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Acute procedural interventions after pediatric blunt abdominal trauma: A prospective multicenter evaluation
Chase A Arbra1, Adam M Vogel, Jingwen Zhang
1From the Department of Surgery, Division of Pediatric Surgery (C.A.A., J.Z., P.D.M., C.J.S.), Medical University of South Carolina, Charleston, South Carolina; Department of Surgery, Division of Pediatric Surgery, Washington University in St Louis (A.M.V.), St. Louis, Missouri; Department of Surgery, Division of Pediatric Surgery, Le Bonheur Children's Hospital (E.Y.H., K.B.S.), University of Tennessee, Memphis, Tennessee; Department of Surgery, Division of Pediatric Surgery, Emory University School of Medicine (M.T.S.), Atlanta, Georgia; Department of Surgery, Division of Pediatric Surgery, University of Texas Health Science Center (K.T., T.G.O.-K.), Houston, Texas; Department of Surgery, Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center (R.A.F.), Cincinnati, Ohio; Department of Surgery, Division of Pediatric Surgery, Arkansas Children's Hospital (M.S.D., J.R.), Little Rock, Arkansas; Department of Surgery, Division of Pediatric Surgery, Virginia Commonwealth University (J.H.H.), Richmond, Virginia; Department of Pediatric Surgery, Vanderbilt University Medical Center (M.L.B.), Nashville, Tennessee; Department of Surgery, Division of Pediatric Surgery, Children's Hospital of Alabama (R.T.R.), Birmingham, Alabama; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital (B.J.N.-M.), Baylor College of Medicine, Houston, Texas; Department of Surgery, Division of Pediatric Surgery, Children's Mercy Hospital (S.D.S.P.), Kansas City, Missouri; Department of Pediatric Surgery, Boston Children's Hospital (D.P.M., C.O.), Boston, Massachusetts; and Department of Surgery, Division of General Pediatric Surgery, Children's Hospital Los Angeles (J.S.U.), Los Angeles, California.
Pediatric intra-abdominal injuries (IAI) from blunt abdominal trauma (BAT) rarely need intervention. When intervention is required, it is typically for hollow viscus injury and performed early, yielding good outcomes.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Emergency Medicine
Background:
- Blunt abdominal trauma (BAT) in children infrequently leads to intra-abdominal injuries (IAI) requiring emergent intervention.
- Understanding the timing and indications for operative and angiographic interventions in pediatric IAI is crucial.
Purpose of the Study:
- To investigate the timing and indications for operative and angiographic embolization in children with intra-abdominal injuries (IAI) resulting from blunt abdominal trauma (BAT).
Main Methods:
- A prospective enrollment of children under 16 with BAT across 14 Level I Pediatric Trauma Centers over one year.
- Comparison of patients with IAI who received intervention (IAI-I) versus those who did not, using descriptive statistics and univariate analysis.
Main Results:
- Of 2,188 patients, 261 (11.9%) had IAI; 45 (17.2%) received acute intervention (38 operations, 7 embolizations).
- Interventions were predominantly for hollow viscus injury (HVI) (59.2% vs. 7.6% for solid organ injury) and occurred within 8 hours.
- Patients requiring intervention were more likely to have specific injury mechanisms, higher activation levels, lower Glasgow Coma Scale scores, and abnormal abdominal exams.
Conclusions:
- Acute procedural interventions for pediatric IAI from BAT are uncommon, primarily indicated for HVI.
- These interventions are performed early in the hospital course and are associated with excellent clinical outcomes.
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