Selective conservatism is the key to the rational management of pediatric trauma, realizing that children may harbour severe occult injuries. The modern treatment of childhood abdominal trauma best exemplifies this approach: nonoperative management of splenic trauma is now standard for children, and a selective conservative approach is advised in the handling of childhood liver and pancreatic injuries. Prevention of childhood injuries should be the goal. The development of a national database of childhood trauma should provide the basis for action to educate and legislate for prevention. When prevention fails, however, up-to-date quality pediatric trauma care is the key.
A retrospective study of intra-abdominal injuries treated during the ten-year period 1977 to 1986, show that road traffic accidents were responsible for the injury in 38% of 221 patients. Accidents from sports and recreation were the cause in 23% of the cases. The median age was 19 years. Renal injuries were most common, followed by splenic injuries. 119 patients (54%) were operated for abdominal injury. 90 patients (41%) needed blood transfusions and 29 (13%) were treated by respirator. 95 patients had concommitant extraabdominal injuries. The overall lethality was 9%.
Non-operative management of splenic injuries has become the treatment of choice in hemodynamically stable patients over the last decades. The aim of the study is to describe the incidence, initial treatment and early outcome of patients with splenic injuries on a national level.
All hospitals in Norway admitting trauma patients were invited to participate in the study. The study period was January through December 2013. The hospitals delivered anonymous data on primarily admitted patients with splenic injury.
Three of the four regional trauma centers and 26 of the remaining 33 acute care hospitals delivered data on a total of 151 patients with splenic injury indicating an incidence of 4 splenic injuries per 100,000 inhabitants/year, and a median of 4 splenic injuries per hospital per year. A total of 128 (85%) patients were successfully treated non-operatively including 20 patients who underwent an angiographic procedure. The remaining 23 (15%) patients underwent open splenectomy or spleen-preserving surgery.
Most patients with splenic injuries are managed non-operatively. Despite the low number of splenic injuries per hospital, the results indicate satisfactory outcome on a national level.
With the increased use of seat belts in motor vehicles, the frequency of morbidity and mortality associated with motor vehicle accidents may have decreased but there is an associated rise in injuries. The purpose of this study was to evaluate the risk of intra-abdominal injury in children who sustained Chance-type fractures in a motor vehicle accident.
A retrospective review was conducted of pediatric patients admitted for injuries sustained in motor vehicle accidents between 1984 and 2001. Patients that sustained lumbar Chance fractures and an abdominal injury were reviewed.
A total of 25 patients with lumbar Chance fractures were seen at our institution; twelve had associated abdominal injuries. The mean age at the time of injury was 10.9 years and the most recent follow-up was a mean of 4.8 years after injury. All patients were involved in high-speed motor vehicle collisions. Eleven patients were restrained using a 2-point restraint and only one was restrained using a 3-point restraint.
The abdominal injury patients had a significantly higher Chance fracture index than those patients who also suffered Chance fractures but no associated abdominal injuries. Success in the management of intra-abdominal injuries is dependent on the awareness that such an injury exists.
Abdominal injuries occur relatively infrequently during trauma, and they rarely require surgical intervention. In this era of non-operative management of abdominal injuries, surgeons are seldom exposed to these patients. Consequently, surgeons may misinterpret the mechanism of injury, underestimate symptoms and radiologic findings, and delay definite treatment. Here, we determined the incidence, diagnosis, and treatment of traumatic abdominal injuries at our hospital to provide a basis for identifying potential hazards in non-operative management of patients with these injuries in a low trauma volume hospital.
This retrospective study included prehospital and in-hospital assessments of 110 patients that received 147 abdominal injuries from an isolated abdominal trauma (n = 70 patients) or during multiple trauma (n = 40 patients). Patients were primarily treated at the University Hospital of Umeå from January 2000 to December 2009.
The median New Injury Severity Score was 9 (range: 1-57) for 147 abdominal injuries. Most patients (94%) received computed tomography (CT), but only 38% of patients with multiple trauma were diagnosed with CT