Outcomes from pediatric solid organ injury: role of standardized care guidelines

Abstract

Clinical experience and published reports addressing specific concerns about the nonoperative treatment of children with solid organ injuries and recent radiologic and endoscopic contributions have made pediatric trauma care increasingly nonoperative. Although the trend is in this direction, the pediatric surgeon should remain the physician-of-record in the multidisciplinary care of critically injured children.

Pediatric Blunt Abdominal Injury: Age is Irrelevant and Delayed Operation is Not Detrimental

“…Children are more susceptible to renal trauma secondary to anatomic differences (less perirenal fat and weaker muscles). 8 The majority of renal trauma is minor with 90% of all injuries categorized as grades I and II. This observation along with finding that operative management led to higher rates of nephrectomy led to a shift in the nonoperative management of blunt renal trauma.…”

“…[2][3][4][5][6][7][8][9] Only a small percentage of all patients injured will require laparotomy or have complications as a result of the nonoperative management. The purpose of this multicenter study was to characterize the cohort of patients that require operative intervention as a result of solid organ injury from blunt abdominal trauma.…”

Delay in diagnosis and treatment of blunt intestinal injury does not adversely affect prognosis in the pediatric trauma patient

“…Most of the literature concerning intraabdominal injury in pediatric trauma has dealt with the management of solid organ injury [3,4]. It is evident that the incidence of solid organ injury in children sustaining blunt trauma is much higher than for intestinal injury.…”

Handlebar injuries in children

“…1). Grading of organ lesions and treatment has been adapted according to Stylianos [5][6][7][8][9] and Strouse [10]. Primary treatment of those with an instable hemodynamic situation is not included in this algorithm but follows ATLS guidelines.…”