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Diagnostic delay increases morbidity in children with gastrointestinal perforation from blunt abdominal trauma
Hayrettin Oztürk1, Abdurrahman Onen, Selçuk Otçu
1Department of Pediatric Surgery, Dicle University Medical School, 21280 Diyarbakir, Turkey.
Insights
Delayed diagnosis of intestinal perforation in children with blunt abdominal trauma increases the risk of septic complications. Rapid diagnosis and treatment are crucial for better outcomes in pediatric blunt abdominal trauma cases.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Gastrointestinal Surgery
Background:
- Intestinal perforation from blunt abdominal trauma is rare in children.
- Delayed diagnosis is a significant concern, potentially increasing morbidity.
- Risk factors for morbidity in pediatric blunt abdominal trauma are not well understood.
Purpose of the Study:
- To evaluate if diagnostic delay increases morbidity in pediatric intestinal perforation due to blunt abdominal trauma.
- To identify potential risk factors associated with increased morbidity.
Main Methods:
- Retrospective analysis of 29 children with blunt abdominal trauma and gastrointestinal perforation.
- Evaluation of the relationship between overall morbidity and potential risk factors.
- Data collected between 1983 and 2001.
Main Results:
- Jejunum was the most frequent site of perforation; simple closure was the commonest surgery.
- Postoperative complications occurred in 17% of patients.
- A delay exceeding 8 hours and an Injury Severity Score (ISS) over 15 were significantly related to septic complications (P < 0.05).
- Falls from flat-roofed houses and delayed operative intervention increased the risk of septic complications.
Conclusions:
- Rapid diagnosis and treatment are vital for preventing complications in pediatric intestinal perforation.
- Diagnostic delays over 8 hours and high ISS scores are linked to significant septic complications.
- Falls from flat-roofed houses represent a notable public safety issue.
Purpose:
Intestinal perforation due to blunt abdominal trauma is rarely seen in children and delayed diagnosis is a major concern. Because the potential risk factors affecting morbidity are not well known, we evaluated whether diagnostic delay increases morbidity in gastrointestinal perforation from blunt abdominal trauma in children.
Methods:
Twenty-nine children with gastrointestinal perforation caused by blunt abdominal trauma, admitted to our clinic between 1983 and 2001, were retrospectively evaluated by analyzing the relationship between overall morbidity and potential risk factors.
Results:
There were 23 boys and 6 girls. Most of the injuries were caused by falls and motor vehicle accidents. The jejunum was the most frequent site of perforation followed by the ileum. Simple closure was the most common surgical procedure. Postoperative complications developed in five patients (17%) and included wound infections in two, wound dehiscence in one, and adhesive small bowel obstruction in two. Potential risk factors such as trauma mechanism, the presence of shock on admission, and associated organ injury were not significantly correlated with postoperative complications, whereas a period of delay exceeding 8 h and an Injury Severity Score (ISS) exceeding 15 were significantly related to septic complications (P < 0.05). The relative risk of a septic complication developing was higher than 2 for the following risk factors: a fall from a flat-roofed house and a time delay before operative intervention. There were three deaths (10%) in this series, caused by sepsis in two patients and head injury in one.
Conclusion:
These findings suggest that rapid diagnosis and treatment is important for preventing complications in patients with intestinal perforation caused by blunt abdominal trauma. A delay exceeding 8 h and an ISS score exceeding 15 were related to significant septic complications, and falls from flat-roofed houses are an important public safety risk in Turkey.