TY - JOUR
T1 - Nonoperative management of solid organ injuries in children
T2 - Is it safe?
AU - Haller, J. Alex
AU - Papa, Pat
AU - Drugas, George
AU - Colombani, Paul
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 1994/6
Y1 - 1994/6
N2 - Objective: The authors reviewed their experience with life-threatening blunt injuries in approximately 2900 children (0-14 years) admitted to the designated state pediatric shock trauma unit between 1990 and 1993. Methods: During this time, the authors treated all severely injured children with a prospective, nonoperative protocol if they were hemodynamically stable after less than 40 mL/kg fluid replacement, had proven evidence of solid organ injuries and remained stable in the pediatric intensive care unit under surgical management. Results: Twenty-eight children had computed tomography (CT) or operatively proven lacerations of the spleen, 25 had lacerations of the liver, 18 had lacerations of the kidney, 7 had lacerations of the pancreas, and 11 had two or more solid organ injuries. Three of the 28 children with injured spleens required laparotomy (two splenectomy, one splenorrhaphy). Two of the 25 children with liver injuries required laparotomy (one suturing, one partial resection). One of the 18 children with kidney injuries required laparotomy (nephrectomy), and 3 of the 7 children with pancreas injuries required laparotomy (two resection, one pseudocyst). There were three deaths after laparotomy (two head, one chest/abdominal). There were no deaths in the children managed nonoperatively, and there were no immediate or long-range complications. Conclusions: Comparison of the authors' data with the National Pediatric Trauma Registry shows similar results. The authors believe that nonoperative management of solid organ injuries under careful surgical observation in a pediatric intensive care unit is safe and appropriate.
AB - Objective: The authors reviewed their experience with life-threatening blunt injuries in approximately 2900 children (0-14 years) admitted to the designated state pediatric shock trauma unit between 1990 and 1993. Methods: During this time, the authors treated all severely injured children with a prospective, nonoperative protocol if they were hemodynamically stable after less than 40 mL/kg fluid replacement, had proven evidence of solid organ injuries and remained stable in the pediatric intensive care unit under surgical management. Results: Twenty-eight children had computed tomography (CT) or operatively proven lacerations of the spleen, 25 had lacerations of the liver, 18 had lacerations of the kidney, 7 had lacerations of the pancreas, and 11 had two or more solid organ injuries. Three of the 28 children with injured spleens required laparotomy (two splenectomy, one splenorrhaphy). Two of the 25 children with liver injuries required laparotomy (one suturing, one partial resection). One of the 18 children with kidney injuries required laparotomy (nephrectomy), and 3 of the 7 children with pancreas injuries required laparotomy (two resection, one pseudocyst). There were three deaths after laparotomy (two head, one chest/abdominal). There were no deaths in the children managed nonoperatively, and there were no immediate or long-range complications. Conclusions: Comparison of the authors' data with the National Pediatric Trauma Registry shows similar results. The authors believe that nonoperative management of solid organ injuries under careful surgical observation in a pediatric intensive care unit is safe and appropriate.
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U2 - 10.1097/00000658-199406000-00005
DO - 10.1097/00000658-199406000-00005
M3 - Article
C2 - 8203971
AN - SCOPUS:0028271020
SN - 0003-4932
VL - 219
SP - 625
EP - 631
JO - Annals of surgery
JF - Annals of surgery
IS - 6
ER -