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Early vasopressor administration in pediatric blunt liver and spleen injury: An ATOMAC+ study
David M Notrica1, Bethany L Sussman1, Lois W Sayrs1
1Phoenix Children's Hospital.
Insights
Early vasopressor use in pediatric blunt liver or spleen injury (BLSI) patients with hypotension increases mortality risk. However, it does not impact nonoperative management failure rates.
Area of Science:
- Pediatric trauma surgery
- Emergency medicine
- Critical care
Background:
- Limited research exists on early vasopressor use in pediatric blunt liver or spleen injury (BLSI).
- Understanding vasopressor impact is crucial for managing pediatric trauma patients.
Purpose of the Study:
- To investigate the outcomes of early vasopressor administration in children with BLSI.
- To determine the association between vasopressor use and mortality and nonoperative management (NOM) failure.
Main Methods:
- Secondary analysis of a prospective, 10-center study involving 1004 children with BLSI.
- Used inverse probability of treatment weighting (IPTW) to compare vasopressor users (<48h) with controls.
- Logistic regression assessed survival and NOM failure related to vasopressor initiation.
Main Results:
- Hypotension treated with vasopressors was linked to a sevenfold increase in mortality (AOR=7.6).
- Excluding cardiac arrest cases, mortality risk rose to an 11-fold increase (AOR=11.4).
- All vasopressor-related deaths occurred within 12 hours of injury; no association with NOM failure was found.
Conclusions:
- Early vasopressor use for hypotension in pediatric BLSI patients is associated with increased mortality.
- Vasopressor administration did not elevate the risk of nonoperative management failure.
Background:
No prior studies have examined the outcomes of early vasopressor use in children sustaining blunt liver or spleen injury (BLSI).
Methods:
A planned secondary analysis of vasopressor use from a 10-center, prospective study of 1004 children with BLSI. Inverse probability of treatment weighting (IPTW) was used to compare patients given vasopressors <48 h after injury to controls based on pretreatment factors. A logistic regression was utilized to assess survival associated with vasopressor initiation factors on mortality and nonoperative management (NOM) failure.
Results:
Of 1004 patients with BLSI, 128 patients were hypotensive in the Pediatric Trauma Center Emergency Department (ED); 65 total patients received vasopressors. Hypotension treated with vasopressors was associated with a sevenfold increase in mortality (AOR = 7.6 [p < 0.01]). When excluding patients first given vasopressors for cardiac arrest, the risk of mortality increased to 11-fold (AOR = 11.4 [p = 0.01]). All deaths in patients receiving vasopressors occurred when started within the first 12 h after injury. Vasopressor administration at any time was not associated with NOM failure.
Conclusion:
After propensity matching, early vasopressor use for hypotension in the ED was associated with an increased risk of death, but did not increase the risk of failure of NOM.
Level Of Evidence:
Level III prognostic and epidemiological, prospective.
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