Pediatric Trauma Society

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Management of Penetrating Rectal Trauma in Pediatric Patients: An APSA Survey
Kate B Savoie1, *Elizabeth Renaud2, *Ankush Gosain1, *James W Eubanks, III1, *Regan F Williams1
1University of Tennessee Health Science Center, Memphis, TN;2Albany Medical Center, Albany, NY

Background: Penetrating rectal injuries(PRI) are rare in pediatric patients. Although management is often based on adult guidelines, there are no guidelines for treatment specifically related to pediatric PRIs; therefore, care of can be highly variable. We hypothesize that management of PRI will vary greatly among pediatric surgeons and may not follow adult guidelines. Methods: A 35-question survey was developed and validated through our institution and a research collaborative. The practicing membership of the American Pediatric Surgical Association was surveyed to assess management of PRIs. Results were summarized as descriptive statistics. Findings: A total of 371 of 1084 members(34%) responded. Most respondents worked at Academic/University hospitals(62%), ACS Pediatric Level 1 accredited facilities(55%), and in large metropolitan areas(59%). Most worked at facilities treating 5-20 penetrating traumas a year(45%) and treated <5 PRIs per year(82%). Most respondents utilized proctosigmoidoscopy to evaluate suspected extraperitoneal injuries(73%); intraperitoneal injuries were generally examined with diagnostic laparoscopy(64%) or exploratory laparotomy(35%). Destructive lesions are frequently treated with proximal diversion regardless of level(88% for intraperitoneal, 72% for extraperitoneal). Higher degree of contamination affected the likelihood of proximal diversion, as did increasing duration from injury to intervention and the amount of blood transfused. Most individuals(76%) had been trained to performed pre-sacral drainage; 22% would place drains for intraperitoneal injuries and 45% would place drains for extraperitoneal injuries. A large proportion would not place pre-sacral drains for any injury(39%). Conclusions: Penetrating rectal injuries remain rare in the pediatric population and multiple factors affect their evaluation and management. Development of pediatric guidelines may help decrease variability and improve care for these at-risk patients.


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