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Nonoperative Management of Blunt Solid Organ Injury in Pediatric Surgery
David M Notrica1, Maria E Linnaus2
1Department of Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA; Trauma Department, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85006, USA; Department of Child Health, University of Arizona College of Medicine, 550 East Van Buren Street, Phoenix, AZ 86004, USA; General and Thoracic Surgery, Mayo Clinic Hospital, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
Insights
Nonoperative management for pediatric liver, spleen, and kidney injuries has increased. An algorithmic approach, focusing on physiologic status and resuscitation, can improve national success rates for these traumatic injuries.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Abdominal Injuries
Background:
- Nonoperative management (NOM) of solid organ injuries in children has gained prominence.
- Previous approaches lacked standardized protocols, potentially impacting national outcomes.
- Liver, spleen, and kidney injuries represent common pediatric blunt abdominal trauma.
Purpose of the Study:
- To evaluate the success of nonoperative management for pediatric liver, spleen, and kidney injuries.
- To identify key factors contributing to successful nonoperative treatment.
- To propose an algorithmic approach for optimizing NOM on a national scale.
Main Methods:
- Review of recent trends in nonoperative management of pediatric blunt abdominal trauma.
- Analysis of factors associated with successful nonoperative treatment.
- Discussion of an algorithmic strategy incorporating physiologic status and resuscitation.
Main Results:
- Higher rates of nonoperative management for liver, spleen, and kidney injuries have been achieved.
- Key success factors include physiologic status, early resuscitation with blood products, and adjunct use.
- Shorter hospitalizations are feasible for hemodynamically stable patients with discharge instructions.
Conclusions:
- An algorithmic approach can enhance the national success of nonoperative management for pediatric solid organ injuries.
- Early resuscitation and tailored management based on patient status are critical.
- Routine imaging is not always necessary for liver/spleen injuries, but reevaluation for renal injuries is common.
Abstract:
In the last decade, higher rates of nonoperative management of liver, spleen, and kidney injuries have been achieved. An algorithmic approach may improve success on a national level. Factors for success include management strategy based on physiologic status of the child, early attempt at resuscitation using blood products, and appropriate use of adjuncts. Shorter hospitalizations are appropriate for children who have not bled significantly, and discharge instructions facilitate the safety of early discharge. Although routine imaging is not required for liver or spleen injury, symptoms should prompt reevaluation. Reimaging of renal injuries remains in common use.
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