were seen by pediatric surgeons instead of ER doctors or adult general surgeons. However, the decision to operate when necessary cannot be delayed, even though most pediatric trauma cases were well treated non-operatively.…”

Section: Discussionmentioning

confidence: 99%

Review of pediatric abdominal trauma: operative and non‐operative treatment in combined adult and pediatric trauma center

Shimizu

Umemura

Fujiwara

et al. 2019

Acute Medicine & Surgery

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Aim More than 90% of pediatric solid organ abdominal injuries are treated non‐operatively. It remains difficult to decide who should graduate to surgical management, more so if adult physicians must make these decisions on pediatric patients. The purpose of this study was to examine outcomes of all pediatric abdominal trauma cases in a single center, focusing on the decision‐making algorithm for operative or non‐operative treatment by pediatric and adult physicians. Methods We undertook a retrospective review of a pediatric trauma database from April 2006 to March 2016. Groups were divided into operative and non‐operative, single or multi‐organ injury, and adult or pediatric physician. Operative treatments included laparotomy or interventional radiology procedures. Primary outcome was survival within 30 days. Results There were 53 abdominal trauma cases; among them, 48 (90.6%) survived and 5 (9.4%) died within 30 days. The probability of survival for mortalities was less than 11%. Forty‐two cases were treated non‐operatively and 11 operatively. Injury Severity Score was higher in operative group (17 [9, 41]/9 [4, 16.3]). Adult physicians saw 33 patients including seven operative, whereas pediatric physicians saw 20 including four operative cases. There was no statistical difference for the management decision between adult and pediatric physicians. Conclusion Our decisions for intervention were within acceptable rates. Adult physicians did not tend to operate more, but there were cases that did not fit the criteria of the algorithm. Further investigation is needed to look at which factors should be focused on to determine whether or not operative treatments are indicated.

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“…9 This essential management difference is further highlighted by a report showing splenectomy rates remain higher in centres that do not have specialist paediatric surgery teams. 10 Solid organs: spleen and liver Splenic trauma is the most common intra-abdominal injury in blunt abdominal trauma (Figure 1), hepatic injury the second most common (Figure 2). Together, they make up 70% of all visceral injuries in paediatric trauma.…”

Section: Abdominal Traumamentioning

confidence: 99%

Paediatric trauma

Fisher

2015

Surgery (Oxford)

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Injury is the commonest cause of death amongst children over the age of 1 year in the developed world. Injury patterns vary across the world. In the UK, paediatric trauma is relatively rare and mainly from blunt injuries. Importantly, the majority of severely injured children are under 10, and more than 25% are less than 1 year of age.Children are anatomically and physically different from adults and their trauma patterns, response and management are also different from those of adults. The evidence shows that children have a better outcome from management under specialist paediatric care.This article covers the principles of trauma management including differences between adult and paediatric management such as volume resuscitation, paediatric trauma imaging and the non-operative approach to solid organ injuries.

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Benchmarks for splenectomy in pediatric trauma: How are we doing?

Cited by 38 publications

References 14 publications

Management of pediatric blunt abdominal trauma in a Dutch level one trauma center

Management of pediatric blunt abdominal trauma in a Dutch level one trauma center

Review of pediatric abdominal trauma: operative and non‐operative treatment in combined adult and pediatric trauma center

Paediatric trauma

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