BAPS paper
Pediatric pancreatic trauma: predictors of nonoperative management failure and associated outcomes

https://doi.org/10.1016/j.jpedsurg.2006.10.006Get rights and content

Abstract

Background

Nonoperative management (NOM) is an accepted treatment of pediatric solid organ injuries and is typically successful. Blunt pancreatic trauma tends to require operative intervention more frequently. We sought to identify predictors of failure of NOM and compare the outcome of operative management against NOM.

Methods

A retrospective analysis was performed from January 1993 to December 2002 of all children with blunt pancreatic injuries from the trauma registries of 7 designated level 1 pediatric trauma centers. Failure of NOM was defined as the need for intraabdominal operative intervention. Injuries were graded I to V, and ductal injury was defined as grades III to V. Parameters included mechanism of injury, injury severity score (ISS), organ grade, Glasgow Coma Scale score, and outcome. Data were analyzed by Fisher exact test and Mann-Whitney U test, with mean values ± SD and significance of P < .05.

Results

Pancreatic injuries were present in 173 (9.2%) of 1823 patients. Of these, 43 (26.0% [43/173]) required an operation. Valid morbidity data was obtained in 118 of 173 patients. ISS was significantly higher in all patients treated operatively. Patients with an injury of grade III to V failed NOM more frequently than all patients with pancreatic injury (P =.0169). Length of stay was longer, and the incidence of pseudocysts, drainage procedures, and pancreatitis was higher in NOM patients, although not significant.

Conclusions

Patients with pancreatic injuries had a NOM failure rate of 26.0%. ISS and injury grades III to V were predictors of NOM failure. Patients with pancreatic ductal injury require more aggressive management.

Section snippets

Methods

A multiinstitutional retrospective case review was conducted from January 1993 to December 2002 of all patients with blunt pancreatic injuries from the trauma registries of 7 designated level I pediatric trauma centers. (Table 1) Failure of nonoperative management was defined as the need for an intraabdominal operative intervention. Injuries were graded I to V according to Organ Injury Scaling of the American Association for the Surgery of Trauma. Ductal Injuries were defined as grades III to V.

Results

There were 1823 patients identified with blunt abdominal trauma, 173 with injury to the pancreas (9.5%). Forty-three patients with pancreatic injury required operative intervention (26.0%). Ductal injuries were present in 53, with 23 requiring an operation (43.4%). The mean age of patients treated nonoperatively was 7.84 years (range, 1 month to 17 years) and was 7.56 years (range, 1-17 years) in patients requiring an operation. Boys accounted for 63.3% of operative patients and 62.2% of those

Discussion

Current standard of care for injury to solid organs after blunt trauma is NOM. The optimal management of injury to the pancreas has been more controversial. A small number of studies in both the adult and pediatric literature have assessed the use of ERCP in patients with pancreatic injury [5], [6]. Several other studies have analyzed the treatment of pancreatic injuries, but few have compared operative treatment to NOM [1], [2], [3], [4], [5], [6], [7], [8]. The data in this study were

References (10)

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Presented as an oral presentation at the British Association of Paediatric Surgeons Conference in Stockholm, Sweden, July 18-21, 2006.

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