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Management of pediatric blunt abdominal trauma in a Dutch level one trauma center
Roy Spijkerman1, Lauren C M Bulthuis2, Lillian Hesselink2
1Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. spijkermanroy@gmail.com.
Insights
Most children with blunt abdominal injuries can be safely managed non-operatively with adequate monitoring. Surgical intervention is reserved for hemodynamically unstable patients or those with specific injuries like bowel perforation.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Abdominal Injuries
Background:
- Non-operative management is often successful for pediatric intra-abdominal injuries.
- Variations in European healthcare systems necessitate standardized treatment protocols for pediatric trauma.
Purpose of the Study:
- To describe management strategies and outcomes for pediatric blunt intra-abdominal injuries.
- To evaluate the effectiveness of a dedicated pediatric trauma center approach.
Main Methods:
- Retrospective, single-center cohort study.
- Analysis of pediatric patients (≤18 years) with blunt abdominal injuries admitted between January 2012 and January 2018.
- Data extracted from the National Trauma Registration database.
Main Results:
- 121 pediatric patients were included; median age 12 years, median ISS 16.
- 14.9% required laparotomy, 3.3% underwent embolization.
- No mortality in non-operatively managed patients; one death in the operative group.
Conclusions:
- Non-operative management is safe for most pediatric blunt abdominal injuries with proper monitoring.
- Surgical intervention is indicated for hemodynamic instability or specific injuries (e.g., bowel perforation).
- Multidisciplinary clinical decision-making is crucial for optimal outcomes.
Purpose:
Most children with intra-abdominal injuries can be managed non-operatively. However, in Europe, there are many different healthcare systems for the treatment of pediatric trauma patients. Therefore, the aim of this study was to describe the management strategies and outcomes of all pediatric patients with blunt intra-abdominal injuries in our unique dedicated pediatric trauma center with a pediatric trauma surgeon.
Methods:
We performed a retrospective, single-center, cohort study to investigate the management of pediatric patients with blunt abdominal trauma. From the National Trauma Registration database, we retrospectively identified pediatric (≤ 18 years) patients with blunt abdominal injuries admitted to the UMCU from January 2012 till January 2018.
Results:
A total of 121 pediatric patients were included in the study. The median [interquartile range (IQR)] age of patients was 12 (8-16) years, and the median ISS was 16 (9-25). High-grade liver injuries were found in 12 patients. Three patients had a pancreas injury grade V. Furthermore, 2 (1.6%) patients had urethra injuries and 10 (8.2%) hollow viscus injuries were found. Eighteen (14.9%) patients required a laparotomy and 4 (3.3%) patients underwent angiographic embolization. In 6 (5.0%) patients, complications were found and in 4 (3.3%) children intervention was needed for their complication. No mortality was seen in patients treated non-operatively. One patient died in the operative management group.
Conclusions:
In conclusion, it is safe to treat most children with blunt abdominal injuries non-operatively if monitoring is adequate. These decisions should be made by the clinicians operating on these children, who should be an integral part of the entire group of treating physicians. Surgical interventions are only needed in case of hemodynamic instability or specific injuries such as bowel perforation.
