Epidemiology and management of abdominal injuries in children
Pradip P Chaudhari1, Jonathan Rodean2, Ryan G Spurrier3
1Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
Insights
Most children with intra-abdominal injuries (IAI) are treated without surgery, with similar management across pediatric hospitals. These findings can guide future efforts to align care with established guidelines for pediatric IAI.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Abdominal Injury
Background:
- Pediatric trauma centers show more guideline-adherent care than adult centers.
- Detailed characterization of pediatric intra-abdominal injury (IAI) management is needed.
- Understanding resource utilization in pediatric IAI is crucial.
Purpose of the Study:
- To describe the epidemiology of IAI in children across U.S. children's hospitals.
- To detail the diagnostic evaluation and management of pediatric IAI.
- To assess interhospital variation in surgical management for pediatric IAI.
Main Methods:
- Cross-sectional study using the Pediatric Health Information System (2010-2019).
- Included children (<18 years) with IAI diagnosed by ICD coding and confirmed by abdominal CT.
- Generalized linear regression used to analyze surgical management proportions.
Main Results:
- 9265 children with IAI were studied; median age was 9 years.
- Abdominal surgery was performed in 16% of cases, with lower rates in children <5 years.
- Liver (38.6%) and spleen (32.1%) were most commonly injured; surgery rates were low (3.1% and 2.8% respectively).
Conclusions:
- The majority of pediatric intra-abdominal injuries are managed nonoperatively.
- Most children's hospitals demonstrate similar management approaches for IAI.
- Data can inform future benchmarking for guideline adherence in pediatric IAI care.
Background:
Although more guideline-adherent care has been described in pediatric compared to adult trauma centers, we aimed to provide a more detailed characterization of management and resource utilization of children with intra-abdominal injury (IAI) within pediatric centers. Our primary objective was to describe the epidemiology, diagnostic evaluation, and management of children with IAI across U.S. children's hospitals. Our secondary objective was to describe the interhospital variation in surgical management of children with IAI.
Methods:
We conducted a cross-sectional study of 33 hospitals in the Pediatric Health Information System. We included children aged <18 years evaluated in the emergency department from 2010 to 2019 with IAI, as defined by ICD coding, and who underwent an abdominal computed tomography (CT). Our primary outcome was abdominal surgery. We categorized IAI by organ system and described resource utilization data. We used generalized linear regression to calculate adjusted hospital-level proportions of abdominal surgery, with a random effect for hospital.
Results:
We studied 9265 children with IAI. Median (IQR) age was 9.0 (6.0-13.0) years. Abdominal surgery was performed in 16% (n = 1479) of children, with the lowest proportion of abdominal surgery observed in children aged <5 years. Liver (38.6%) and spleen (32.1%) were the most common organs injured. A total of 3.1% of children with liver injuries and 2.8% with splenic injuries underwent abdominal surgery. Although there was variation in rates of surgery across hospitals (p < 0.001), only three of 33 hospitals had rates that were statistically different from the aggregate mean of 16%.
Conclusions:
Most children with IAI are managed nonoperatively, and most children's hospitals manage children with IAI similarly. These data can be used to inform future benchmarking efforts across hospitals to assess concordance with guidelines for the management of children with IAI.
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