Pediatric Blunt Solid Organ Injury: Beyond the APSA Guidelines

Abstract

The APSA guidelines were published in 2000 making nonoperative management of pediatric blunt liver and spleen injury standard for most injured children.

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

“…In our study, it was evidenced that despite having these resources (FAST echo in 4.47% of cases and conventional ultrasound in 28.4%), they are almost not used in our area 35 . In the last 30-40 years, the NOM has been considered as a fundamental tool in the hepatic 17 and splenic lesions secondary to closed abdominal trauma management, supported by the use of CAT, along with a better knowledge of the pathophysiology of this type of injuries 1,4,[11][12][13][18][19][20][21] . The success rates reported in the pediatric population according to the different series were between 83-100% [15][16][17] , in agreement with our work, in which the success rate was 95.7%, being the main surgical indication the hemodynamic instability.…”

“…The main complications reported are 1,4,7,11,[18][19][20][21][22] : bleeding, biliary leakage (biliary fistula, bilioma) 24 , arterial pseudoaneurysm with hemobilia, abdominal compartment syndrome, presence of other inadvertent visceral lesions, hepatic, gallbladder or splenic necrosis, hepatic or splenic abscess and left pleural effusion in splenic lesions 25 . In our series, the rate of complications was very low in 6.8% of the patients in the successful NOM group, 50% of which were due to rebleeding with a mortality rate lower than that reported in other series presenting only in 1 patient with hypovolemic shock.…”

“…The included patient should present hemodynamic stability, absence of signs of peritoneal irritation 1,4,9,10,12,13,18,19,23,28,29 , whose age were between 0-14 years old, with an initial NOM for hepatic or splenic trauma, no trauma to other solid organs or other voids rather than liver or spleen, which has required to proceed with surgery; patients who present evidence of tomographic images for classification of hepatic or splenic trauma and evidence of clinical and paraclinical data (Hb levels) in clinical history.…”

“…Trauma is the main cause of morbidity and permanent disability in children between 1 and 14 years old [1][2][3][4][5] . 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 .…”

“…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] . Although the principles of trauma in pediatrics are similar to those of the adult population, there are anatomical and physiological characteristics in the pediatric group that make it more susceptible to injury to intra-abdominal organs such as: the greater elasticity in the child's body, the relative proximity of the intra-abdominal organs, the thinness of the abdominal wall and the smaller adipose paniculus 1,3,4,9,10 . 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.…”