Non-operative management of high-grade pancreatic trauma: Is it worth the wait?

Alana L. Beres, Paul W. Wales, Emily R. Christison-Lagay, Mary Elizabeth McClure, Mary E. Fallat, Mary E. Brindle

Research output: Contribution to journalArticle

35 Scopus citations

Abstract

AbstractBackground Whether children with pancreatic trauma should be managed non-operatively or operatively is controversial. We reviewed outcomes of high-grade pancreatic injuries at two high-volume pediatric surgical centres comparing non-operative and operative management strategies. Methods All pancreatic traumas presenting from January 1993 to July 2010 were reviewed. Patients with high-grade pancreatic injuries were stratified based on early operative or non-operative therapy. Baseline characteristics and outcomes were compared. Regression analyses were performed to assess complication rates, length of stay, and TPN duration while controlling for injury severity score and associated injuries. Results Of 77 patients with pancreatic injuries, 39 were grade 3 or higher. The mean ISS was 19.2 ± 10.8. Nineteen patients (50%) had associated injuries. Fifteen patients (38%) were managed operatively. Baseline characteristics were similar between groups other than ISS (p = 0.03). Duration of hospitalization (p = 0.01), days of TPN (p = 0.003), and overall complications (p = 0.007) were higher in non-operative patients. Controlling for both ISS and any associated injury, non-operative management was associated with more complications (OR 8.11; 95% CI 1.60-41.23) and was a significant predictor of prolonged TPN (13 days longer; p = 0.024). Conclusion Primary non-operative management of high-grade pancreatic injuries is associated with a significant increase in complications and TPN dependency. Early operative intervention should be pursued whenever feasible.

Original languageEnglish (US)
Pages (from-to)1060-1064
Number of pages5
JournalJournal of Pediatric Surgery
Volume48
Issue number5
DOIs
StatePublished - May 1 2013

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Keywords

  • Complications
  • Management
  • Outcomes
  • Pancreas trauma
  • Pediatrics

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Beres, A. L., Wales, P. W., Christison-Lagay, E. R., McClure, M. E., Fallat, M. E., & Brindle, M. E. (2013). Non-operative management of high-grade pancreatic trauma: Is it worth the wait? Journal of Pediatric Surgery, 48(5), 1060-1064. https://doi.org/10.1016/j.jpedsurg.2013.02.027