Failure of nonoperative management of pediatric blunt liver and spleen injuries
| Autor: | David M. Notrica, Todd Maxson, Todd A. Ponsky, Alexander Raines, Nilda M. Garcia, Shawn D. St. Peter, Charles M. Leys, David W. Tuggle, Crystal S. Langlais, Adam C. Alder, Amina Bhatia, Karla A. Lawson, Daniel J. Ostlie, Robert W. Letton, James W. Eubanks, Maria E. Linnaus |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Standard of care Adolescent Wounds Nonpenetrating Critical Care and Intensive Care Medicine Treatment failure 03 medical and health sciences 0302 clinical medicine Blunt Risk Factors X ray computed Humans Medicine Prospective Studies Treatment Failure Nonoperative management Child Prospective cohort study Arkansas biology business.industry General surgery Arizona Oklahoma 030208 emergency & critical care medicine biology.organism_classification medicine.disease Tennessee Texas Liver Child Preschool 030220 oncology & carcinogenesis Practice Guidelines as Topic Surgery Tomography X-Ray Computed business Memphis Spleen Pediatric trauma |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 82:672-679 |
| ISSN: | 2163-0755 |
| DOI: | 10.1097/ta.0000000000001375 |
| Popis: | Nonoperative management (NOM) is standard of care for most pediatric blunt liver and spleen injuries (BLSI); only 5% of patients fail NOM in retrospective reports. No prospective studies examine failure of NOM of BLSI in children. The aim of this study was to determine the frequency and clinical characteristics of failure of NOM in pediatric BLSI patients.A prospective observational study was conducted on patients 18 years or younger presenting to any of 10 Level I pediatric trauma centers April 2013 and January 2016 with BLSI on computed tomography. Management of BLSI was based on the Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium pediatric guideline. Failure of NOM was defined as needing laparoscopy or laparotomy.A total of 1008 patients met inclusion; 499 (50%) had liver injury, 410 (41%) spleen injury, and 99 (10%) had both. Most patients were male (n = 624; 62%) with a median age of 10.3 years (interquartile range, 5.9, 14.2). A total of 69 (7%) underwent laparotomy or laparoscopy, but only 34 (3%) underwent surgery for spleen or liver bleeding. Other (nonexclusive) operations were for 21 intestinal injuries; 15 hematoma evacuations, washouts, or drain placements; 9 pancreatic injuries; 5 mesenteric injuries; 3 diaphragm injuries; and 2 bladder injuries. Patients who failed were more likely to receive blood (52 of 69 vs. 162 of 939; p0.001) and median time from injury to first blood transfusion was 2.3 hours for those who failed versus 5.9 hours for those who did not (p = 0.002). Overall mortality rate was 24% (8 of 34) in those who failed NOM due to bleeding.NOM fails in 7% of children with BLSI, but only 3% of patients failed for bleeding due to liver or spleen injury. For children failing NOM due to bleeding, the mortality was 24%.Therapeutic study, level II. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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