Acute procedural interventions after pediatric blunt abdominal trauma: A prospective multicenter evaluation

Chase A. Arbra, Adam M. Vogel, Jingwen Zhang, Patrick D. Mauldin, Eunice Huang, Kate B. Savoie, Matthew T. Santore, Kuojen Tsao, Tiffany G. Ostovar-Kermani, Richard A. Falcone, M. Sidney Dassinger, John Recicar, Jeffrey H. Haynes, Martin L. Blakely, Robert T. Russell, Bindi J. Naik-Mathuria, Shawn D. St Peter, David P. Mooney, Chinwendu Onwubiko, Jeffrey S. UppermanChristian J. Streck

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND Pediatric intra-abdominal injuries (IAI) from blunt abdominal trauma (BAT) rarely require emergent intervention. For those children undergoing procedural intervention, our aim was to understand the timing and indications for operation and angiographic embolization. METHODS We prospectively enrolled children younger than 16 years after BAT at 14 Level I Pediatric Trauma Centers over a 1-year period. Patients with IAI who received an intervention (IAI-I) were compared with those who did not receive an intervention using descriptive statistics and univariate analysis; p less than 0.05 was considered significant. RESULTS Two hundred sixty-one (11.9%) of 2,188 patients had IAI. Forty-five (17.2%) IAI patients received an acute procedural intervention (38 operations, seven angiographic embolization). The mean age for patients requiring intervention was 7.1 ± 4.1 years and not different from the population. Most patients (88.9%) with IAI-I were normotensive. IAI-I patients were significantly more likely to have a mechanism of motor vehicle collision (66.7% vs. 38.9%), more likely to present as a Level I activation (44.4% vs. 26.9%), more likely to have a Glascow Coma Scale less than 14 (31.1% vs. 15.5%), and more likely to have an abnormal abdominal physical examination (93.3% vs. 65.7%) than patients that did not require acute intervention. All patients underwent computed tomography scan before intervention. Operations consisted of laparotomy (n = 21), laparoscopy converted to open (n = 11), and laparoscopy alone (n = 6). The most common surgical indications were hollow viscus injury (HVI) (11 small bowel, 10 colon, 6 small bowel/colon, 2 duodenum). All interventions for solid organ injury, including seven angioembolic procedures, occurred within 8 hours of arrival; many had hypotension and received a transfusion. Procedural interventions were more common for HVI than for solid organ injury (59.2% vs. 7.6%). Postoperative mortality from IAI was 2.6%. CONCLUSION Acute procedural interventions for children with IAI from BAT are rare, predominantly for HVI, are performed early in the hospital course and have excellent clinical outcomes. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)597-602
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume83
Issue number4
DOIs
StatePublished - Oct 1 2017

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Abdominal Injuries
Pediatrics
Wounds and Injuries
Viscera
Laparoscopy
Colon
Trauma Centers
Motor Vehicles
Coma
Duodenum
Hypotension
Laparotomy
Physical Examination
Epidemiologic Studies
Tomography
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Acute procedural interventions after pediatric blunt abdominal trauma : A prospective multicenter evaluation. / Arbra, Chase A.; Vogel, Adam M.; Zhang, Jingwen; Mauldin, Patrick D.; Huang, Eunice; Savoie, Kate B.; Santore, Matthew T.; Tsao, Kuojen; Ostovar-Kermani, Tiffany G.; Falcone, Richard A.; Dassinger, M. Sidney; Recicar, John; Haynes, Jeffrey H.; Blakely, Martin L.; Russell, Robert T.; Naik-Mathuria, Bindi J.; St Peter, Shawn D.; Mooney, David P.; Onwubiko, Chinwendu; Upperman, Jeffrey S.; Streck, Christian J.

In: Journal of Trauma and Acute Care Surgery, Vol. 83, No. 4, 01.10.2017, p. 597-602.

