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The management and outcome of pediatric blunt chest-abdominal injuries
Tomohiro Kurahachi1, Naoki Hashizume1,2, Kimio Asagiri1
1Department of Pediatric Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan.
Insights
Pediatric blunt chest-abdominal injuries (BCAIs) are often caused by traffic incidents. Management strategies, including non-operative management with angioembolization, are crucial for severe organ injuries in children.
Area of Science:
- Pediatric Trauma Surgery
- Emergency Medicine
- Abdominal Imaging
Background:
- Pediatric blunt chest-abdominal injuries (BCAIs) represent a significant challenge in trauma care.
- Understanding the epidemiology and management spectrum of BCAIs is essential for improving outcomes.
Purpose of the Study:
- To determine the frequency and nature of pediatric blunt chest-abdominal injuries (BCAIs).
- To summarize the management strategies for BCAIs, including non-operative management (NOM) with or without angioembolization (AE), and surgical interventions.
Main Methods:
- Retrospective study of patients admitted for BCAIs between January 1996 and December 2017.
- Data collected included patient demographics, injury patterns, affected organs, treatment modalities, and outcomes.
Main Results:
- 132 pediatric patients (mean age 7.68 years) were included, with motor-vehicle incidents being the most common cause (n=60).
- Liver (n=42) and spleen (n=35) were the most frequently injured organs.
- Non-operative management with angioembolization (NOM with AE) was performed in 16 cases for significant organ bleeding.
Conclusions:
- Management of organ injury in children must integrate bleeding control strategies.
- Severe organ injuries in pediatric patients necessitate treatment at specialized trauma centers equipped for AE.
Background:
The aim of this study was to determine the frequency and nature of pediatric blunt chest-abdominal injuries (BCAIs) and to summarize their management, ranging from non-operative management (NOM), with or without angioembolization (AE), to surgical treatment.
Methods:
This retrospective study included patients admitted to our hospital for BCAIs from January 1996 to December 2017. The age, injury pattern, organs of injury, outcome, and treatment were summarized.
Results:
One hundred and thirty-two patients (98 males, 34 females, mean age 7.68 years ± 3.58, range 1-15 years) were included in the study. Their injuries resulted from motor-vehicle traffic incidents (n = 60), single-bicycle injuries (n = 16), falls (n = 33), sports (n = 10), assault (n = 6), abuse (n = 3), and others (n = 4). There were no injured organs in 31 cases, while there were 130 injured organs in 101 cases, including the liver (n = 42), spleen (n = 35), lung (n = 23), kidney (n = 13), intestine (n = 10), pancreas (n = 5), and adrenal gland (n = 2). Angiography (AG) was performed in 20 cases, and NOM with AE was performed in 16 cases, including 17 organs (liver injury [n = 9], splenic injury [n = 5], and kidney injury [n = 4]). Surgical treatment was performed in eight cases (splenic injury in one, pancreas injury in one, and intestinal injury in six). NOM without AE was performed in the other cases.
Conclusions:
The management of organ injury must take into consideration the management of integrated bleeding. It is recommended that children with severe organ injury are treated in dedicated trauma centers in which AE is available.
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