[PDF][PDF] Associated factors to non-operative management failure of hepatic and splenic lesions secondary to blunt abdominal trauma in children

AE Medina, CHM Uribe, VMV Marín… - Rev. Chil …, 2017 - pdfs.semanticscholar.org
AE Medina, CHM Uribe, VMV Marín, JAM Montoya, DF Aguillón
Rev. Chil. Pediatr, 2017pdfs.semanticscholar.org
Introduction: The non operative management (NOM) is the standard management of splenic
and liver blunt trauma in pediatric patients. Hemodynamic instability and massive
transfusions have been identified as management failures. Few studies evaluate whether
there exist factors allowing anticipation of these events. The objective was to identify factors
associated with the failure of NOM in splenic and liver injuries for blunt abdominal trauma.
Patients and Method: Retrospective analysis between 2007-2015 of patients admitted to the …
Introduction
The non operative management (NOM) is the standard management of splenic and liver blunt trauma in pediatric patients. Hemodynamic instability and massive transfusions have been identified as management failures. Few studies evaluate whether there exist factors allowing anticipation of these events. The objective was to identify factors associated with the failure of NOM in splenic and liver injuries for blunt abdominal trauma.
Patients and Method
Retrospective analysis between 2007-2015 of patients admitted to the pediatric surgery at University Hospital Saint Vincent Foundation with liver trauma and/or closed Spleen.
Results
70 patients were admitted with blunt abdominal trauma, 3 were excluded for immediate surgery (2 hemodynamic instability, 1 peritoneal irritation). Of 67 patients who received NOM, 58 were successful and 9 showed failure (8 hemodynamic instability, 1 hollow viscera injury). We found 3 factors associated with failure NOM: blood pressure (BP)< 90 mmHg at admission (p= 0.0126; RR= 5.19), drop in hemoglobin (Hb)> 2 g/dl in the first 24 hours (p= 0.0009; RR= 15.3), and transfusion of 3 or more units of red blood cells (RBC)(0.00001; RR= 17.1). Mechanism and severity of trauma and Pediatric Trauma Index were not associated with failure NOM.
Conclusions
Children with blunted hepatic or splenic trauma respond to NOM. Factors such as BP< 90 mmHg at admission, an Hb fall> 2 g/dl in the first 24 hours and transfusion of 3 or more units of RBC were associated with the failure in NOM.
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