Management of children with solid organ injuries after blunt torso trauma

David H. Wisner, Nathan Kuppermann, Arthur Cooper, Jay Menaker, Peter Ehrlich, Josh Kooistra, Prashant Mahajan, Lois Lee, Lawrence J. Cook, Kenneth Yen, Kathy Lillis, James F. Holmes

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

BACKGROUND Management of children with intra-abdominal solid organ injuries has evolved markedly. We describe the current management of children with intra-abdominal solid organ injuries after blunt trauma in a large multicenter network. METHODS We performed a planned secondary analysis of a prospective, multicenter observational study of children (<18 years) with blunt torso trauma. We included children with spleen, liver, or kidney injuries identified by computed tomography, laparotomy/laparoscopy, or autopsy. Outcomes included disposition and interventions (blood transfusion for intra-abdominal hemorrhage, angiography, laparotomy/laparoscopy). We performed subanalyses of children with isolated injuries. RESULTS A total of 12,044 children were enrolled; 605 (5.0%) had intra-abdominal solid organ injuries. The mean (SD) age was 10.7 (5.1) years, and injured organs included spleen 299 (49.4%), liver 282 (46.6%), and kidney 147 (24.3%). Intraperitoneal fluid was identified on computed tomography in 461 (76%; 95% confidence interval [CI], 73-80%), and isolated solid organ injuries were present in 418 (69%; 95% CI, 65-73%). Treatment included therapeutic laparotomy in 17 (4.1%), angiographic embolization in 6 (1.4%), and blood transfusion in 46 (11%) patients. Laparotomy rates for isolated injury were 11 (5.4%) of 205 (95% CI, 2.7-9.4%) at non-freestanding children's hospitals and 6 (2.8%) of 213 (95% CI, 1.0-6.0%) at freestanding children's hospitals (difference, 2.6%; 95% CI, -7.1% to 12.2%). Dispositions of the 212 children with isolated Grade I or II organ injuries were home in 6 (3%), emergency department observation in 9 (4%), ward in 114 (54%), intensive care unit in 73 (34%), operating suite in 7 (3%), and transferred in 3 (1%) patients. Intensive care unit admission for isolated Grade I or II injuries varied by center from 9% to 73%. CONCLUSION Most children with solid organ injuries are managed with observation. Blood transfusion, while uncommon, is the most frequent therapeutic intervention; angiographic embolization and laparotomy are uncommon. Emergency department disposition of children with isolated Grade I to II solid organ injuries is highly variable and often differs from published guidelines. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)206-214
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume79
Issue number2
DOIs
StatePublished - Aug 6 2015

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Torso
Nonpenetrating Wounds
Wounds and Injuries
Laparotomy
Confidence Intervals
Blood Transfusion
Laparoscopy
Intensive Care Units
Hospital Emergency Service
Spleen
Tomography
Observation
Kidney
Liver
Therapeutics
Multicenter Studies
Observational Studies
Epidemiologic Studies
Autopsy
Angiography

Keywords

  • abdominal organ injury
  • children's hospitals
  • Pediatric trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Wisner, D. H., Kuppermann, N., Cooper, A., Menaker, J., Ehrlich, P., Kooistra, J., ... Holmes, J. F. (2015). Management of children with solid organ injuries after blunt torso trauma. Journal of Trauma and Acute Care Surgery, 79(2), 206-214. https://doi.org/10.1097/TA.0000000000000731

Management of children with solid organ injuries after blunt torso trauma. / Wisner, David H.; Kuppermann, Nathan; Cooper, Arthur; Menaker, Jay; Ehrlich, Peter; Kooistra, Josh; Mahajan, Prashant; Lee, Lois; Cook, Lawrence J.; Yen, Kenneth; Lillis, Kathy; Holmes, James F.

In: Journal of Trauma and Acute Care Surgery, Vol. 79, No. 2, 06.08.2015, p. 206-214.

