Primary hepatic artery embolization in pediatric blunt hepatic trauma

Ong, Caroline C. P.; Toh, Luke; Lo, R.; Yap, Te‐Lu; Narasimhan, Kannan Laksmi

doi:10.1016/j.jpedsurg.2012.09.050

Cited by 29 publications

(18 citation statements)

References 28 publications

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“…Arteriography and embolization are among the armamentarium available for the NOM, the usefulness of which has been confirmed in multiple studies, with success rates varying between 85-91% 13,15,26 , depending on the different series. In our series, this resource was used in 4 patients with a 100% of success.…”

Section: Discussionmentioning

confidence: 93%

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

Medina

Uribe

et al. 2017

Rev. chil. pediatr.

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Results: 70 patients were admitted with blunt abdominal trauma, 3 were excluded for immediate surgery (2 hemodynamic instability, 1 peritoneal irritation). Of 67 patients who received NOM, 58 were successful and 9 showed failure (8 hemodynamic instability, 1 hollow viscera injury). We found 3 factors associated with failure NOM: blood pressure (BP) < 90 mmHg at admission (p = 0.0126; RR = 5.19), drop in hemoglobin (Hb) > 2 g/ dl in the first 24 hours (p = 0.0009; RR = 15.3), and transfusion of 3 or more units of red blood cells (RBC) (0.00001; RR = 17.1). Mechanism and severity of trauma and Pediatric Trauma Index were not associated with failure NOM. Conclusions: Children with blunted hepatic or splenic trauma respond to NOM. Factors such as BP < 90 mmHg at admission, an Hb fall > 2 g/dl in the first 24 hours and transfusion of 3 or more units of RBC were associated with the failure in NOM.

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Section: Discussionmentioning

confidence: 93%

“…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 . Despite the above, laparotomy and angioembolization outcomes are rare (13,15,19,26).…”

Section: Discussionmentioning

confidence: 99%

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

Medina

Uribe

et al. 2017

Rev. chil. pediatr.

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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%

“…However, literature describing the experience with arterial embolization for blunt solid organ injuries in children is limited, but more and more trauma centers are embolizing children. [8,[15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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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“…As the blood flow in children is less than that in adults, bloodless treatments such as CT-guided surgery and embolization might be effective for pediatric patients with pelvic fracture. Although it is difficult to select an appropriate sheath and/or catheter size for pediatric patients when angiography is performed, according to case studies of TAE performed in children with hepatic injury, splenic injury or pelvic fracture, TAE could be performed without complications such as vessel laceration or thrombosis [25][26][27]. Thus, if operators can select an appropriate catheter size for pediatric patients, angiography could be performed safely without complications.…”

Section: Discussionmentioning

confidence: 99%

Pelvic angiography is effective for emergency pediatric patients with pelvic fractures: a propensity-score-matching study with a nationwide trauma registry in Japan

Katayama

Kitamura

Hirose

et al. 2019

Eur J Trauma Emerg Surg

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Purpose The aim of this study was to evaluate the association between the implementation of pelvic angiography (PA) and outcome in emergency pediatric patients with pelvic fracture. Methods We extracted data on pelvic fracture patients aged ≤ 19 years between 2004 and 2015 from a nationwide trauma registry in Japan. The main outcome was hospital mortality. We assessed the relationship between implementation of PA and hospital mortality using one-to-one propensity-score-matching analysis to reduce potential confounding effects in comparing the PA group with the non-PA group. Results In total, 1351 patients were eligible for our analysis, with 221 patients (16.4%) included in the PA group and 1130 patients (83.6%) included in the non-PA group. For all patients, the proportion of hospital mortality was higher in the PA group than in the non-PA group [13.6% (30/221) vs 7.1% (80/1130), crude odds ratio (OR) 2.062 (95% confidence interval (CI), 1.318-3.224); p = 0.002]. In the propensity-score-matched patients, the proportion of hospital mortality was lower in the PA group than in the non-PA group [10.5% (22/200) vs 18.2% (38/200), p = 0.027]. This finding was confirmed in both the multivariable logistic regression model [adjusted OR 0.392 (95% CI, 0.171-0.896); p = 0.026] and the conditional logistic regression model [conditional OR 0.484 (95% CI, 0.261-0.896); p = 0.021]. Conclusion The implementation of PA was significantly associated with lower hospital mortality among emergency pediatric patients with pelvic fractures compared with the non-implementation of PA.

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Primary hepatic artery embolization in pediatric blunt hepatic trauma

Cited by 29 publications

References 28 publications

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

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

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

Pelvic angiography is effective for emergency pediatric patients with pelvic fractures: a propensity-score-matching study with a nationwide trauma registry in Japan

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