Research output: Contribution to journalArticle

Arbra, CA, Vogel, AM, Zhang, J, Mauldin, PD, Huang, E, Savoie, KB, Santore, MT, Tsao, K, Ostovar-Kermani, TG, Falcone, RA, Dassinger, MS, Recicar, J, Haynes, JH, Blakely, ML, Russell, RT, Naik-Mathuria, BJ, St Peter, SD, Mooney, DP, Onwubiko, C, Upperman, JS & Streck, CJ 2017, 'Acute procedural interventions after pediatric blunt abdominal trauma: A prospective multicenter evaluation', Journal of Trauma and Acute Care Surgery, vol. 83, no. 4, pp. 597-602. https://doi.org/10.1097/TA.0000000000001533
Arbra, Chase A. ; Vogel, Adam M. ; Zhang, Jingwen ; Mauldin, Patrick D. ; Huang, Eunice ; Savoie, Kate B. ; Santore, Matthew T. ; Tsao, Kuojen ; Ostovar-Kermani, Tiffany G. ; Falcone, Richard A. ; Dassinger, M. Sidney ; Recicar, John ; Haynes, Jeffrey H. ; Blakely, Martin L. ; Russell, Robert T. ; Naik-Mathuria, Bindi J. ; St Peter, Shawn D. ; Mooney, David P. ; Onwubiko, Chinwendu ; Upperman, Jeffrey S. ; Streck, Christian J. / Acute procedural interventions after pediatric blunt abdominal trauma : A prospective multicenter evaluation. In: Journal of Trauma and Acute Care Surgery. 2017 ; Vol. 83, No. 4. pp. 597-602.
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abstract = "BACKGROUND Pediatric intra-abdominal injuries (IAI) from blunt abdominal trauma (BAT) rarely require emergent intervention. For those children undergoing procedural intervention, our aim was to understand the timing and indications for operation and angiographic embolization. METHODS We prospectively enrolled children younger than 16 years after BAT at 14 Level I Pediatric Trauma Centers over a 1-year period. Patients with IAI who received an intervention (IAI-I) were compared with those who did not receive an intervention using descriptive statistics and univariate analysis; p less than 0.05 was considered significant. RESULTS Two hundred sixty-one (11.9{\%}) of 2,188 patients had IAI. Forty-five (17.2{\%}) IAI patients received an acute procedural intervention (38 operations, seven angiographic embolization). The mean age for patients requiring intervention was 7.1 ± 4.1 years and not different from the population. Most patients (88.9{\%}) with IAI-I were normotensive. IAI-I patients were significantly more likely to have a mechanism of motor vehicle collision (66.7{\%} vs. 38.9{\%}), more likely to present as a Level I activation (44.4{\%} vs. 26.9{\%}), more likely to have a Glascow Coma Scale less than 14 (31.1{\%} vs. 15.5{\%}), and more likely to have an abnormal abdominal physical examination (93.3{\%} vs. 65.7{\%}) than patients that did not require acute intervention. All patients underwent computed tomography scan before intervention. Operations consisted of laparotomy (n = 21), laparoscopy converted to open (n = 11), and laparoscopy alone (n = 6). The most common surgical indications were hollow viscus injury (HVI) (11 small bowel, 10 colon, 6 small bowel/colon, 2 duodenum). All interventions for solid organ injury, including seven angioembolic procedures, occurred within 8 hours of arrival; many had hypotension and received a transfusion. Procedural interventions were more common for HVI than for solid organ injury (59.2{\%} vs. 7.6{\%}). Postoperative mortality from IAI was 2.6{\%}. CONCLUSION Acute procedural interventions for children with IAI from BAT are rare, predominantly for HVI, are performed early in the hospital course and have excellent clinical outcomes. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.",
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TY - JOUR

T1 - Acute procedural interventions after pediatric blunt abdominal trauma

T2 - A prospective multicenter evaluation

AU - Arbra, Chase A.

AU - Vogel, Adam M.

AU - Zhang, Jingwen

AU - Mauldin, Patrick D.

AU - Huang, Eunice

AU - Savoie, Kate B.

AU - Santore, Matthew T.

AU - Tsao, Kuojen

AU - Ostovar-Kermani, Tiffany G.

AU - Falcone, Richard A.

AU - Dassinger, M. Sidney

AU - Recicar, John

AU - Haynes, Jeffrey H.

AU - Blakely, Martin L.

AU - Russell, Robert T.

AU - Naik-Mathuria, Bindi J.

