Reimaging in pediatric blunt spleen and liver injury

David M. Notrica, Bethany L. Sussman, Nilda M. Garcia, Charles M. Leys, R. Todd Maxson, Amina Bhatia, Robert W. Letton, Todd Ponsky, Karla A. Lawson, James W. Eubanks, Adam C. Alder, Cynthia Greenwell, Daniel J. Ostlie, David W. Tuggle, Shawn D. St. Peter

Research output: Contribution to journalArticle

Abstract

Background: APSA guidelines do not recommend routine reimaging for pediatric blunt liver or spleen injury (BLSI). This study characterizes the symptoms, reimaging, and outcomes associated with a selective reimaging strategy for pediatric BLSI patients. Methods: A planned secondary analysis of reimaging in a 3-year multi-site prospective study of BLSI patients was completed. Inclusion required successful nonoperative management of CT confirmed BLSI without pancreas or kidney injury and follow up at 14 or 60 days. Patients with re-injury after discharge were excluded. Results: Of 1007 patients with BLSI, 534 (55%) met inclusion criteria (median age: 10.18 [IQR: 6, 14]; 62% male). Abdominal reimaging was performed on 27/534 (6%) patients; 3 of 27 studies prompting hospitalization and/or intervention. Abdominal pain was associated with reimaging, but decreased appetite predicted imaging findings associated with readmission and intervention. Conclusion: Selective abdominal reimaging for BLSI was done in 6% of patients, and 11% of studies identified radiologic findings associated with intervention or re-hospitalization. A selective reimaging strategy appears safe, and even reimaging symptomatic patients rarely results in intervention. Reimaging after 14 days did not prompt intervention in any of the 534 patients managed nonoperatively. Level of evidence: Level II, Prognosis.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Spleen
Pediatrics
Liver
Wounds and Injuries
Hospitalization
Appetite
Abdominal Pain
Pancreas
Prospective Studies
Guidelines
Kidney

Keywords

  • Abdominal trauma
  • Blunt trauma
  • Liver injury
  • Pediatric
  • Reimaging
  • Spleen injury

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Notrica, D. M., Sussman, B. L., Garcia, N. M., Leys, C. M., Maxson, R. T., Bhatia, A., ... St. Peter, S. D. (Accepted/In press). Reimaging in pediatric blunt spleen and liver injury. Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2018.08.060

Reimaging in pediatric blunt spleen and liver injury. / Notrica, David M.; Sussman, Bethany L.; Garcia, Nilda M.; Leys, Charles M.; Maxson, R. Todd; Bhatia, Amina; Letton, Robert W.; Ponsky, Todd; Lawson, Karla A.; Eubanks, James W.; Alder, Adam C.; Greenwell, Cynthia; Ostlie, Daniel J.; Tuggle, David W.; St. Peter, Shawn D.

In: Journal of Pediatric Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Notrica, DM, Sussman, BL, Garcia, NM, Leys, CM, Maxson, RT, Bhatia, A, Letton, RW, Ponsky, T, Lawson, KA, Eubanks, JW, Alder, AC, Greenwell, C, Ostlie, DJ, Tuggle, DW & St. Peter, SD 2018, 'Reimaging in pediatric blunt spleen and liver injury', Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2018.08.060
Notrica DM, Sussman BL, Garcia NM, Leys CM, Maxson RT, Bhatia A et al. Reimaging in pediatric blunt spleen and liver injury. Journal of Pediatric Surgery. 2018 Jan 1. https://doi.org/10.1016/j.jpedsurg.2018.08.060
Notrica, David M. ; Sussman, Bethany L. ; Garcia, Nilda M. ; Leys, Charles M. ; Maxson, R. Todd ; Bhatia, Amina ; Letton, Robert W. ; Ponsky, Todd ; Lawson, Karla A. ; Eubanks, James W. ; Alder, Adam C. ; Greenwell, Cynthia ; Ostlie, Daniel J. ; Tuggle, David W. ; St. Peter, Shawn D. / Reimaging in pediatric blunt spleen and liver injury. In: Journal of Pediatric Surgery. 2018.
@article{f2bb01e6387949e9b9b4814d0bb75220,
title = "Reimaging in pediatric blunt spleen and liver injury",
abstract = "Background: APSA guidelines do not recommend routine reimaging for pediatric blunt liver or spleen injury (BLSI). This study characterizes the symptoms, reimaging, and outcomes associated with a selective reimaging strategy for pediatric BLSI patients. Methods: A planned secondary analysis of reimaging in a 3-year multi-site prospective study of BLSI patients was completed. Inclusion required successful nonoperative management of CT confirmed BLSI without pancreas or kidney injury and follow up at 14 or 60 days. Patients with re-injury after discharge were excluded. Results: Of 1007 patients with BLSI, 534 (55{\%}) met inclusion criteria (median age: 10.18 [IQR: 6, 14]; 62{\%} male). Abdominal reimaging was performed on 27/534 (6{\%}) patients; 3 of 27 studies prompting hospitalization and/or intervention. Abdominal pain was associated with reimaging, but decreased appetite predicted imaging findings associated with readmission and intervention. Conclusion: Selective abdominal reimaging for BLSI was done in 6{\%} of patients, and 11{\%} of studies identified radiologic findings associated with intervention or re-hospitalization. A selective reimaging strategy appears safe, and even reimaging symptomatic patients rarely results in intervention. Reimaging after 14 days did not prompt intervention in any of the 534 patients managed nonoperatively. Level of evidence: Level II, Prognosis.",
keywords = "Abdominal trauma, Blunt trauma, Liver injury, Pediatric, Reimaging, Spleen injury",
author = "Notrica, {David M.} and Sussman, {Bethany L.} and Garcia, {Nilda M.} and Leys, {Charles M.} and Maxson, {R. Todd} and Amina Bhatia and Letton, {Robert W.} and Todd Ponsky and Lawson, {Karla A.} and Eubanks, {James W.} and Alder, {Adam C.} and Cynthia Greenwell and Ostlie, {Daniel J.} and Tuggle, {David W.} and {St. Peter}, {Shawn D.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jpedsurg.2018.08.060",
language = "English (US)",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Reimaging in pediatric blunt spleen and liver injury