Research output: Contribution to journalArticle

Wisner, DH, Kuppermann, N, Cooper, A, Menaker, J, Ehrlich, P, Kooistra, J, Mahajan, P, Lee, L, Cook, LJ, Yen, K, Lillis, K & Holmes, JF 2015, 'Management of children with solid organ injuries after blunt torso trauma', Journal of Trauma and Acute Care Surgery, vol. 79, no. 2, pp. 206-214. https://doi.org/10.1097/TA.0000000000000731
Wisner DH, Kuppermann N, Cooper A, Menaker J, Ehrlich P, Kooistra J et al. Management of children with solid organ injuries after blunt torso trauma. Journal of Trauma and Acute Care Surgery. 2015 Aug 6;79(2):206-214. https://doi.org/10.1097/TA.0000000000000731
Wisner, David H. ; Kuppermann, Nathan ; Cooper, Arthur ; Menaker, Jay ; Ehrlich, Peter ; Kooistra, Josh ; Mahajan, Prashant ; Lee, Lois ; Cook, Lawrence J. ; Yen, Kenneth ; Lillis, Kathy ; Holmes, James F. / Management of children with solid organ injuries after blunt torso trauma. In: Journal of Trauma and Acute Care Surgery. 2015 ; Vol. 79, No. 2. pp. 206-214.
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abstract = "BACKGROUND Management of children with intra-abdominal solid organ injuries has evolved markedly. We describe the current management of children with intra-abdominal solid organ injuries after blunt trauma in a large multicenter network. METHODS We performed a planned secondary analysis of a prospective, multicenter observational study of children (<18 years) with blunt torso trauma. We included children with spleen, liver, or kidney injuries identified by computed tomography, laparotomy/laparoscopy, or autopsy. Outcomes included disposition and interventions (blood transfusion for intra-abdominal hemorrhage, angiography, laparotomy/laparoscopy). We performed subanalyses of children with isolated injuries. RESULTS A total of 12,044 children were enrolled; 605 (5.0{\%}) had intra-abdominal solid organ injuries. The mean (SD) age was 10.7 (5.1) years, and injured organs included spleen 299 (49.4{\%}), liver 282 (46.6{\%}), and kidney 147 (24.3{\%}). Intraperitoneal fluid was identified on computed tomography in 461 (76{\%}; 95{\%} confidence interval [CI], 73-80{\%}), and isolated solid organ injuries were present in 418 (69{\%}; 95{\%} CI, 65-73{\%}). Treatment included therapeutic laparotomy in 17 (4.1{\%}), angiographic embolization in 6 (1.4{\%}), and blood transfusion in 46 (11{\%}) patients. Laparotomy rates for isolated injury were 11 (5.4{\%}) of 205 (95{\%} CI, 2.7-9.4{\%}) at non-freestanding children's hospitals and 6 (2.8{\%}) of 213 (95{\%} CI, 1.0-6.0{\%}) at freestanding children's hospitals (difference, 2.6{\%}; 95{\%} CI, -7.1{\%} to 12.2{\%}). Dispositions of the 212 children with isolated Grade I or II organ injuries were home in 6 (3{\%}), emergency department observation in 9 (4{\%}), ward in 114 (54{\%}), intensive care unit in 73 (34{\%}), operating suite in 7 (3{\%}), and transferred in 3 (1{\%}) patients. Intensive care unit admission for isolated Grade I or II injuries varied by center from 9{\%} to 73{\%}. CONCLUSION Most children with solid organ injuries are managed with observation. Blood transfusion, while uncommon, is the most frequent therapeutic intervention; angiographic embolization and laparotomy are uncommon. Emergency department disposition of children with isolated Grade I to II solid organ injuries is highly variable and often differs from published guidelines. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.",
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N2 - BACKGROUND Management of children with intra-abdominal solid organ injuries has evolved markedly. We describe the current management of children with intra-abdominal solid organ injuries after blunt trauma in a large multicenter network. METHODS We performed a planned secondary analysis of a prospective, multicenter observational study of children (<18 years) with blunt torso trauma. We included children with spleen, liver, or kidney injuries identified by computed tomography, laparotomy/laparoscopy, or autopsy. Outcomes included disposition and interventions (blood transfusion for intra-abdominal hemorrhage, angiography, laparotomy/laparoscopy). We performed subanalyses of children with isolated injuries. RESULTS A total of 12,044 children were enrolled; 605 (5.0%) had intra-abdominal solid organ injuries. The mean (SD) age was 10.7 (5.1) years, and injured organs included spleen 299 (49.4%), liver 282 (46.6%), and kidney 147 (24.3%). Intraperitoneal fluid was identified on computed tomography in 461 (76%; 95% confidence interval [CI], 73-80%), and isolated solid organ injuries were present in 418 (69%; 95% CI, 65-73%). Treatment included therapeutic laparotomy in 17 (4.1%), angiographic embolization in 6 (1.4%), and blood transfusion in 46 (11%) patients. Laparotomy rates for isolated injury were 11 (5.4%) of 205 (95% CI, 2.7-9.4%) at non-freestanding children's hospitals and 6 (2.8%) of 213 (95% CI, 1.0-6.0%) at freestanding children's hospitals (difference, 2.6%; 95% CI, -7.1% to 12.2%). Dispositions of the 212 children with isolated Grade I or II organ injuries were home in 6 (3%), emergency department observation in 9 (4%), ward in 114 (54%), intensive care unit in 73 (34%), operating suite in 7 (3%), and transferred in 3 (1%) patients. Intensive care unit admission for isolated Grade I or II injuries varied by center from 9% to 73%. CONCLUSION Most children with solid organ injuries are managed with observation. Blood transfusion, while uncommon, is the most frequent therapeutic intervention; angiographic embolization and laparotomy are uncommon. Emergency department disposition of children with isolated Grade I to II solid organ injuries is highly variable and often differs from published guidelines. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.

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