Does Angioembolization of High-Grade Blunt Liver Injuries Benefit Adolescent-Age Children?

Current adult guidelines for the management of high-grade blunt liver injuries include early angioembolization, while pediatric guidelines recommend angioembolization based on hemodynamics and response to blood product transfusion. Adolescent patients are unique with adult-equivalent size while maintaining pediatric physiology. Therefore, our aim is to evaluate the management of adolescent-aged children with high-grade blunt liver injuries to compare outcomes of angioembolization to nonoperative management (NOM).

A retrospective review of the National Trauma Data Bank from 2017 to 2019 of children ages 12 to 17 with grades IV or V blunt liver injuries was conducted. Cohorts were defined as NOM, initial hepatic surgical intervention, and initial hepatic angioembolization. Primary outcomes included mortality, hospital length of stay (LOS), and ICU LOS. The NOM and angioembolization cohorts were then matched on injury severity score, Shock Index Pediatric Adjusted (SIPA), and trauma center type for further analysis.

We identified 752 adolescent patients with high-grade blunt liver injuries, with 630 undergoing NOM, 76 undergoing hepatic surgical intervention, and 46 undergoing angioembolization. Propensity-matched analysis for 138 of the NOM cohort and 46 of the angioembolization cohort revealed prolonged LOS and more frequent blood product requirements for patients undergoing angioembolization, but no difference in mortality or ICU LOS.

Adolescent trauma patients with blunt liver injuries managed with initial angioembolization have similar primary outcomes to those undergoing NOM, aside from prolonged LOS, demonstrating that the application of pediatric nonoperative solid organ protocols might be appropriate in this population.