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Practice variability exists in the management of high-grade pediatric pancreatic trauma
1Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1210, Houston, TX, 77030, USA. bnaik@texaschildrens.org.
Insights
Pediatric surgeons show significant practice variability in managing high-grade pancreatic trauma, using both operative and non-operative management (NOM). This highlights the need for a prospective trial to establish optimal treatment strategies for these complex injuries.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Surgical Practice Variation
Background:
- High-grade pancreatic trauma in children presents complex management challenges.
- Recent evidence suggests early surgical intervention, but practice patterns remain debated.
Purpose of the Study:
- To evaluate practice variability in the management of pediatric high-grade pancreatic injuries.
- To assess current approaches to both operative and non-operative strategies.
Main Methods:
- A survey was distributed to pediatric trauma centers within the Pediatric Trauma Society.
- Data from institutional databases covering a 3-year period (2012-2014) were analyzed.
- Descriptive statistics were used to present the findings.
Main Results:
- 123 high-grade pancreatic injuries (grades II-IV) were reported across 19 centers.
- 49% of injuries involving the pancreatic duct were managed non-operatively (NOM), and 51% operatively.
- Significant variability was observed in NOM strategies, including feeding, pseudocyst drainage, and ERCP use.
Conclusions:
- Wide practice variability exists among North American pediatric surgeons for high-grade pancreatic injuries.
- Both initial management approach and non-operative care strategies differ significantly.
- A prospective trial is needed to determine optimal management strategies.
Purpose:
Management of high-grade pancreatic trauma in children is controversial, although recent evidence supports early operation. We sought to evaluate whether practice variability exists regarding the management of these rare and complex injuries.
Methods:
A study group of pediatric trauma centers within the Pediatric Trauma Society completed a survey following a query of their institutional database. Results are presented using descriptive statistics.
Results:
Over a 3-year period (2012-2014), 123 pancreatic injuries (grades II-IV) were reported from 19 pediatric trauma centers (median 6, range 1-22). Sixty-two injuries involving injury to the pancreatic duct (clear/suspected) were reported (median 1, range 0-9). Of these, 49 % were managed with non-operative management (NOM) and 51 % with operative management. Surgeons at the majority (63 %) of institutions used both approaches. Of the operative cases, 21 % were laparoscopic. There was wide variability in clinical management of NOM patients: the most common feeding strategy was reported by 52 % of centers, percutaneous drainage of traumatic pseudocyst by 42 % and ERCP (early/after pseudocyst) by 72 %.
Conclusion:
Wide practice variability exists among North American pediatric surgeons regarding both the initial approach to high-grade pancreatic injury and non-operative management. These results highlight the need for a prospective trial to determine the optimal strategy for these patients.
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Assessment: