Solid organ injury in blunt trauma abdomen in pediatric patients

Abstract

Background: Children and young people are most often killed and disabled by accidents. Blunt trauma accounts for more than 90% of traumatic mechanisms of injury in children. Blunt abdominal trauma accounts for between 10 and 15% of all blunt mechanisms. The establishment of the present non-operative treatment for the majority of blunt solid organ injuries in the pediatric age group was prompted by observations that most blunt solid organ injuries will heal on their own and that surgical intervention would thwart this mechanism. Aim: This is a prospective observational study done in department of pediatrics surgery in SMS medical college and hospital from January 2022 to July 2023. The aim of this study is to determine the management of solid organ injuries in blunt trauma abdomen (BTA) in children whether to conserve or operate at tertiary health care center in high patient load hospital in India. Methodology: 116 patients with blunt abdominal trauma due to any cause, the medical records of all patients with trauma of any kind age up to 13 years were carefully reviewed. The injured organ, patient age, sex, injury grade, imaging findings, intervention, length of hospital stay, and complications were prospectively reviewed using medical records. Initial resuscitation was done according to ATLS protocol. Ultimate management decision was based on stability of patients after resuscitation. Data was entered and analyzed through SPSS-26. Chi-square test and student's t-test were applied and P value <0.05 was considered statistically significant. Results: The mean age was 5.34 years. Most of the patients suffered from road traffic accident, 50(86.2%). 104 (89.65%) patients showed free fluid in the abdomen. CT abdomen with intravenous contrast confirmed findings of ultra sonography. Despite resuscitation, 12 (10.6%) patients remained unstable and were operated. 104 [89.4%] patients were kept on conservative treatment. Hospital stays ranged from 5-19 days. Pancreatic injury patient has more hospital stay. Conclusion: BTA is common in boys under age of 10 years. Although non-operative management is the treatment of choice in blunt trauma abdomen with solid organ injury but stability of the injured child is the central pivot around which the whole management revolves. Delay in presentation and failure of timely resuscitation results into high operative intervention.