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Paediatric and adolescent traumatic gastrointestinal injuries: results of a European multicentre analysis
E E Fischerauer1, S Zötsch, C Capito
1Department of Pediatric- and Adolescent Surgery, Medical University of Graz, Graz, Austria.
Insights
Paediatric gastrointestinal injuries (GIIs) are rare but require prompt diagnosis for better outcomes. Early diagnosis (<24 hours) in children with traumatic GIIs significantly reduces hospital stays, highlighting the importance of timely and accurate diagnostic approaches.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Gastrointestinal Surgery
Background:
- Paediatric gastrointestinal injuries (GIIs) are uncommon events.
- Evaluating outcomes in a large cohort is crucial for understanding GII management.
- Multicentre studies provide robust data on rare paediatric conditions.
Purpose of the Study:
- To evaluate the outcomes of paediatric traumatic gastrointestinal injuries.
- To analyze diagnostic accuracy and delays in paediatric GIIs.
- To assess surgical management and associated morbidities in paediatric GIIs.
Main Methods:
- A multicentre review of hospital databases from 10 European paediatric surgical centres.
- Inclusion criteria: paediatric traumatic GIIs managed between 2000-2010.
- Data analysis focused on diagnostics, surgical interventions, hospital stay, and outcomes.
Main Results:
- Ninety-seven paediatric patients with GIIs were identified (72 blunt, 25 penetrating).
- Initial diagnostics had a 71% correct diagnosis rate, with delays in 26 patients.
- Shorter hospital stays were associated with diagnosis within 24 hours (p=0.011).
- Laparoscopy had a 50% conversion rate but can aid diagnosis.
- Five lethal outcomes occurred, primarily due to associated injuries.
Conclusions:
- Initial diagnostics for traumatic paediatric GIIs yield false negatives in one-third of cases.
- Diagnostic delays exceeding 24 hours correlate with longer hospital stays.
- Laparoscopy, despite a 50% conversion rate, is valuable for diagnosing suspected GIIs to prevent unnecessary laparotomies.
Aim:
Paediatric gastrointestinal injuries (GIIs) are rare, and the aim of this multicentre study was to evaluate their outcomes in a large cohort.
Methods:
Hospital databases of 10 European paediatric surgical centres were reviewed for paediatric traumatic GIIs managed between 2000-2010.
Results:
Ninety-seven patients with a median age of 9 years (0-17 years) were identified, with 72 blunt and 25 penetrating GIIs. Initial diagnostics in 90 patients led to correct diagnosis in 71%. Diagnostics were delayed in 26 patients (median 24 h). Eighty-two patients required surgery (67 laparotomy, 12 laparoscopy and three other approaches). There was a 50% conversion in the laparoscopic group. Median hospital stay was 10 days (range 1-137 days), with longer duration influenced by associated injuries (n = 41). Diagnosis <24 h was associated with significantly shorter hospital stay compared to more than 24 h (p = 0.011). In one-third of patients, morbidities were not related to a diagnostic delay or type of injury. There were five lethal outcomes, four due to associated injuries.
Conclusion:
Initial diagnostics in traumatic paediatric GIIs provide false negatives in one-third of patients. Diagnostic delay <24 h is associated with a significantly shorter hospital stay. Although laparoscopy is associated with a conversion rate of 50%, it can be used for diagnosis in suspected cases to avoid nontherapeutic laparotomy.
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