Management of pediatric blunt abdominal trauma with split liver or spleen injuries: a retrospective study

Zakaria, Ossama M; Daoud, Mahmoud; Zakaria, Hazem; Naim, Abdulrahman Al; Bshr, Fatemah A Al; Arfaj, Haytham Al; Abdulqader, Ahmad A Al; Mulhim, Khalid N Al; Buhalim, Mohamed A; Moslem, Abdulrahman R Al; Bubshait, M.; Alalwan, Qasem; Eid, Ahmed Fathi; AlAlwan, Mohammed Q; Albuali, Waleed H.; Hassan, Ahmed A.; Kamal, Ahmed Hassan; Majzoub, Rabab Abbas; AlAlwan, Abdullah; Saleh, Omar Abdelrahman

doi:10.1007/s00383-023-05379-0

Cited by 5 publications

(1 citation statement)

References 37 publications

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“…CEUS může být použito k dalšími sledování nejistých CT nálezů nebo ke sledování konzervativně zvládnutých traumat. (12,13) U dětí s předpokládaným závažným poraněním dutiny břišní nebo u dětí…”

Section: Otázka č 2: Je Břicho Zdrojem Krvácení?unclassified

Abdominal solid organ injuries in children - identification, basic principles of clinical evaluation and management

Trávníček,

Nowaková,

Dudík

et al. 2024

Ces-slov Pediat

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souhrn trávníček b, nowaková M, Dudík I, Pavlíček J. Úrazy břicha u dětí -identifikace, základní principy klinické rozvahy a léčbyPoranění břicha u dětí patří k významným úrazům, převažuje zavřený (tupý) typ poranění, nejčastěji poraněnými orgány jsou slezina, játra a ledviny. Při nerozpoznání poranění orgánů a intraabdominálního krvácení ohrožuje pacienta akutně vývoj hemoragického šoku nebo subakutně rozvoj infekčních komplikací. Důležité je správné klinické a zobrazovací vyšetření k identifikaci krvácení a stupně poškození orgánů a správně navržená terapie. Ze zobrazovacích metod se dnes nejlépe uplatňuje FAST (focused assessment with sonography in trauma) v kombinaci s CT (computer tomography) s podáním kontrastní látky. V léčbě břišních úrazů dětí dominuje konzervativní přístup a neoperační management, podmínkou je zajištění hemodynamické stability a optimální monitoring. Z invazivních terapeutických postupů je možné ošetření krvácení ve spolupráci s intervenčním radiologem nebo chirurgický zákrok. Při izolovaném poranění je prognóza dobrá, při kombinaci s polytraumatem nitrobřišní poranění zvyšuje mortalitu dítěte. Klíčová slova: dítě, chirurgický zákrok, úraz, nitrobřišní poranění, sonografie, hemoragický šok suMMary trávníček b, nowaková M, Dudík I, Pavlíček J. abdominal solid organ injuries in children -identification, basic principles of clinical evaluation and managementAbdominal trauma represents a significant type of injury in childhood, the majority being of a blunt mechanism. Organs the most commonly involved are spleen, liver and kidney. If not recongnised and managed in optimal timely manner, these injuries endanger a patient with acute haemorrhagic shock or subsequent development of infectious complications. To identify the source of bleeding and the grade of the injury, it is essential to provide an appropriate clinical as well as radiological examination, the most commonly used modalities being FAST and contrast -enhanced computer tomography (CT). In children, the majority of solid organ injuries are managed conservatively (non-operative management, NOM). For this approach, the haemodynamic stability of a child and appropriate monitoring are crucial conditions. Regarding the invasive management, both intervention radiology and surgery are possible (based on the the services available). In isolated solid organ injury the prognosis is usually good. However, if a part of polytrauma, solid organ injuries increase the mortality in children.

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Section: Otázka č 2: Je Břicho Zdrojem Krvácení?unclassified

Abdominal solid organ injuries in children - identification, basic principles of clinical evaluation and management

Trávníček,

Nowaková,

Dudík

et al. 2024

Ces-slov Pediat

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Diagnostic performance of contrast-enhanced ultrasound in traumatic solid organ injuries in children: a systematic review and meta-analysis

Jannatdoust,

Valizadeh,

Hassankhani

et al. 2024

Pediatr Radiol

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Background Blunt abdominal trauma (BAT) is a significant contributor to pediatric mortality, often causing liver and spleen injuries. Contrast-enhanced computed tomography (CT), the gold standard for diagnosing solid organ injury, poses radiation risks to children. Contrast-enhanced ultrasound (CEUS) may be a promising alternative imaging modality. Objectives To evaluate the diagnostic utility of CEUS for detecting solid organ injuries following BAT in the pediatric population. Methods A systematic review and meta-analysis were conducted through a thorough literature search in PubMed, Scopus, Web of Science, and Embase databases up to October 1, 2023. Diagnostic accuracy metrics were aggregated using a bivariate model, and subgroup meta-analysis compared CEUS accuracy across various organs. Results Meta-analysis from four studies, including 364 pediatric patients, revealed a pooled sensitivity of 88.5% (95%CI 82.5–92.6%) and specificity of 98.5% (95%CI 94.9–99.6%), with an area under the curve of 96% (95%CI 88 – 99%). Splenic injuries showed higher sensitivity than liver injuries (P-value < 0.01), while kidney assessments demonstrated higher specificity (P-value < 0.05). Conclusion This study highlights the diagnostic potential of CEUS for pediatric solid organ injuries caused by BAT. Further large-scale studies are needed due to the limited number and sample size of the included studies.

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Single centre analysis of factors influencing surgical treatment of splenic trauma in children

Zhao,

Hao,

et al. 2024

Journal of Tropical Pediatrics

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Objective This study aims to investigate determinants impacting the surgical management of splenic trauma in paediatric patients by scrutinizing age distribution, etiological factors and concomitant injuries. The analysis seeks to establish a foundation for delineating optimal operative timing. Methods A cohort of 262 paediatric cases presenting with splenic trauma at our institution from January 2011 to December 2021 underwent categorization into either the conservative or operative group. Results Significantly disparate attributes between the two groups included age, time of presentation, blood pressure, haemoglobin levels, blood transfusion requirements, thermal absorption, American Association for the Surgery of Trauma (AAST) classification and associated injuries. Logistic regression analysis revealed age, haemoglobin levels, AAST classification and blood transfusion as autonomous influencers of surgical intervention (OR = 1.024, 95% CI: 1.011–1.037; OR = 1.067, 95% CI: 1.01–1.127; OR = 0.2760, 95% CI: 0.087–0.875; OR = 7.873, 95% CI: 2.442–25.382; OR = 0.016, 95% CI: 0.002–0.153). The AAST type and age demonstrated areas under the receiver operating characteristic (ROC) curve of 0.782 and 0.618, respectively. Conclusion Age, haemoglobin levels, AAST classification and blood transfusion independently influence the decision for surgical intervention in paediatric patients with splenic trauma. Age and AAST classification emerge as viable parameters for assessing and prognosticating the likelihood of surgical intervention in this patient cohort.

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Management of pediatric blunt abdominal trauma with split liver or spleen injuries: a retrospective study

Cited by 5 publications

References 37 publications

Abdominal solid organ injuries in children - identification, basic principles of clinical evaluation and management

Abdominal solid organ injuries in children - identification, basic principles of clinical evaluation and management

Diagnostic performance of contrast-enhanced ultrasound in traumatic solid organ injuries in children: a systematic review and meta-analysis

Single centre analysis of factors influencing surgical treatment of splenic trauma in children

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