Management of children with solid organ injuries after blunt torso trauma

David H Wisner, Nathan Kuppermann, Arthur Cooper, Jay Menaker, Peter Ehrlich, Josh Kooistra, Prashant Mahajan, Lois Lee, Lawrence J. Cook, Kenneth Yen, Kathy Lillis, James F Holmes Jr

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

BACKGROUND Management of children with intra-abdominal solid organ injuries has evolved markedly. We describe the current management of children with intra-abdominal solid organ injuries after blunt trauma in a large multicenter network. METHODS We performed a planned secondary analysis of a prospective, multicenter observational study of children (<18 years) with blunt torso trauma. We included children with spleen, liver, or kidney injuries identified by computed tomography, laparotomy/laparoscopy, or autopsy. Outcomes included disposition and interventions (blood transfusion for intra-abdominal hemorrhage, angiography, laparotomy/laparoscopy). We performed subanalyses of children with isolated injuries. RESULTS A total of 12,044 children were enrolled; 605 (5.0%) had intra-abdominal solid organ injuries. The mean (SD) age was 10.7 (5.1) years, and injured organs included spleen 299 (49.4%), liver 282 (46.6%), and kidney 147 (24.3%). Intraperitoneal fluid was identified on computed tomography in 461 (76%; 95% confidence interval [CI], 73-80%), and isolated solid organ injuries were present in 418 (69%; 95% CI, 65-73%). Treatment included therapeutic laparotomy in 17 (4.1%), angiographic embolization in 6 (1.4%), and blood transfusion in 46 (11%) patients. Laparotomy rates for isolated injury were 11 (5.4%) of 205 (95% CI, 2.7-9.4%) at non-freestanding children's hospitals and 6 (2.8%) of 213 (95% CI, 1.0-6.0%) at freestanding children's hospitals (difference, 2.6%; 95% CI, -7.1% to 12.2%). Dispositions of the 212 children with isolated Grade I or II organ injuries were home in 6 (3%), emergency department observation in 9 (4%), ward in 114 (54%), intensive care unit in 73 (34%), operating suite in 7 (3%), and transferred in 3 (1%) patients. Intensive care unit admission for isolated Grade I or II injuries varied by center from 9% to 73%. CONCLUSION Most children with solid organ injuries are managed with observation. Blood transfusion, while uncommon, is the most frequent therapeutic intervention; angiographic embolization and laparotomy are uncommon. Emergency department disposition of children with isolated Grade I to II solid organ injuries is highly variable and often differs from published guidelines. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)206-214
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume79
Issue number2
DOIs
StatePublished - Aug 6 2015

Keywords

  • abdominal organ injury
  • children's hospitals
  • Pediatric trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

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    Wisner, D. H., Kuppermann, N., Cooper, A., Menaker, J., Ehrlich, P., Kooistra, J., Mahajan, P., Lee, L., Cook, L. J., Yen, K., Lillis, K., & Holmes Jr, J. F. (2015). Management of children with solid organ injuries after blunt torso trauma. Journal of Trauma and Acute Care Surgery, 79(2), 206-214. https://doi.org/10.1097/TA.0000000000000731