National trends in pediatric blunt spleen and liver injury management and potential benefits of an abbreviated bed rest protocol

Factores asociados a falla en el manejo no operatorio de lesiones hepáticas o esplénicas secundarias a trauma abdominal cerrado en niños

“…Certain conditions have been associated with this fact, such as severe hepatic or splenic lesions (IV-V), since the more severe the lesion, the greater the probability of hemodynamic instability or association with injury to other organs, the hemoperitoneum abundant (3-4 quadrants), pseudoaneurysms and/or leakage of radiological contrast IV in CAT 1,[12][13][14]24,27,28,36 . However, other series have shown that 61-86% of grade IV lesions and 32-77% of grade V lesions (in the absence of hemodynamic instability) have been treated conservatively 6,7,[12][13][14][15]22 , and it does not matter the age, gender, mechanism of trauma and degree of injury 13,17 , because it is hemodynamic instability the one that does not show improvement after 6 hours of adequate resuscitation, which predicts almost a 100% of correlation between the need for laparotomy and splenectomy in children with closed trauma spleen 29 . The above is clear, a periodic evaluations by trained personnel are necessary in order to allow the early detection of the surgical interventions need and to identify patients at high risk, avoiding failure of NOM 6,7,[12][13][14][15]23,27,[29][30][31] .…”

“…The NOM complications are low, with an overall morbidity rate of 25% and mortality < 5%, counting among the advantages 1,6,7,[20][21][22][23] : less hospital and ICU stay, lower incidence of infections and less need for transfusion compared to conventional surgical management. The main complications reported are 1,4,7,11,[18][19][20][21][22] : bleeding, biliary leakage (biliary fistula, bilioma) 24 , arterial pseudoaneurysm with hemobilia, abdominal compartment syndrome, presence of other inadvertent visceral lesions, hepatic, gallbladder or splenic necrosis, hepatic or splenic abscess and left pleural effusion in splenic lesions 25 .…”

“…The main complications reported are 1,4,7,11,[18][19][20][21][22] : bleeding, biliary leakage (biliary fistula, bilioma) 24 , arterial pseudoaneurysm with hemobilia, abdominal compartment syndrome, presence of other inadvertent visceral lesions, hepatic, gallbladder or splenic necrosis, hepatic or splenic abscess and left pleural effusion in splenic lesions 25 . In our series, the rate of complications was very low in 6.8% of the patients in the successful NOM group, 50% of which were due to rebleeding with a mortality rate lower than that reported in other series presenting only in 1 patient with hypovolemic shock.…”

Pediatric Blunt Solid Organ Injury: Beyond the APSA Guidelines

“…There was no literature about early discharge, and case reports of delayed bleeding provided no denominators to gauge the risk [22]. The same studies that evaluated an abbreviated period of bedrest, also evaluated early discharge [ [23].…”

Review of pediatric abdominal trauma: operative and non‐operative treatment in combined adult and pediatric trauma center

“…3 Over the past several decades, the care of abdominal trauma has changed dramatically as non-operative management has become the standard of care. [4][5][6][7][8] More than 90% of pediatric solid organ abdominal injuries are treated non-operatively. However, it is certain that some of the patients need operative treatment.…”