Non-operative management of solid organ injuries in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review

Robert L. Gates, Mitchell Price, Danielle B. Cameron, Stig Somme, Robert Ricca, Tolulope A. Oyetunji, Yigit S. Guner, Ankush Gosain, Robert Baird, Dave R. Lal, Timothy Jancelewicz, Julia Shelton, Karen A. Diefenbach, Julia Grabowski, Akemi Kawaguchi, Roshni Dasgupta, Cynthia Downard, Adam Goldin, John K. Petty, Steven StylianosRegan Williams

Research output: Contribution to journalReview article

Abstract

Purpose: The American Pediatric Surgical Association (APSA) guidelines for the treatment of isolated solid organ injury (SOI) in children were published in 2000 and have been widely adopted. The aim of this systematic review by the APSA Outcomes and Evidence Based Practice Committee was to evaluate the published evidence regarding treatment of solid organ injuries in children. Methods: A comprehensive search strategy was crafted and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Four principal questions were examined based upon the previously published consensus APSA guidelines regarding length of stay (LOS), activity level, interventional radiologic procedures, and follow-up imaging. A literature search was performed including multiple databases from 1996 to 2016. Results: LOS for children with isolated solid organ injuries should be based upon clinical findings and may not be related to grade of injury. Total LOS may be less than recommended by the previously published APSA guidelines. Restricting activity to grade of injury plus two weeks is safe but shorter periods of activity restriction have not been adequately studied. Prophylactic embolization of SOI in stable patients with image-confirmed arterial extravasation is not indicated and should be reserved for patients with evidence of ongoing bleeding. Routine follow-up imaging for asymptomatic, uncomplicated, low-grade injured children with abdominal blunt trauma is not warranted. Limited data are available to support the need for follow-up imaging for high grade injuries. Conclusion: Based upon review of the recent literature, we recommend an update to the current APSA guidelines that includes: hospital length of stay based on physiology, shorter activity restrictions may be safe, minimizing post-injury imaging for lower injury grades and embolization only in patients with evidence of ongoing hemorrhage. Type of Study: Systematic Review. Levels of Evidence: Levels 2–4.

Original languageEnglish (US)
Pages (from-to)1519-1526
Number of pages8
JournalJournal of pediatric surgery
Volume54
Issue number8
DOIs
StatePublished - Aug 1 2019

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Evidence-Based Practice
Advisory Committees
Pediatrics
Wounds and Injuries
Length of Stay
Guidelines
Hemorrhage
Meta-Analysis
Databases

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Non-operative management of solid organ injuries in children : An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. / Gates, Robert L.; Price, Mitchell; Cameron, Danielle B.; Somme, Stig; Ricca, Robert; Oyetunji, Tolulope A.; Guner, Yigit S.; Gosain, Ankush; Baird, Robert; Lal, Dave R.; Jancelewicz, Timothy; Shelton, Julia; Diefenbach, Karen A.; Grabowski, Julia; Kawaguchi, Akemi; Dasgupta, Roshni; Downard, Cynthia; Goldin, Adam; Petty, John K.; Stylianos, Steven; Williams, Regan.

In: Journal of pediatric surgery, Vol. 54, No. 8, 01.08.2019, p. 1519-1526.

Research output: Contribution to journalReview article

Gates, RL, Price, M, Cameron, DB, Somme, S, Ricca, R, Oyetunji, TA, Guner, YS, Gosain, A, Baird, R, Lal, DR, Jancelewicz, T, Shelton, J, Diefenbach, KA, Grabowski, J, Kawaguchi, A, Dasgupta, R, Downard, C, Goldin, A, Petty, JK, Stylianos, S & Williams, R 2019, 'Non-operative management of solid organ injuries in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review', Journal of pediatric surgery, vol. 54, no. 8, pp. 1519-1526. https://doi.org/10.1016/j.jpedsurg.2019.01.012
Gates, Robert L. ; Price, Mitchell ; Cameron, Danielle B. ; Somme, Stig ; Ricca, Robert ; Oyetunji, Tolulope A. ; Guner, Yigit S. ; Gosain, Ankush ; Baird, Robert ; Lal, Dave R. ; Jancelewicz, Timothy ; Shelton, Julia ; Diefenbach, Karen A. ; Grabowski, Julia ; Kawaguchi, Akemi ; Dasgupta, Roshni ; Downard, Cynthia ; Goldin, Adam ; Petty, John K. ; Stylianos, Steven ; Williams, Regan. / Non-operative management of solid organ injuries in children : An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. In: Journal of pediatric surgery. 2019 ; Vol. 54, No. 8. pp. 1519-1526.
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AU - Cameron, Danielle B.

AU - Somme, Stig

AU - Ricca, Robert

AU - Oyetunji, Tolulope A.

AU - Guner, Yigit S.

AU - Gosain, Ankush

AU - Baird, Robert

AU - Lal, Dave R.

AU - Jancelewicz, Timothy

AU - Shelton, Julia

AU - Diefenbach, Karen A.

AU - Grabowski, Julia

AU - Kawaguchi, Akemi

AU - Dasgupta, Roshni

AU - Downard, Cynthia

AU - Goldin, Adam

AU - Petty, John K.

AU - Stylianos, Steven

AU - Williams, Regan

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N2 - Purpose: The American Pediatric Surgical Association (APSA) guidelines for the treatment of isolated solid organ injury (SOI) in children were published in 2000 and have been widely adopted. The aim of this systematic review by the APSA Outcomes and Evidence Based Practice Committee was to evaluate the published evidence regarding treatment of solid organ injuries in children. Methods: A comprehensive search strategy was crafted and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Four principal questions were examined based upon the previously published consensus APSA guidelines regarding length of stay (LOS), activity level, interventional radiologic procedures, and follow-up imaging. A literature search was performed including multiple databases from 1996 to 2016. Results: LOS for children with isolated solid organ injuries should be based upon clinical findings and may not be related to grade of injury. Total LOS may be less than recommended by the previously published APSA guidelines. Restricting activity to grade of injury plus two weeks is safe but shorter periods of activity restriction have not been adequately studied. Prophylactic embolization of SOI in stable patients with image-confirmed arterial extravasation is not indicated and should be reserved for patients with evidence of ongoing bleeding. Routine follow-up imaging for asymptomatic, uncomplicated, low-grade injured children with abdominal blunt trauma is not warranted. Limited data are available to support the need for follow-up imaging for high grade injuries. Conclusion: Based upon review of the recent literature, we recommend an update to the current APSA guidelines that includes: hospital length of stay based on physiology, shorter activity restrictions may be safe, minimizing post-injury imaging for lower injury grades and embolization only in patients with evidence of ongoing hemorrhage. Type of Study: Systematic Review. Levels of Evidence: Levels 2–4.

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