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Isolated and multisystem hepatic trauma in children: the true role of non-operative management
R Kumar1, A J A Holland, E Shi
1Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Royal Alexandra Hospital for Children, Sydney, Australia.
Insights
Multisystem hepatic trauma (MHT) in children is associated with higher rates of shock, blood transfusion, and surgery compared to isolated hepatic trauma (IHT). This highlights the severity differences in pediatric liver injuries.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Hepatobiliary Surgery
Background:
- Hepatic injuries (HI) in children require careful management.
- Distinguishing between isolated hepatic trauma (IHT) and multisystem hepatic trauma (MHT) is crucial for understanding outcomes.
Purpose of the Study:
- To compare the characteristics and outcomes of pediatric patients with isolated hepatic trauma versus multisystem hepatic trauma.
- To identify factors influencing the need for operative intervention in pediatric hepatic injuries.
Main Methods:
- Retrospective review of pediatric patients with hepatic injuries admitted between January 1982 and December 1999.
- Comparison of patient demographics, injury mechanisms, injury severity, management, and outcomes between IHT and MHT groups.
Main Results:
- 127 children with HI were identified; 91 (71%) had MHT and 36 had IHT.
- MHT was associated with significantly higher rates of shock, blood transfusion, and operative intervention compared to IHT.
- While overall mortality was similar, 39% of children with significant HI required operative intervention within 24 hours.
Conclusions:
- Multisystem hepatic trauma in children presents with greater severity and requires more aggressive management than isolated hepatic trauma.
- The success rates of non-operative management for hepatic injuries may be overestimated due to the inclusion of less severe or subclinical injuries in some studies.
Abstract:
We retrospectively reviewed children with hepatic injuries (HI) admitted to our institutions from January 1982 to December 1999. Specific comparison was made of isolated (IHT) and multisystem hepatic trauma (MHT). Over the 18-year period 127 patients were identified with HI, 91 (71%) with MHT and 36 with IHT. The median age was 8 years (range 13 months to 14 years). Motor vehicle injury was the most common mechanism in both groups, but bicycle injuries were more common in IHT ( P<0.001). Shock ( P=0.02), the requirement for blood transfusion ( P<0.001), and operative intervention for the HI ( P=0.001) were all significantly more common in MHT. The distribution of liver injury grades was similar between the two groups. Twenty-two (17.3%) children died and in 18 the HI was the main cause or contributed significantly. There were 19 and 3 deaths in the MHT and IHT groups, respectively, a difference that was not significant. After excluding children with minor HI, 27 (39%) required operative intervention within 24 h of their injury. This suggests that the high success rate for non-operative management of HIs in the literature may have been biased by the inclusion of a significant proportion of subclinical injuries.
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