Routine Repeat Imaging of Pediatric Blunt Solid Organ Injuries Is Not Necessary

2021 ◽  
pp. 000313482110385
Author(s):  
Kelsey L. Fletcher ◽  
Mitchell Meagher ◽  
Brianna L. Spencer ◽  
Madison E. Morgan ◽  
Shawn D. Safford ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Clinical Status ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Solid Organ ◽  
Clinical Change ◽  
Organ Specific ◽  
Delayed Complications ◽  
Hepatic Injuries ◽  
Repeat Imaging

Introduction Nonoperative management of hemodynamically stable patients with blunt splenic and/or hepatic injury has been widely accepted in the pediatric population. However, variability exists in the utilization and timing of repeat imaging to assess for delayed complications during index hospitalization. Recent level-IV evidence suggests that repeat imaging in children should be performed based on a patient’s clinical status rather than on a routine basis. The aim of this study is to examine the rate of delayed complications and interventions in pediatric trauma patients with blunt splenic and/or hepatic injuries who undergo repeat imaging prompted either by a clinical change (CC) or non-clinical change (NCC). Methods A 9-year (2011-2019), retrospective, dual-institution study was performed of children (0-17 years) with blunt splenic and/or hepatic injuries. Patients were grouped based on reason for repeat imaging: CC or NCC. The rate of organ-specific delayed complications and interventions was examined by reason for scan. Results A total of 307 injuries were included in the study period (174 splenic, 113 hepatic, and 20 both). Of 194 splenic injuries, 30(15.5%) underwent repeat imaging (CC = 19; NCC = 11). Of 133 hepatic injuries, 27(20.3%) underwent repeat imaging (CC = 21; NCC = 6). There was no difference in the incidence of organ-specific delayed complications between the CC and NCC groups. Of the 4 patients with complications necessitating intervention, only one was identified based on NCC. Conclusions Our data suggest routine repeat imaging is unnecessary in children with blunt splenic and/or hepatic injuries; therefore, practitioners may rely on a patient’s clinical change.

The Frequency of Random Findings on Abdominal / Pelvis Computed Tomography in Pediatric Trauma Patients

2020 ◽  
Vol 16 ◽  
Author(s):  
Betül Tiryaki Baştuğ
Keyword(s):  
Computed Tomography ◽  
Incidental Findings ◽  
Pediatric Population ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Injured Child ◽  
Level 3 ◽  
Male Patients ◽  
Clinically Significant ◽  
Discharge Summaries

Aims: In this study, we aimed to find the percentage of random pathologies and abdominopelvic region anomalies that are not related to trauma in pediatric patients. Background: An abdominal assessment of an injured child usually involves computed tomography imaging of the abdomen and pelvis (CTAP) to determine the presence and size of injuries. Imaging may accidentally reveal irrelevant findings. Objectives: Although the literature in adults has reviewed the frequency of discovering these random findings, few studies have been identified in the pediatric population. Methods: Data on 142( 38 female, 104 male) patients who underwent CTAP during their trauma evaluation between January 2019 and January 2020 dates were obtained from our level 3 pediatric trauma center trauma records. The records and CTAP images were examined retrospectively for extra traumatic pathologies and anomalies. Results: 67 patients (47%) had 81 incidental findings. There were 17 clinically significant random findings. No potential tumors were found in this population. Conclusion: Pediatric trauma CTAP reveals random findings. For further evaluation, incidental findings should be indicated in the discharge summaries.

scholarly journals Effect of Under Triage on Early Mortality After Major Pediatric Trauma: A Registry-based Propensity Score Matching Analysis

2020 ◽  
Author(s):  
François-Xavier Ageron ◽  
Jordan Porteaud ◽  
Jean-Noël Evain ◽  
Anne Millet ◽  
Jules Greze ◽  
...  
Keyword(s):  
Propensity Score ◽  
Trauma Care ◽  
Pediatric Population ◽  
Pediatric Trauma ◽  
Trauma System ◽  
Early Death ◽  
Risk Difference ◽  
Early Mortality ◽  
Trauma Patients ◽  
Risk Of Death

Abstract Backgroundlittle is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24 hour-mortality after major pediatric trauma in a regional trauma systemMethodsThis cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24 hour-mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. ResultsA total of 1 143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 hours. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference: 6.0 [95% CI 1.3-10.7]) and Ps matching analyses (risk difference: 3.1 [95% CI 0.8-5.4]).ConclusionsIn a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.

