Surgeon choice in management of pediatric abdominal trauma

Butler, Eric; Groner, Jonathan I.; Vavilala, Monica S.; Bulger, Eileen M.; Rivara, Frederick P.

doi:10.1016/j.jpedsurg.2020.09.023

Cited by 11 publications

(7 citation statements)

References 20 publications

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“…This may also be due to increasing utilization of selective non-operative management in pediatric blunt abdominal trauma, with pediatric patients less likely to undergo operative exploration, which may result in some missed diaphragm injuries. 54 In particular, right-sided TDH is a more frequently delayed or missed diagnosis, largely owing to the protective effect of the liver preventing intrathoracic herniation of abdominal contents. 5 , 26 We found that 75% of patients with right-sided TDH has a delayed or missed diagnosis, compared to only 48.5% of left-sided TDH.…”

Section: Discussionmentioning

confidence: 99%

“…56 Supporting this, a survey of pediatric surgeons and adult trauma surgeons found that pediatric surgeons were 2.2-times more likely to choose laparoscopic evaluation over laparotomy in the pediatric patient sustaining blunt force polytrauma. 54 Future trends in open versus laparoscopic or thoracoscopic repair of pediatric TDH merit ongoing evaluation. In the stable patient with concern for TDH on imaging, diagnostic laparoscopy or thoracoscopy may be warranted due to the difficulty in detecting TDH by exam or by imaging.…”

Section: Discussionmentioning

confidence: 99%

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Blunt Traumatic Diaphragmatic Hernia in Children: A Systematic Review

Theodorou

Jackson

Beres

et al. 2021

Journal of Surgical Research

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Blunt Traumatic Diaphragmatic Hernia in Children: A Systematic Review

Theodorou

Jackson

Beres

et al. 2021

Journal of Surgical Research

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“…Currently, the global trend is towards the conservative treatment of blunt abdominal trauma, often with prolonged hospitalization and aggressive hemodynamic monitoring of affected children, as well as the intense use of imaging methods to follow-up these children [11][12][13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

Analysis of the efficacy and safety of conservative treatment of blunt abdominal trauma in children: retrospective study. Conservative treatment of blunt abdominal trauma in children

Cunha

FILHO

Miranda

et al. 2023

Rev. Col. Bras. Cir.

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Introduction: in Brazil, trauma is responsible for 40% of deaths in the age group between 5 and 9 years old, and 18% between 1 and 4 years, and bleeding is the leading cause of preventable death in the traumatized child. Conservative management of blunt abdominal trauma with solid organs injury - started in the 60s - is the current world trend, with studies showing survival rates above 90%. The objective was to assess the efficacy and safety of conservative treatment in children with blunt abdominal trauma treated at the Clinical Hospital of the University of Campinas, in the last five years. Methods: retrospective analysis of medical records of patients classified by levels of injury severity, in 27 children. Results: only one child underwent surgery for initial failure of conservative treatment (persistent hemodynamic instability), resulting in a 96% overall success rate of the conservative treatment. Five other children (22%) developed late complications that required elective surgery: a bladder injury, two cases of infected perirenal collections (secondary to injury of renal collecting system), a pancreatic pseudocyst and a splenic cyst. Resolution of the complications was attained in all children, with anatomical and functional preservation of the affected organ. There were no deaths in this series. Conclusion: the conservative initial approach in the treatment of blunt abdominal trauma was effective and safe with high resolution and low rate of complications leading to a high preservation rate of the affected organs. Level of evidence III - prognostic and therapeutic study.

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“…6 Studies have shown significant practice and outcome variation in pediatric trauma care, which contributes to the burden of disease. [7][8][9][10][11][12][13] A systematic review suggested that up to 45% of children presenting with multisystem trauma experience deficiencies in their care. 14 In an attempt to reduce practice variation, medical associations, such as the National Institute for Care Excellence (UK), the American College of Surgeons (USA), and the Pediatric Trauma Society (USA), have published clinical practice guideline (CPG) recommendations for the optimal triage, transfer, and treatment of children with injury.…”

mentioning

confidence: 99%

“…Studies have shown significant practice and outcome variation in pediatric trauma care, which contributes to the burden of disease 7–13 . A systematic review suggested that up to 45% of children presenting with multisystem trauma experience deficiencies in their care 14 .…”

mentioning

confidence: 99%

Clinical Practice Guideline Recommendations For Pediatric Multisystem Trauma Care

et al. 2023

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To systematically review clinical practice guidelines (CPGs) for pediatric multisystem trauma, appraise their quality, synthesize the strength of recommendations and quality of evidence, and identify knowledge gaps. Background: Traumatic injuries are the leading cause of death and disability in children, who require a specific approach to injury care. Difficulties integrating CPG recommendations may cause observed practice and outcome variation in pediatric trauma care. Methods: We conducted a systematic review using Medline, Embase, Cochrane Library, Web of Science, ClinicalTrials, and grey literature, from January 2007 to November 2022. We included CPGs targeting pediatric multisystem trauma with recommendations on any acute care diagnostic or therapeutic interventions. Pairs of reviewers independently screened articles, extracted data, and evaluated the quality of CPGs using "Appraisal of Guidelines, Research, and Evaluation II." Results: We reviewed 19 CPGs, and 11 were considered high quality. Lack of stakeholder engagement and implementation strategies were weaknesses in guideline development. We extracted 64 recommendations: 6 (9%) on trauma readiness and patient transfer, 24 (38%) on resuscitation, 22 (34%) on diagnostic imaging, 3 (5%) on pain management, 6 (9%) on ongoing inpatient care, and 3 (5%) on patient and family support. Forty-two (66%) recommendations were strong or moderate, but only 5 (8%) were based on high-quality evidence. We did not identify recommendations on trauma survey assessment, spinal motion restriction, inpatient rehabilitation, mental health management, or discharge planning. Conclusions:We identified 5 recommendations for pediatric multisystem trauma with high-quality evidence. Organizations could improve CPGs by engaging all relevant stakeholders and considering barriers to implementation. There is a need for robust pediatric trauma research, to support recommendations.

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Surgeon choice in management of pediatric abdominal trauma

Cited by 11 publications

References 20 publications

Blunt Traumatic Diaphragmatic Hernia in Children: A Systematic Review

Blunt Traumatic Diaphragmatic Hernia in Children: A Systematic Review

Analysis of the efficacy and safety of conservative treatment of blunt abdominal trauma in children: retrospective study. Conservative treatment of blunt abdominal trauma in children

Clinical Practice Guideline Recommendations For Pediatric Multisystem Trauma Care

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