Nonoperative management of blunt hepatic and splenic injury in children

Annals of Surgery
S J BondJ G Randolph

Abstract

The authors assessed the risks of nonoperative management of solid visceral injuries in children (age range, 4 months-14 years) who were consecutively admitted to a level I pediatric trauma center during a 6-year period ending in 1991. One hundred seventy-nine children (5.0%) sustained injury to the liver or spleen. Nineteen children (11.2%) died. Of the 160 children who survived, 4 received emergency laparotomies; 156 underwent diagnostic computer tomography and were managed nonoperatively. The percentage of children who were successfully treated nonoperatively was 97.4%. Delayed diagnosis of enteric perforations occurred in two children. Fifty-three children (34.0%) received transfusions (mean volume 16.7 mL/kg); however, transfusion rates during the latter half of the study decreased from 50% to 19% in children with hepatic injuries, despite increasing grade of injury, and decreased from 57% to 23% in the splenic group with similar injury grade (p < 0.005, chi square test and Student's t test). Pediatric blunt hepatic and splenic trauma is associated with significant mortality. Nonoperative management based on physiologic parameters, rather than on computed tomography grading of organ injury, was highly successful, with few ...Continue Reading

References

Nov 1, 1976·The Journal of Trauma·S P Baker, B O'Neill
Jul 1, 1991·Injury·S CywesA J Millar
Jul 1, 1991·AJR. American Journal of Roentgenology·C J SivitM R Eichelberger
Dec 1, 1989·The Journal of Trauma·E E MooreM L Ramenofsky
Sep 1, 1989·AJR. American Journal of Roentgenology·D I BulasM R Eichelberger
Sep 1, 1989·Annals of Emergency Medicine·M R EichelbergerC S Gotschall
Aug 1, 1983·Journal of Pediatric Surgery·M P KarpT C Jewett
Jul 1, 1983·Radiology·M P Federle, R B Jeffrey
Oct 1, 1981·Surgery·D R KingE T Boles
Feb 1, 1993·AJR. American Journal of Roentgenology·D I BulasC S Gotschall

❮ Previous
Next ❯

Citations

Mar 16, 2004·Journal of Pediatric Surgery·Nicolas LutzPerry W Stafford
Jan 17, 2003·Critical Care Medicine·Barbara A Gaines, Henri R Ford
Apr 26, 2000·The Journal of Trauma·C S CocanourJ H Duke
May 24, 2000·The Journal of Trauma·D A PartrickF M Karrer
Jul 20, 2002·Current Opinion in Pediatrics·David P Mooney
Jun 11, 2003·Annals of Surgery·Joseph J TepasCarla DiScala
Aug 13, 2003·The Journal of Trauma·Oscar D GuillamondeguiMichael L Nance
Dec 31, 2005·The Journal of Trauma·Jordy C CoxMartin A Croce
Aug 19, 2006·The Journal of Trauma·Michael HurtukFred A Luchette
Dec 13, 2007·The Journal of Trauma·Monika TatariaSusan I Brundage
Aug 27, 1999·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·J F HolmesN Kuppermann
May 11, 2000·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·J F HolmesN Kuppermann
Apr 1, 2008·Journal of Indian Association of Pediatric Surgeons·Chrysostomos KepertisKonstantinos Kallergis
Jun 1, 2008·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Hugo T C VegerPaul J Bode
Jun 8, 2000·The New England Journal of Medicine·N S Adzick, M L Nance
Jan 30, 2013·The Journal of Surgical Research·James S DavisJuan E Sola
Jun 19, 2008·Journal of Pediatric Surgery·Marcene R McVaySamuel D Smith
Jan 22, 2008·Journal of Pediatric Surgery·Shawn D St PeterDaniel J Ostlie
Apr 1, 2006·Pediatric Clinics of North America·Stephen WegnerDonald Van Wie
Jun 24, 2005·ANZ Journal of Surgery·James Wood, Erik La Hei
Feb 3, 2012·ANZ Journal of Surgery·Anton E A FickRajendra Kumar
Dec 11, 1999·Journal of Pediatric Surgery·D A PartrickF M Karrer
Sep 15, 2004·Seminars in Pediatric Surgery·Martin S Keller
Apr 6, 2004·Journal of Pediatric Surgery·Jason C Fisher, Steven L Moulton
Jan 25, 2006·Annals of Emergency Medicine·Robert SteeleBismark Oh
Apr 26, 2005·Journal of the American College of Surgeons·J David Richardson
Jul 5, 2016·Disease Markers·Serdar BaygeldiBilsel Baç
Dec 19, 2001·Current Problems in Surgery·A B PeitzmanR N Townsend
Jan 7, 1998·The Journal of Trauma·D Shibata, R C Shamberger
Oct 21, 1999·The Journal of Trauma·M J ShapiroJ E Mazuski
Jul 1, 1997·The British Journal of Surgery·P D LostyD A Lloyd

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.