Thrombelastography and Transfusion Patterns in Severely Injured Pediatric Trauma Patients with Blunt Solid Organ Injuries

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jenny Stevens ◽  
Kaci Pickett ◽  
Hunter Moore ◽  
Marina L. Reppucci ◽  
Ryan Phillips ◽  
...  
Keyword(s):  
Pediatric Trauma ◽  
Trauma Patients ◽  
Solid Organ ◽  
Severely Injured

scholarly journals Epidemiology and injury pattern in blunt trauma abdomen in pediatric population: a two-year experience in a tertiary care institute of Kashmir, India

2018 ◽  
Vol 5 (11) ◽  
pp. 3713
Author(s):  
Arshid Iqbal Qadri ◽  
Younis Ahmad ◽  
Gowhar Aziz Bhat ◽  
Aamir A. Khan ◽  
Khalid Bashir
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Predictive Value ◽  
Road Traffic ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Pediatric Trauma ◽  
Injury Pattern ◽  
Trauma Patients

Background: Blunt abdominal trauma is a frequent cause for presentation of children to the Emergency Department. Children are prone to sustain injuries to intra-abdominal organs after blunt abdominal trauma because of their peculiar body habitus and relatively immature musculoskeletal system. Objectives of this study is to assess the various epidemiological parameters that influences the causation of trauma as well as injury pattern in blunt trauma abdomen in pediatric population.Methods: The present observational hospital based prospective study was carried out in 96 blunt abdominal trauma patients of both sexes aged up to 12 years, over a period of 2 years. The parameters such as age group, sex, mode of trauma, type of injury, and the overall mortality as well as mortality were assessed.Results: The most common mode of injury was road traffic accidents (54.2%) followed by fall from height (41.70%). Splenic injury was the most common in 58.30%, followed by hepatic injuries 34.40% and renal injuries 12.50 %. The accuracy of ultrasonography (USG) was 83.33% while accuracy of computed tomography (CECT) as a diagnostic test was 93.33%. When comparing USG findings with operative findings sensitivity of USG was 88% with positive predictive value (PPV) of 91.66% while as specificity was 60% with negative predictive value (NPV) of 50%. Sensitivity of CT scan was 96.00% with PPV of 96.00% and specificity of CECT scan was 80.00% with NPV of 80.00%.Conclusions: The majority of pediatric injuries are preventable by knowing the epidemiology and pattern of pediatric trauma.

Continuous hemoglobin monitoring in pediatric trauma patients with solid organ injury

2018 ◽  
Vol 53 (10) ◽  
pp. 2055-2058 ◽  
Author(s):  
Emily Welker ◽  
Jennifer Novak ◽  
Lindsey Jelsma ◽  
Tracy Koehler ◽  
Alan Davis ◽  
...  
Keyword(s):  
Pediatric Trauma ◽  
Organ Injury ◽  
Trauma Patients ◽  
Solid Organ ◽  
Solid Organ Injury

Repeat Imaging in Blunt Hepatic Injuries Can Wait for Clinical Change

2021 ◽  
Vol 268 ◽  
pp. 119-124
Author(s):  
Kelsey L. Fletcher ◽  
Lindsey L. Perea ◽  
Madison E. Morgan ◽  
Banan W. Otaibi ◽  
Joshua P. Hazelton
Keyword(s):  
Clinical Change ◽  
Hepatic Injuries ◽  
Repeat Imaging

scholarly journals Effect of under triage on early mortality after major pediatric trauma: a registry-based propensity score matching analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
François-Xavier Ageron ◽  
◽  
Jordan Porteaud ◽  
Jean-Noël Evain ◽  
Anne Millet ◽  
...  
Keyword(s):  
Propensity Score ◽  
Trauma Care ◽  
Pediatric Population ◽  
Pediatric Trauma ◽  
Trauma System ◽  
Early Death ◽  
Risk Difference ◽  
Early Mortality ◽  
Trauma Patients ◽  
Risk Of Death

