Management of Pediatric Solid Organ Injuries

Overview

Journal Children (Basel)

Specialty Health Services

Date 2024 Jun 27

PMID 38929246

Authors

Bailey D Lyttle

Regan F Williams

Steven Stylianos

Affiliations

Soon will be listed here.

Abstract

Solid organ injury (SOI) is common in children who experience abdominal trauma, and the management of such injuries has evolved significantly over the past several decades. In 2000, the American Pediatric Surgical Association (APSA) published the first societal guidelines for the management of blunt spleen and/or liver injury (BLSI), advocating for optimized resource utilization while maintaining patient safety. Nonoperative management (NOM) has become the mainstay of treatment for SOI, and since the publication of the APSA guidelines, numerous groups have evaluated how invasive procedures, hospitalization, and activity restrictions may be safely minimized in children with SOI. Here, we review the current evidence-based management guidelines in place for the treatment of injuries to the spleen, liver, kidney, and pancreas in children, including initial evaluation, inpatient management, and long-term care, as well as gaps that exist in the current literature that may be targeted for further optimization of protocols for pediatric SOI.

Citing Articles

The Diagnosis and Management of Pediatric Blunt Abdominal Trauma-A Comprehensive Review.

Baskovic M, Keretic D, Lackovic M, Boric Krakar M, Pogorelic Z Diagnostics (Basel). 2024; 14(20).

PMID: 39451580 PMC: 11506325. DOI: 10.3390/diagnostics14202257.

References

Long M, Vohra M, Bonnette A, Parra P, Miller S, Ayub E . Focused assessment with sonography for trauma in predicting early surgical intervention in hemodynamically unstable children with blunt abdominal trauma. J Am Coll Emerg Physicians Open. 2022; 3(1):e12650. PMC: 8795205. DOI: 10.1002/emp2.12650. View

Stewart S, Fraser J, Rentea R, Aguayo P, Juang D, Fraser J . Institutional outcomes of blunt liver and splenic injury in the Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium era. J Trauma Acute Care Surg. 2023; 95(3):295-299. DOI: 10.1097/TA.0000000000003870. View

Stundner-Ladenhauf H, Bauer L, Heil C, Holzinger J, Stundner O, Metzger R . Minimally Invasive Approaches for Traumatic Rupture of the Pancreas in Children-A Case Series. Children (Basel). 2022; 9(8). PMC: 9329767. DOI: 10.3390/children9081102. View

Notrica D, Sayrs L, Krishna N, Ostlie D, Letton R, Alder A . Adherence to APSA activity restriction guidelines and 60-day clinical outcomes for pediatric blunt liver and splenic injuries (BLSI). J Pediatr Surg. 2018; 54(2):335-339. DOI: 10.1016/j.jpedsurg.2018.08.061. View

Lippert S, Hartin Jr C, Ozgediz D, Glick P, Caty M, Flynn W . Splenic conservation: variation between pediatric and adult trauma centers. J Surg Res. 2012; 182(1):17-20. DOI: 10.1016/j.jss.2012.07.036. View

Edwards M, Crudo D, Carlson T, Pedersen A, Keller L . Pancreatic atrophy and diabetes mellitus following blunt abdominal trauma. J Pediatr Surg. 2013; 48(2):432-5. DOI: 10.1016/j.jpedsurg.2012.11.030. View

Jabbour G, Lombardo G, Litow K, Prabhakaran K, Carroll F, Policastro A . Bilateral Renal Artery Occlusion after Blunt Abdominal Trauma. Am Surg. 2020; 86(4):e210-e212. View

Lynch T, Kilgar J, Al Shibli A . Pediatric Abdominal Trauma. Curr Pediatr Rev. 2017; 14(1):59-63. DOI: 10.2174/1573396313666170815100547. View

Serafetinides E, Kitrey N, Djakovic N, Kuehhas F, Lumen N, Sharma D . Review of the current management of upper urinary tract injuries by the EAU Trauma Guidelines Panel. Eur Urol. 2015; 67(5):930-6. DOI: 10.1016/j.eururo.2014.12.034. View

10.

Katz M, Kastenberg Z, Taylor M, Bolinger C, Scaife E, Fenton S . Reduction of resource utilization in children with blunt solid organ injury. J Pediatr Surg. 2018; 54(2):354-357. DOI: 10.1016/j.jpedsurg.2018.10.066. View

11.

Iqbal C, St Peter S, Tsao K, Cullinane D, Gourlay D, Ponsky T . Operative vs nonoperative management for blunt pancreatic transection in children: multi-institutional outcomes. J Am Coll Surg. 2014; 218(2):157-62. DOI: 10.1016/j.jamcollsurg.2013.10.012. View

12.

Derderian S, Meier M, Bensard D, Partrick D, Acker S . Adolescent blunt solid organ injury: Differences in management strategies and outcomes between pediatric and adult trauma centers. Am J Surg. 2022; 224(1 Pt A):13-17. DOI: 10.1016/j.amjsurg.2022.02.054. View

13.

Gaines B . Intra-abdominal solid organ injury in children: diagnosis and treatment. J Trauma. 2009; 67(2 Suppl):S135-9. DOI: 10.1097/TA.0b013e3181adc17a. View

14.

Ozcan A, Ahn T, Akay B, Menoch M . Imaging for Pediatric Blunt Abdominal Trauma With Different Prediction Rules: Is the Outcome the Same?. Pediatr Emerg Care. 2021; 38(2):e654-e658. DOI: 10.1097/PEC.0000000000002346. View

15.

Mora M, Wong K, Friderici J, Bittner K, Moriarty K, Patterson L . Operative vs Nonoperative Management of Pediatric Blunt Pancreatic Trauma: Evaluation of the National Trauma Data Bank. J Am Coll Surg. 2016; 222(6):977-82. DOI: 10.1016/j.jamcollsurg.2015.12.005. View

16.

Ishikawa M, Shimojima N, Koyama T, Miyaguni K, Tsukizaki A, Mizuno Y . Efficacy of early endoscopic intervention in pediatric pancreatic duct injury management. Pediatr Surg Int. 2021; 37(12):1711-1718. DOI: 10.1007/s00383-021-05003-z. View

17.

Tahir F, Ahmed J, Malik F . Post-splenectomy Sepsis: A Review of the Literature. Cureus. 2020; 12(2):e6898. PMC: 7059871. DOI: 10.7759/cureus.6898. View

18.

Swendiman R, Goldshore M, Blinman T, Nance M . Laparoscopic Management of Pediatric Abdominal Trauma: A National Trauma Data Bank Experience. J Laparoendosc Adv Surg Tech A. 2019; 29(8):1052-1059. DOI: 10.1089/lap.2019.0128. View

19.

Hagedorn J, Fox N, Ellison J, Russell R, Witt C, Zeller K . Pediatric blunt renal trauma practice management guidelines: Collaboration between the Eastern Association for the Surgery of Trauma and the Pediatric Trauma Society. J Trauma Acute Care Surg. 2019; 86(5):916-925. DOI: 10.1097/TA.0000000000002209. View

20.

Gong S, An S, Shin I, Jung P . Usefulness of Endoscopic Retrograde Cholangiopancreatography in the Diagnosis and Treatment of Traumatic Pancreatic Injury in Children. Diagnostics (Basel). 2023; 13(12). PMC: 10296815. DOI: 10.3390/diagnostics13122044. View