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Blunt traumatic small bowel rupture: are children different?
1Trauma Services, Auckland Hospital and Starship Children's Hospital, New Zealand. hamill@clear.net.nz
Insights
Children with small bowel rupture (SBR) present differently than adults, with longer delays and fewer injuries. However, similar diagnostic findings suggest a unified approach is feasible for pediatric and adult surgeons.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Surgical Diagnostics
Background:
- Small bowel rupture (SBR) diagnosis and management can differ between pediatric and adult patients.
- A comparative review was conducted to identify these differences and assess a unified diagnostic approach.
Purpose of the Study:
- To compare pediatric and adult patients with small bowel rupture (SBR).
- To determine if a single diagnostic approach is teachable to both pediatric and adult surgeons.
Main Methods:
- Retrospective review of 17 pediatric and 16 adult SBR cases from dedicated children's and adult hospitals.
- Analysis of patient records, injury mechanisms, presentation times, injury severity, and diagnostic findings.
Main Results:
- Adults had a higher incidence of motor vehicle crash injuries (75%) compared to children (35.7%).
- Children exhibited significantly longer presentation intervals (median 2.9 h) than adults (median 65 min).
- Despite differences in etiology and presentation, clinical findings, CT scans, and outcomes were similar, though peritoneal signs were less frequent in children (54.6%) versus adults (90.9%).
Conclusions:
- Pediatric and adult SBR cases differ in etiology, presentation time, and associated injuries.
- Similarities in diagnostic parameters suggest a single diagnostic approach is viable for both age groups, with awareness of physical examination limitations in young children.
Background:
In order to identify differences between children and adults with small bowel rupture (SBR) and to determine if a single diagnostic approach could be taught to paediatric and adult surgeons, a review of the experience at a children's and an adults' hospital was performed.
Methods:
Using the hospital patient database 17 children were identified with SBR over a 13.6-year period, and clinical records were available for review for 14. Using a trauma registry 16 adults were identified with SBR over a 4.7-year period and clinical records were reviewed in all 16.
Results:
The population incidence was 0.48/100000 per annum in children and 0.58/100000 per annum in adults. Motor vehicle crash was a less common mechanism of injury in children (35.7%) than in adults (75%). The time from injury to presentation (presentation interval) was significantly longer in children than in adults, even after excluding child abuse cases (median 2.9 h vs 65 min, respectively). The injury severity score was lower in children (median: 10) than in adults (median: 16.5). Peritoneal signs on follow-up examination were documented in 54.6% of children and in 90.9% of adults in whom follow-up examination was performed. Clinical findings on admission, findings on computed tomography, indications for operation and outcome were similar in children and adults.
Conclusion:
Children differed from adults in aetiology, longer presentation interval and fewer associated injuries. Similarities in diagnostic parameters suggest that a single diagnostic approach could be taught for children and adults provided that the limitations of physical examination in small children are recognized.