Outcome of children with blunt liver or spleen injuries: Experience from a single institution in Korea

Kim, Ki Hoon; Kim, Woon-Won

doi:10.1016/j.ijsu.2016.12.119

Cited by 11 publications

(5 citation statements)

References 27 publications

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“…Similarly to our findings, a study on admissions of 6,577 MLCs to the pediatric emergency unit revealed that blunt or sharp force injuries were most frequently seen in the age group of 14.5 to 18 years (10). Blunt trauma constitutes the majority of pediatric traumas (11). In the USA, it has been reported that nearly half a million children under the age of fourteen experience traumatic brain injuries annually, with 90% of them being discharged with minor injuries, but nearly three thousand children do not survive (12).…”

Section: Discussionsupporting

confidence: 87%

Rare Medico Legal Cases of Pediatric Intensive Care Unit

Kılıç,

Oto

2023

Med Sci Discov

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Objective: While Multiple Life-threatening Conditions (MLCs) admitted to the Pediatric Intensive Care Unit represent a substantial healthcare burden, the risk factors, epidemiological data, and clinical manifestations of these cases have yet to be systematically and comprehensively documented. Material and Methods: This study was conducted in the Pediatric Intensive Care Unit at Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey, between January 1, 2017, and January 1, 2022. The study included 31 males (35.4%) and 17 females (64.6%) with an average age of 4.7 ± 4.1 years. MLCs were classified into nine groups, including Foreign Body Aspiration (FBA), Blunt Trauma (BT), Asphyxia (ASP), Firearm Injury (FI), Sharp and Penetrating Object Injury (SPOI), Electric Injury (EI), Sports-Related Injury (SRI), Animal Bite Injury (ABI), and Home Accident (HA). Results: Foreign Body Aspiration (FBA) was the most prevalent type of MLC in this study (29.1%). The average hospital stay for FBA cases in the general ward was 3 days (range: 1-11 days), and in the Pediatric Intensive Care Unit was 2 days (range: 1-8 days). Blunt Trauma (BT) cases had an average hospital stay of 4 days (range: 1-12 days) in the general ward and 3 days (range: 1-10 days) in the Pediatric Intensive Care Unit. Surgical intervention was required for 29.1% of patients (n=14). The mean cost of treating a case in our study was calculated to be 5744 ₺ (approximately US$308.57). The majority of MLCs were attributed to FBA (n=14, 43%), followed by BT (n=9, 18%), and ASP (n=8, 16%). Conclusion: The predominance of Multiple Life-threatening Conditions (MLCs) in the Pediatric Intensive Care Unit, with Foreign Body Aspiration (FBA) being the most common cause, underscores the need for heightened awareness and prevention efforts. Understanding the risk factors, clinical presentations, and healthcare costs associated with these cases is essential for healthcare professionals and policymakers in their pursuit of reducing the incidence of MLCs.

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Section: Discussionsupporting

confidence: 87%

Rare Medico Legal Cases of Pediatric Intensive Care Unit

Kılıç,

Oto

2023

Med Sci Discov

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“…A relatively low percentage of patients who underwent a splenectomy (6.2%) was found in relation to comparable international studies (1,13,20,(30)(31)(32)(33)(34)(35)(36)(37)(38) (Supplementary Table 3) and studies performed in the Netherlands, in which 17.4% and 21.3% of patients underwent a splenectomy, respectively (16,39). This study supports that unstable hemodynamics is an independent risk factor for splenectomy in children (5), possibly in combination with the presence of an active blush on the CT scan.…”