Abstract Background Little is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24-h mortality after major pediatric trauma in a regional trauma system. Methods This cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24-h mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. Results A total of 1143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 h. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference 6.0 [95% CI 1.3–10.7]) and Ps matching analyses (risk difference 3.1 [95% CI 0.8–5.4]). Conclusions In a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.

Pediatric Trauma Patients with Temporal Bone Fractures Are at Risk for Multiple Cranial CT Scans

2020 ◽  
Author(s):  
Joshua Ewy ◽  
Martin Piazza ◽  
Brian Thorp ◽  
Michael Phillips ◽  
Carolyn Quinsey
Keyword(s):  
At Risk ◽  
Temporal Bone ◽  
Bone Fractures ◽  
Pediatric Trauma ◽  
Ct Scans ◽  
Trauma Patients ◽  
Cranial Ct

Validation of the Surgical Intervention for Traumatic Injury scale in the pediatric population

2020 ◽  
Vol 26 (1) ◽  
pp. 92-97
Author(s):  
David Dornbos ◽  
Christy Monson ◽  
Andrew Look ◽  
Kristin Huntoon ◽  
Luke G. F. Smith ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Pediatric Population ◽  
Traumatic Injury ◽  
Pediatric Trauma ◽  
Current Method ◽  
Clinical Findings ◽  
Surgical Decompression ◽  
Operative Intervention ◽  
Admission Diagnosis ◽  
Communication Tool

OBJECTIVEWhile the Glasgow Coma Scale (GCS) has been effective in describing severity in traumatic brain injury (TBI), there is no current method for communicating the possible need for surgical intervention. This study utilizes a recently developed scoring system, the Surgical Intervention for Traumatic Injury (SITI) scale, which was developed to efficiently communicate the potential need for surgical decompression in adult patients with TBI. The objective of this study was to apply the SITI scale to a pediatric population to provide a tool to increase communication of possible surgical urgency.METHODSThe SITI scale uses both radiographic and clinical findings, including the GCS score on presentation, pupillary examination, and CT findings. To examine the scale in pediatric TBI, a neurotrauma database at a level 1 pediatric trauma center was retrospectively evaluated, and the SITI score for all patients with an admission diagnosis of TBI between 2010 and 2015 was calculated. The primary endpoint was operative intervention, defined as a craniotomy or craniectomy for decompression, performed within the first 24 hours of admission.RESULTSA total of 1524 patients met inclusion criteria for the study during the 5-year span: 1469 (96.4%) were managed nonoperatively and 55 (3.6%) patients underwent emergent operative intervention. The mean SITI score was 4.98 ± 0.31 for patients undergoing surgical intervention and 0.41 ± 0.02 for patients treated nonoperatively (p < 0.0001). The area under the receiver operating characteristic (AUROC) curve was used to examine the diagnostic accuracy of the SITI scale in this pediatric population and was found to be 0.98. Further evaluation of patients presenting with moderate to severe TBI revealed a mean SITI score of 5.51 ± 0.31 in 40 (15.3%) operative patients and 1.55 ± 0.02 in 221 (84.7%) nonoperative patients, with an AUROC curve of 0.95.CONCLUSIONSThe SITI scale was designed to be a simple, objective communication tool regarding the potential need for surgical decompression after TBI. Application of this scale to a pediatric population reveals that the score correlated with the perceived need for emergent surgical intervention, further suggesting its potential utility in clinical practice.

Sign in / Sign up

Export Citation Format

Share Document