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Published on: January 25, 2010
Severe blunt hepatic trauma in children
J P Pryor1, P W Stafford, M L Nance
1Department of Pediatric General and Thoracic Surgery, The Children's Hospital of Philadelphia, and the Division of Traumatology and Surgical Critical Care, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Severe blunt liver injuries in children have high mortality. Nonoperative management offers good outcomes for stable patients, while low Glasgow Coma Scale (GCS) scores indicate poor prognosis in pediatric liver trauma.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Pediatric Critical Care
Background:
- Severe blunt hepatic injuries in children carry a high mortality risk.
- Optimal treatment for severe pediatric liver trauma remains debated, unlike for milder injuries.
Observation:
- A review of a statewide trauma registry identified 30 children (age ≤18) with American Association for the Surgery of Trauma grade V liver injuries.
- The overall survival rate was 56%, with survivors showing higher Glasgow Coma Scale (GCS) scores and a trend toward lower Injury Severity Scores (ISS).
Findings:
- A low GCS (less than 8) significantly decreased survival rates (30% vs. 76%).
- Nonoperative management in 11 patients resulted in a 91% survival rate, with good outcomes.
- Patients undergoing immediate laparotomy had similar ISS and GCS between survivors and non-survivors, suggesting unclear indications for surgery.
Implications:
- Glasgow Coma Scale (GCS) may be a critical prognostic factor for pediatric blunt liver trauma.
- Nonoperative management should be considered for children with severe liver injuries who demonstrate a stable physiologic response to resuscitation.
- Further research is needed to clarify surgical indications for severe pediatric hepatic injuries.
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