AU - St Peter, Shawn D.

AU - Mooney, David P.

AU - Onwubiko, Chinwendu

AU - Upperman, Jeffrey S.

AU - Streck, Christian J.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - BACKGROUND Pediatric intra-abdominal injuries (IAI) from blunt abdominal trauma (BAT) rarely require emergent intervention. For those children undergoing procedural intervention, our aim was to understand the timing and indications for operation and angiographic embolization. METHODS We prospectively enrolled children younger than 16 years after BAT at 14 Level I Pediatric Trauma Centers over a 1-year period. Patients with IAI who received an intervention (IAI-I) were compared with those who did not receive an intervention using descriptive statistics and univariate analysis; p less than 0.05 was considered significant. RESULTS Two hundred sixty-one (11.9%) of 2,188 patients had IAI. Forty-five (17.2%) IAI patients received an acute procedural intervention (38 operations, seven angiographic embolization). The mean age for patients requiring intervention was 7.1 ± 4.1 years and not different from the population. Most patients (88.9%) with IAI-I were normotensive. IAI-I patients were significantly more likely to have a mechanism of motor vehicle collision (66.7% vs. 38.9%), more likely to present as a Level I activation (44.4% vs. 26.9%), more likely to have a Glascow Coma Scale less than 14 (31.1% vs. 15.5%), and more likely to have an abnormal abdominal physical examination (93.3% vs. 65.7%) than patients that did not require acute intervention. All patients underwent computed tomography scan before intervention. Operations consisted of laparotomy (n = 21), laparoscopy converted to open (n = 11), and laparoscopy alone (n = 6). The most common surgical indications were hollow viscus injury (HVI) (11 small bowel, 10 colon, 6 small bowel/colon, 2 duodenum). All interventions for solid organ injury, including seven angioembolic procedures, occurred within 8 hours of arrival; many had hypotension and received a transfusion. Procedural interventions were more common for HVI than for solid organ injury (59.2% vs. 7.6%). Postoperative mortality from IAI was 2.6%. CONCLUSION Acute procedural interventions for children with IAI from BAT are rare, predominantly for HVI, are performed early in the hospital course and have excellent clinical outcomes. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.

AB - BACKGROUND Pediatric intra-abdominal injuries (IAI) from blunt abdominal trauma (BAT) rarely require emergent intervention. For those children undergoing procedural intervention, our aim was to understand the timing and indications for operation and angiographic embolization. METHODS We prospectively enrolled children younger than 16 years after BAT at 14 Level I Pediatric Trauma Centers over a 1-year period. Patients with IAI who received an intervention (IAI-I) were compared with those who did not receive an intervention using descriptive statistics and univariate analysis; p less than 0.05 was considered significant. RESULTS Two hundred sixty-one (11.9%) of 2,188 patients had IAI. Forty-five (17.2%) IAI patients received an acute procedural intervention (38 operations, seven angiographic embolization). The mean age for patients requiring intervention was 7.1 ± 4.1 years and not different from the population. Most patients (88.9%) with IAI-I were normotensive. IAI-I patients were significantly more likely to have a mechanism of motor vehicle collision (66.7% vs. 38.9%), more likely to present as a Level I activation (44.4% vs. 26.9%), more likely to have a Glascow Coma Scale less than 14 (31.1% vs. 15.5%), and more likely to have an abnormal abdominal physical examination (93.3% vs. 65.7%) than patients that did not require acute intervention. All patients underwent computed tomography scan before intervention. Operations consisted of laparotomy (n = 21), laparoscopy converted to open (n = 11), and laparoscopy alone (n = 6). The most common surgical indications were hollow viscus injury (HVI) (11 small bowel, 10 colon, 6 small bowel/colon, 2 duodenum). All interventions for solid organ injury, including seven angioembolic procedures, occurred within 8 hours of arrival; many had hypotension and received a transfusion. Procedural interventions were more common for HVI than for solid organ injury (59.2% vs. 7.6%). Postoperative mortality from IAI was 2.6%. CONCLUSION Acute procedural interventions for children with IAI from BAT are rare, predominantly for HVI, are performed early in the hospital course and have excellent clinical outcomes. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.

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