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Pediatric liver trauma

Jessica A Zagory, Avafia Dossa, Jamie Golden, Aaron R Jensen, Catherine J Goodhue, Jeffrey S Upperman, Christopher P Gayer
PURPOSE: Current guidelines for computed tomography (CT) after blunt trauma were developed to capture all intra-abdominal injuries (IAI). We hypothesize that current AST/ALT guidelines are too low leading to unnecessary CT scans for children after blunt abdominal trauma (BAT). METHODS: Patients who received CT of the abdomen after blunt trauma at our Level I Pediatric Trauma Center were stratified into a high risk (HR) (liver/spleen/kidney grade ≥III, hollow viscous, or pancreatic injuries) and low risk (LR) (liver/kidney/spleen injuries grade ≤II, or no IAI) groups...
November 23, 2016: Pediatric Surgery International
Farrokh Taftachi, Leyla Abdolkarimi, Maryam Ameri, Azadeh Memarian, Alireza Behzadi, Hooman Bakhshandeh
Adrenal hematoma is a common hidden catastrophic complication in pediatric victims of multiple blunt traumas. Adrenal hematoma has no obvious symptoms and may not be detected by diagnostic methods such as magnetic resonance imaging, computed tomography scan, and sonography; consequently, this complication may be neglected in children with multiple blunt traumas and cause death through sudden adrenal crisis.The current study was conducted on 55 dead children (<13 y) and 110 matured youths (13-17 y) who died in consequence of multiple blunt traumas, comprising car crashes, fall from heights, and falling debris...
August 4, 2016: Global Journal of Health Science
Maria E Linnaus, David M Notrica, Crystal S Langlais, Shawn D St Peter, Charles M Leys, Daniel J Ostlie, R Todd Maxson, Todd Ponsky, David W Tuggle, James W Eubanks, Amina Bhatia, Adam C Alder, Cynthia Greenwell, Nilda M Garcia, Karla A Lawson, Prasenjeet Motghare, Robert W Letton
BACKGROUND: Age-adjusted pediatric shock index (SIPA) does not require knowledge of age-adjusted blood pressure norms, yet correlates with mortality, serious injury, and need for transfusion in trauma. No prospective studies support its validity. METHODS: A multicenter prospective observational study of patients 4-16years presenting April 2013-January 2016 with blunt liver and/or spleen injury (BLSI). SIPA (maximum heart rate/minimum systolic blood pressure) thresholds of >1...
September 23, 2016: Journal of Pediatric Surgery
Nathan Vaughan, Jeff Tweed, Cynthia Greenwell, David M Notrica, Crystal S Langlais, Shawn D St Peter, Charles M Leys, Daniel J Ostlie, R Todd Maxson, Todd Ponsky, David W Tuggle, James W Eubanks, Amina Bhatia, Cynthia Greenwell, Nilda M Garcia, Karla A Lawson, Prasenjeet Motghare, Robert W Letton, Adam C Alder
INTRODUCTION: Obesity is an epidemic in the pediatric population. Childhood obesity in trauma has been associated with increased incidence of long-bone fractures, longer ICU stays, and decreased closed head injuries. We investigated for differences in the likelihood of failure of non-operative management (NOM), and injury grade using a subset of a multi-institutional, prospective database of pediatric patients with solid organ injury (SOI). METHODS: We prospectively collected data on all pediatric patients (<18years) admitted for liver or splenic injury from September 2013 to January 2016...
September 13, 2016: Journal of Pediatric Surgery
Alexis Strickler, Natalia Vásquez, Leonardo Maggi, Juvenal Hernández, Ximena Hidalgo
Human toxocarosis is a chronic larval parasitosis listed as one of the five most important neglected diseases by the CDC. The larvae can spread systemically and migrate to different tissues including liver and gallbladder. Acalculous acute cholecystitis (AAC) is a rare disease in children. The diagnosis is based on clinical parameters and imaging criteria. It has been reported in relation to sepsis, shock, trauma, burns, severe systemic diseases, congenital anomalies, infections and also in healthy children...
June 2016: Revista Chilena de Infectología: órgano Oficial de la Sociedad Chilena de Infectología
Peter James Bruhn, Lene Østerballe, Jens Hillingsø, Lars Bo Svendsen, Frederik Helgstrand
BACKGROUND: Computed tomography (CT) is the gold standard in the initial evaluation of the hemodynamically stable patient with suspected liver trauma. However, the adverse effects of radiation exposure are of specific concern in the pediatric population. It is therefore desirable to explore alternative diagnostic modalities. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are hepatic enzymes, which are elevated in peripheral blood in relation to liver injury. The aim of the present study was to investigate a potential role of normal liver transaminase levels in the decision algorithm in suspected pediatric blunt liver trauma...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Jonathan E Kohler, Nikunj K Chokshi
Injury to the solid abdominal organs-liver, spleen, kidney, and pancreas-is one of the most common injury patterns in pediatric blunt trauma. Pediatric trauma centers are becoming increasingly successful in managing these injuries without operative intervention. Well-validated guidelines have been established for liver and spleen injury management, and operative intervention is reserved for patients who show evidence of active bleeding after resuscitation. No such guidelines yet exist for the management of traumatic injury of the kidney or pancreas...
July 1, 2016: Pediatric Annals
Martha-Conley E Ingram, Ragavan V Siddharthan, Andrew D Morris, Sarah J Hill, Curtis D Travers, Courtney E McKracken, Kurt F Heiss, Mehul V Raval, Matthew T Santore
BACKGROUND: There are no widely accepted guidelines for management of pediatric patients who have evidence of solid organ contrast extravasation ("blush") on computed tomography (CT) scans following blunt abdominal trauma. We report our experience as a Level 1 pediatric trauma center in managing cases with hepatic and splenic blush. METHODS: All pediatric blunt abdominal trauma cases resulting in liver or splenic injury were queried from 2008 to 2014. Patients were excluded if a CT was unavailable in the medical record...
August 2016: Journal of Trauma and Acute Care Surgery
Vittorio Miele, Claudia Lucia Piccolo, Margherita Trinci, Michele Galluzzo, Stefania Ianniello, Luca Brunese
Trauma is a leading cause of morbidity and mortality in childhood, and blunt trauma accounts for 80-90 % of abdominal injuries. The mechanism of trauma is quite similar to that of the adults, but there are important physiologic differences between children and adults in this field, such as the smaller blood vessels and the high vasoconstrictive response, leading to the spreading of a non-operative management. The early imaging of children undergoing a low-energy trauma can be performed by CEUS, a valuable diagnostic tool to demonstrate solid organ injuries with almost the same sensitivity of CT scans; nevertheless, as for as urinary tract injuries, MDCT remains still the technique of choice, because of its high sensitivity and accuracy, helping to discriminate between an intra-peritoneal form a retroperitoneal urinary leakage, requiring two different managements...
May 2016: La Radiologia Medica
Abdullah Emre Yıldırım, Reskan Altun, Serkan Ocal, Murat Kormaz, Figen Ozcay, Haldun Selcuk
Experience with endoscopic retrograde cholangiopancreatography in the pediatric population is limited. The aim of this study was to evaluate the outcomes of ERCP in the pediatric population performed by adult gastroenterologists with standard duodenoscopes. This study is a structured retrospective review of endoscopic reports, computerized and paper medical records, and radiographic images of patients under the age of 18 who underwent ERCP for any indication at a tertiary referral centre. Data regarding demographic characteristics and medical history of patients, indications, technical success rate, final clinical diagnosis, and complications were analyzed...
2016: SpringerPlus
Elsa Rosado, Michael Riccabona
OBJECTIVES: The purpose of this study was to collect and analyze the published data related to intravenous (IV) use of ultrasound (US) contrast agents in children. METHODS: We searched the literature to collect all of the published studies reporting the IV administration of a second-generation US contrast agent in children. RESULTS: We analyzed 9 case series and 5 case reports, as well as 5 individual cases, of pediatric contrast-enhanced US use reported in a study group that also included adults...
March 2016: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Shannon N Acker, Branden Petrun, David A Partrick, Genie E Roosevelt, Denis D Bensard
BACKGROUND: Current management protocols for children with blunt solid organ injury to the liver and spleen call for serial monitoring of the child's hemoglobin and hematocrit every 6, 12, or 24 hours, depending on the injury grade. We hypothesized that children who require emergent intervention in the form of laparotomy, angioembolization, or packed red blood cell (PRBC) transfusion because of bleeding from a solid organ injury will have changes in their vital signs that alert the clinician to the need for intervention, making scheduled laboratory evaluation unnecessary...
December 2015: Journal of Trauma and Acute Care Surgery
Natalie Durkin, Annamaria Deganello, Maria E Sellars, Paul S Sidhu, Mark Davenport, Erica Makin
BACKGROUND: Pseudoaneurysm (PA) formation following blunt and penetrating abdominal trauma is a recognized complication in solid organ injury, usually diagnosed by contrast-enhanced CT (CECT) imaging. Delayed rupture is a potentially life-threatening event, although its frequency is not known in pediatric trauma. Contrast enhanced ultrasound (CEUS) is a novel radiation-free alternative to CECT with the potential to identify PA. METHODS: A retrospective review of consecutive cases of significant liver and splenic injuries admitted to single institution (tertiary and quaternary referrals) over more than a 12year period was performed...