AU - Notrica, David M.

AU - Sussman, Bethany L.

AU - Garcia, Nilda M.

AU - Leys, Charles M.

AU - Maxson, R. Todd

AU - Bhatia, Amina

AU - Letton, Robert W.

AU - Ponsky, Todd

AU - Lawson, Karla A.

AU - Eubanks, James W.

AU - Alder, Adam C.

AU - Greenwell, Cynthia

AU - Ostlie, Daniel J.

AU - Tuggle, David W.

AU - St. Peter, Shawn D.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: APSA guidelines do not recommend routine reimaging for pediatric blunt liver or spleen injury (BLSI). This study characterizes the symptoms, reimaging, and outcomes associated with a selective reimaging strategy for pediatric BLSI patients. Methods: A planned secondary analysis of reimaging in a 3-year multi-site prospective study of BLSI patients was completed. Inclusion required successful nonoperative management of CT confirmed BLSI without pancreas or kidney injury and follow up at 14 or 60 days. Patients with re-injury after discharge were excluded. Results: Of 1007 patients with BLSI, 534 (55%) met inclusion criteria (median age: 10.18 [IQR: 6, 14]; 62% male). Abdominal reimaging was performed on 27/534 (6%) patients; 3 of 27 studies prompting hospitalization and/or intervention. Abdominal pain was associated with reimaging, but decreased appetite predicted imaging findings associated with readmission and intervention. Conclusion: Selective abdominal reimaging for BLSI was done in 6% of patients, and 11% of studies identified radiologic findings associated with intervention or re-hospitalization. A selective reimaging strategy appears safe, and even reimaging symptomatic patients rarely results in intervention. Reimaging after 14 days did not prompt intervention in any of the 534 patients managed nonoperatively. Level of evidence: Level II, Prognosis.

AB - Background: APSA guidelines do not recommend routine reimaging for pediatric blunt liver or spleen injury (BLSI). This study characterizes the symptoms, reimaging, and outcomes associated with a selective reimaging strategy for pediatric BLSI patients. Methods: A planned secondary analysis of reimaging in a 3-year multi-site prospective study of BLSI patients was completed. Inclusion required successful nonoperative management of CT confirmed BLSI without pancreas or kidney injury and follow up at 14 or 60 days. Patients with re-injury after discharge were excluded. Results: Of 1007 patients with BLSI, 534 (55%) met inclusion criteria (median age: 10.18 [IQR: 6, 14]; 62% male). Abdominal reimaging was performed on 27/534 (6%) patients; 3 of 27 studies prompting hospitalization and/or intervention. Abdominal pain was associated with reimaging, but decreased appetite predicted imaging findings associated with readmission and intervention. Conclusion: Selective abdominal reimaging for BLSI was done in 6% of patients, and 11% of studies identified radiologic findings associated with intervention or re-hospitalization. A selective reimaging strategy appears safe, and even reimaging symptomatic patients rarely results in intervention. Reimaging after 14 days did not prompt intervention in any of the 534 patients managed nonoperatively. Level of evidence: Level II, Prognosis.

KW - Abdominal trauma

KW - Blunt trauma

KW - Liver injury

KW - Pediatric

KW - Reimaging

KW - Spleen injury

UR - http://www.scopus.com/inward/record.url?scp=85054454553&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054454553&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2018.08.060

DO - 10.1016/j.jpedsurg.2018.08.060

M3 - Article

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

ER -