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Published on: July 28, 2020
Management of Pediatric Solid Organ Injuries
Bailey D Lyttle1, Regan F Williams2, Steven Stylianos3
1Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, 12631 East 17th Avenue, Room 6111, Aurora, CO 80045, USA.
Insights
Management of pediatric solid organ injury (SOI) has evolved, emphasizing nonoperative approaches. Current guidelines focus on optimizing care for spleen, liver, kidney, and pancreas injuries, minimizing interventions while ensuring patient safety.
Area of Science:
- Pediatric Surgery
- Trauma Management
Background:
- Solid organ injury (SOI) is a frequent consequence of pediatric abdominal trauma.
- Management strategies for SOI have undergone significant evolution.
- The American Pediatric Surgical Association (APSA) published initial guidelines for blunt spleen and/or liver injury (BLSI) in 2000.
Purpose of the Study:
- To review current evidence-based management guidelines for pediatric solid organ injuries.
- To cover initial evaluation, inpatient management, and long-term care.
- To identify gaps in current literature for protocol optimization.
Main Methods:
- Review of current evidence-based management guidelines.
- Analysis of literature on nonoperative management (NOM) strategies.
- Examination of approaches to minimize invasive procedures, hospitalization, and activity restrictions.
Main Results:
- Nonoperative management (NOM) is the predominant treatment for SOI.
- Numerous studies have evaluated safe reductions in invasive procedures, hospitalization, and activity restrictions.
- Established guidelines exist for spleen, liver, kidney, and pancreas injuries in children.
Conclusions:
- Current management of pediatric SOI emphasizes NOM and resource optimization.
- Further research is needed to address existing gaps and refine treatment protocols.
- Optimizing protocols for pediatric SOI requires continued evaluation of evidence-based practices.
Abstract:
Solid organ injury (SOI) is common in children who experience abdominal trauma, and the management of such injuries has evolved significantly over the past several decades. In 2000, the American Pediatric Surgical Association (APSA) published the first societal guidelines for the management of blunt spleen and/or liver injury (BLSI), advocating for optimized resource utilization while maintaining patient safety. Nonoperative management (NOM) has become the mainstay of treatment for SOI, and since the publication of the APSA guidelines, numerous groups have evaluated how invasive procedures, hospitalization, and activity restrictions may be safely minimized in children with SOI. Here, we review the current evidence-based management guidelines in place for the treatment of injuries to the spleen, liver, kidney, and pancreas in children, including initial evaluation, inpatient management, and long-term care, as well as gaps that exist in the current literature that may be targeted for further optimization of protocols for pediatric SOI.
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Assessment:
1. Clinical Evaluation:
History: