Acute Procedural Interventions Following Pediatric Blunt Abdominal Trauma: A Prospective Multicenter Evaluation.

BACKGROUND: Pediatric intraabdominal 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 <16 years following BAT at 14 Level-One Pediatric Trauma Centers over a 1-year period. Patients with IAI who received an intervention (IAI-I) were compared to those who did not receive an intervention using descriptive statistics and univariate analysis; p < 0.05 was considered significant.

RESULTS: 261 of 2188 patients (11.9%) had IAI. 45 IAI patients (17.2%) received an acute procedural intervention (38 operations, 7 angiographic embolization). The mean age for patients requiring intervention was 7.1+/-4.1 years and not different from the population. The majority of patients with IAI-I were normotensive (88.9%). IAI-I patients were significantly more likely to have a mechanism of MVC (66.7% vs. 38.9%), more likely to present as a level I activation (44.4% vs. 26.9%), more likely to have a GCS < 14 (31.1% vs. 15.5%), and more likely to have an abnormal abdominal physical exam (93.3% vs. 65.7%) than patients that did not require acute intervention. All patients underwent CT 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 (SOI), including 7 angioembolic procedures, occurred within 8 hours of arrival; many had hypotension and received a transfusion. Procedural interventions were more common for HVI than for SOI (59.2% vs. 7.6%). Post-operative mortality from IAI was 2.6%.

CONCLUSIONS: 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.