February 2016: Journal of Pediatric Surgery
Vittorio Miele, Claudia Lucia Piccolo, Michele Galluzzo, Stefania Ianniello, Barbara Sessa, Margherita Trinci
Baseline ultrasound is essential in the early assessment of patients with a huge haemoperitoneum undergoing an immediate abdominal surgery; nevertheless, even with a highly experienced operator, it is not sufficient to exclude parenchymal injuries. More recently, a new ultrasound technique using second generation contrast agents, named contrast-enhanced ultrasound (CEUS) has been developed. This technique allows all the vascular phase to be performed in real time, increasing ultrasound capability to detect parenchymal injuries, enhancing some qualitative findings, such as lesion extension, margins and its relationship with capsule and vessels...
2016: British Journal of Radiology
Nedeljka Glavan, Gordana Zamolo, Miljenko Katunarić, Nives Jonjić
No abstract text is available yet for this article.
2015: Acta Dermatovenerologica Croatica: ADC
Arash Safavi, Erik D Skarsgard, Peter Rhee, Bardiya Zangbar, Narong Kulvatunyou, Andrew Tang, Terence O'Keeffe, Randall S Friese, Bellal Joseph
BACKGROUND: Nonoperative management of hemodynamically stable children with Solid Organ Injury (SOI) has become standard of care. The aim of this study is to identify differences in management of children with SOI treated at Adult Trauma Centers (ATC) versus Pediatric Trauma Centers (PTC). We hypothesized that patients treated at ATC would undergo more procedures than PTC. METHODS: Patients younger than 18 years old with isolated SOI (spleen, liver, kidney) who were treated at level I-II ATC or PTC were identified from the 2011-2012 National Trauma Data Bank...
March 2016: Journal of Pediatric Surgery
David M Notrica, James W Eubanks, David W Tuggle, Robert Todd Maxson, Robert W Letton, Nilda M Garcia, Adam C Alder, Karla A Lawson, Shawn D St Peter, Steve Megison, Pamela Garcia-Filion
BACKGROUND: Nonoperative management of liver and spleen injury should be achievable for more than 95% of children. Large national studies continue to show that some regions fail to meet these benchmarks. Simultaneously, current guidelines recommend hospitalization for injury grade + 2 (in days). A new treatment algorithm, the ATOMAC guideline, is in clinical use at many centers but has not been prospectively validated. METHODS: A literature review conducted through MEDLINE identified publications after the American Pediatric Surgery Association guidelines using the search terms blunt liver trauma pediatric, blunt spleen trauma pediatric, and blunt abdominal trauma pediatric...
October 2015: Journal of Trauma and Acute Care Surgery
Chinwendu Onwubiko, David P Mooney
INTRODUCTION: Historically, computed tomography (CT) scans of injured children obtained at referring emergency departments were not reinterpreted by trauma center radiologists at our institution, creating a dilemma for trauma physicians: rescan, use the outside interpretation, or interpret scans themselves. In 2010, our radiologists began reinterpreting all referring hospital trauma CT scans; this study examines the effect of that change. METHODS: Transferred patients who had undergone an abdomen/pelvis CT (CTAP) scan between December 2010 and December 2012 were identified in our trauma registry...
March 2016: Journal of Pediatric Surgery
Leslie A Dervan, Mary A King, Joseph Cuschieri, Frederick P Rivara, Noel S Weiss
BACKGROUND: Although nonoperative management has become the standard of care for solid organ injury, variability exists in the care patients receive, and there are limited data regarding nonoperative management in patients with high grades of organ injury and substantial overall injury. We aimed to evaluate operative intervention frequency, including splenectomy, and patient outcomes before and after institution of the pediatric solid organ injury pathway at Harborview Medical Center (HMC) in 2005...
August 2015: Journal of Trauma and Acute Care Surgery
Calista M Harbaugh, Maksim A Shlykov, Ryan E Tsuchida, Sven A Holcombe, Jake Hirschl, Stewart C Wang, Peter F Ehrlich
BACKGROUND: Motor vehicle crashes are the leading cause of injury-related mortality in children, with a higher rate of multiorgan injuries than in adults. This may be related to increased solid organ volume relative to abdominal cavity and decreased protection of an underdeveloped cartilaginous rib cage in young children. To date, these anatomic relationships have not been fully described. Our study used analytic morphomics to obtain precise measures of the pediatric liver, spleen, kidneys, and ribs...
June 2015: Journal of Trauma and Acute Care Surgery
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