Management of children with solid organ injuries after blunt torso trauma

Abstract

Prognostic/epidemiologic study, level III; therapeutic study, level IV.

Factores asociados a falla en el manejo no operatorio de lesiones hepáticas o esplénicas secundarias a trauma abdominal cerrado en niños

“…Similar to what was previously reported in other series 1,3,6,7,15,23,27 , pedestrian-like traffic accidents are the predominant trauma mechanism in the hepatic and splenic injuries due to closed trauma in our study group, followed by falls from high heights in second place and others less common causes, as trauma on bicycle or skateboards, trauma with blunt objects among others. The most affected group was the 5 to 10 years old children.…”

“…Certain conditions have been associated with this fact, such as severe hepatic or splenic lesions (IV-V), since the more severe the lesion, the greater the probability of hemodynamic instability or association with injury to other organs, the hemoperitoneum abundant (3-4 quadrants), pseudoaneurysms and/or leakage of radiological contrast IV in CAT 1,[12][13][14]24,27,28,36 . However, other series have shown that 61-86% of grade IV lesions and 32-77% of grade V lesions (in the absence of hemodynamic instability) have been treated conservatively 6,7,[12][13][14][15]22 , and it does not matter the age, gender, mechanism of trauma and degree of injury 13,17 , because it is hemodynamic instability the one that does not show improvement after 6 hours of adequate resuscitation, which predicts almost a 100% of correlation between the need for laparotomy and splenectomy in children with closed trauma spleen 29 . The above is clear, a periodic evaluations by trained personnel are necessary in order to allow the early detection of the surgical interventions need and to identify patients at high risk, avoiding failure of NOM 6,7,[12][13][14][15]23,27,[29][30][31] .…”

“…However, other series have shown that 61-86% of grade IV lesions and 32-77% of grade V lesions (in the absence of hemodynamic instability) have been treated conservatively 6,7,[12][13][14][15]22 , and it does not matter the age, gender, mechanism of trauma and degree of injury 13,17 , because it is hemodynamic instability the one that does not show improvement after 6 hours of adequate resuscitation, which predicts almost a 100% of correlation between the need for laparotomy and splenectomy in children with closed trauma spleen 29 . The above is clear, a periodic evaluations by trained personnel are necessary in order to allow the early detection of the surgical interventions need and to identify patients at high risk, avoiding failure of NOM 6,7,[12][13][14][15]23,27,[29][30][31] . The primary indication for surgical intervention in hemodynamically stable children is the requirement for serial transfusions exceeding half the blood volume or 40 cc/kg for 24 hours after injury 1,9,14,15,17 .…”

“…In Colombia, a 14.2% of deaths in children between 1 to 4 years old are registered, and a 14% in the age group between 5 and 14 years old 3 . Traffic accidents are the leading cause of trauma mortality with 44% of all deaths 1,3,6,7 , mainly in the population between 5 and 14 years of age. Penetrating trauma is much less common in young children, rating only 1% to 10% of the consultation reasons in pediatric trauma centers [1][2][3] .…”

“…The spleen and liver are the most commonly injured intraabdominal organs in pediatric patients, similar to adult patients (28% and 30%, respectively), cases of closed abdominal trauma. In most cases, these lesions can be managed without surgery 6,[11][12][13][14][15][16] . This therapeutic approach is called non-operative Management (NOM) and it is defined as that management performed in the patient, after a primary and secondary revision and after the taking the relevant images, which support the decision of not perfoming surgery immediately 12,13 .…”