Section: Managementsupporting

confidence: 63%

The management and outcome of paediatric splenic injuries in the Netherlands

Grootenhaar

Lamers²,

Ulzen³

et al. 2021

Preprint

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Background: Non-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in management exist. This study analyses local trends in aetiology and management of paediatric splenic injuries and evaluates the implementation of the guidelines proposed by the American Paediatric Surgical Association (APSA) in a level 1 trauma centre. Methods: The charts of paediatric patients with blunt splenic injury (BSI) who were admitted or transferred to a level 1 trauma centre between 2003 and 2020 were retrospectively assessed. Information pertaining to demographics, mechanism of injury, injury description, associated injuries, intervention and outcomes were analysed and compared to international literature.Results: There were 130 patients with BSI identified (63.1% male), with a mean age of 11.3 ± 4.0 and a mean injury severity score (ISS) of 21.6 ± 13.7. Bicycle accidents were the most common trauma mechanism (23.1%). Sixty-four percent were multi-trauma patients, 25% received blood transfusions, and 31% were hemodynamically unstable. Mean injury grade was 3.0, with 30% of patients having a high-grade injury. In total, 75% of patients underwent NOM with a 100% efficacy rate. Total splenectomy rate was 6.2%. Four patients died due to brain damage. Patients with a high-grade BSI (grade IV-V) had a significantly higher ISS and longer bedrest and more often presented with an active blush on computed tomography (CT) scans than patients with a low-grade BSI (grade I-III). Non-operative management was mainly the choice of treatment in both groups (76.6% and 79.5%, respectively). Hemodynamic instability was a predictor for operative management (OM) (p=0.001). Predictors for a longer length of stay (LOS) included concomitant injuries, hemodynamic instability and OM (all p < 0.02). Interobserver agreement in the grading of BSI is moderate, with a Cohens Kappa coefficient of 0.493.Conclusion: Non-operative management has proven to be a realistic management approach in both low- and high-grade splenic injuries. Consideration for operative management should be based on hemodynamic instability. Compared to the anticipated length of bedrest and hospital stay outlined in the APSA guidelines, the Netherlands can reduce the length of bedrest and hospital stay through their non-operative management.Level of evidence: Therapeutic study, level III

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“…In the present study, none of the patients who were followed up without surgery had no delayed surgical requirements. Recent studies have reported that the success rate of non-surgical follow-up in patients with high-grade liver injuries is between 60-70% (20,21). In the present study, for 4 patients with Grade IV injuries, non-surgical follow up was achieved at the rate of 50%.…”

Section: Discussionsupporting

confidence: 46%

Non-surgical follow-up success in blunt abdominal trauma. Can we protect patients with blunt abdominal trauma from surgery?

Yıldırım

Şahiner

Kendirci

et al. 2021

Journal of Health Sciences and Medicine

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Backgrounds: Abdominal traumas have an important place in the emergency room. Historically, surgical intervention was adopted as a treatment method for liver and spleen traumas. However, with the development of imaging methods, the possibility of non-surgical follow-up was obtained. In this study, the advantages and disadvantages of conservative treatment for surgical intervention were investigated. Material and Method:The patients with complaints of blunt abdominal trauma, who were admitted to the third step research center emergency service during the 27-month period and were referred to general surgery, were retrospectively examined.Results: Of patients, 58.2% (n=53) was monitored conservatively, 34.1% (n=31) had splenectomy and 4.4% (n=4) underwent the primary repair due to isolated liver injury, and both splenectomy and liver primary repair were performed in 3.3% (n=3) because of multiple solid organ injury. We observed that the injuries of non-surgical spleen trauma patients changed between grade I and III. All patients with grade IV-V injuries underwent splenectomy. Patients with decreased hematocrit and whose hematocrit did not increase despite erythrocyte replacement were operated on. Conclusion:In this study, it was explained that patients who were followed up without surgery did not need surgery and that both liver trauma and spleen trauma should be given the chance to follow up without surgery.

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Outcome of children with blunt liver or spleen injuries: Experience from a single institution in Korea

Cited by 11 publications

References 27 publications

Rare Medico Legal Cases of Pediatric Intensive Care Unit

Rare Medico Legal Cases of Pediatric Intensive Care Unit

The management and outcome of paediatric splenic injuries in the Netherlands

Non-surgical follow-up success in blunt abdominal trauma. Can we protect patients with blunt abdominal trauma from surgery?

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