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Surgeon choice in management of pediatric abdominal trauma
Elissa K Butler1, Jonathan I Groner2, Monica S Vavilala3
1Harborview Injury Prevention & Research Center, University of Washington, 325 9th Ave Box 359960, Seattle, WA 98122, USA; Department of Surgery, University of Washington, 1959 NE Pacific Street, WA 98195, USA; Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
Insights
Management of pediatric hollow viscus injury varies significantly. Injury characteristics and surgeon type influence decisions, highlighting the need for evidence-based guidelines to standardize care for these critical cases.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Surgical Management
Background:
- No established guidelines exist for managing hemodynamically stable children with suspected hollow viscus injury.
- Surgeon management decisions for these pediatric patients lack standardization.
Purpose of the Study:
- To identify factors influencing surgeon management of hemodynamically stable children with suspected hollow viscus injury.
- To analyze variations in surgical approaches based on injury characteristics and surgeon specialty.
Main Methods:
- A cross-sectional survey was distributed to members of the Eastern Association for the Surgery of Trauma and American Pediatric Surgical Association.
- The survey presented scenarios of blunt (isolated, multisystem, TBI) and penetrating abdominal injuries.
- Multivariable logistic regression analyzed factors associated with observation versus operation decisions.
Main Results:
- Surgeons were more likely to opt for operation in cases of multisystem injury (aOR 2.20) or traumatic brain injury (TBI) (aOR 3.60) compared to isolated blunt injury.
- Pediatric surgeons were less likely to choose immediate operation (aOR 0.32).
- Significant variation was observed in the management of penetrating injuries, with observation, local wound exploration, and laparoscopy chosen by 39.1%, 29.5%, and 31.5% of surgeons, respectively.
Conclusions:
- Substantial variability exists in the surgical management of hemodynamically stable children with suspected hollow viscus injury.
- Both patient injury characteristics and surgeon-specific factors, such as specialty, influence management decisions.
- Development of evidence-based practice guidelines is crucial to standardize care and improve outcomes.
Background:
No guidelines exist for management of hemodynamically stable children with suspected hollow viscus injury. We sought to determine factors contributing to surgeon management of these patients.
Methods:
Surgeon members of the Eastern Association for the Surgery of Trauma and American Pediatric Surgical Association completed a survey on 3 blunt abdominal injury scenarios: (1) isolated, (2) with multisystem injury, and (3) with traumatic brain injury (TBI), and a penetrating injury scenario. Multivariable logistic regression was used to determine factors associated with initial management of observation vs. operation for blunt injury and observation vs. local wound exploration versus laparoscopy for penetrating injury.
Results:
Of 394 surgeons (response rate 22.3%), 50.3% were pediatric surgeons. For scenarios 1-3, 32.2%, 49.3%, and 60.7% of surgeons chose operation over observation, respectively. Compared to isolated blunt injury, surgeons were more likely to choose operation for patients with multisystem injury (aOR 2.20, 95%CI: 1.78-2.72) or TBI (aOR 3.60, 95%CI: 2.79-4.66). Pediatric surgeons were less likely to choose operation (aOR 0.32, 95%CI: 0.22-0.44). For penetrating injury, 39.1%, 29.5%, and 31.5% of surgeons chose observation, local wound exploration, and laparoscopy, respectively.
Conclusions:
Large variation exists in management of hemodynamically stable children with suspected hollow viscus injury. Although patient injury characteristics account for some variation, surgeon factors such as type of surgeon also play a role. Evidence-based practice guidelines should be developed to standardize care.
Type Of Study:
Cross-Sectional Survey.
Level Of Evidence:
N/A.
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