Variation in the management of adolescent patients with blunt abdominal solid organ injury between adult versus pediatric trauma centers: an analysis of a statewide trauma database

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.…”

Benchmarks for splenectomy in pediatric trauma: How are we doing?

“…To improve care for injured children, pediatric trauma centers (PTC) were developed and are now verified by the American College of Surgeons Committee on Trauma (ACSCOT) [1,2]. While children who receive care at PTC benefit from improved outcomes, many children do not have access to a PTC [2][3][4][5]. Differences in outcomes between PTC and other institutions are likely owing to variability in management.…”

“…Differences in outcomes between PTC and other institutions are likely owing to variability in management. In children with blunt abdominal trauma, those treated at institutions without pediatric trauma specialization were more likely to receive operative management [4,5]. Since nonoperative management of most blunt splenic injuries has been shown to be safe and associated with improved outcomes including decreased hospital stay and need for transfusion, management guidelines and benchmarks were developed by the American Pediatric Surgery Association (APSA) in 2000 [6].…”