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Pancreatic Trauma Prehospital Trial

Pancreatic Study Training Guide
Pancreatic Trauma Prehospital Trial Protocol
Clinical Pathway for NOM of Blunt Pancreatic Trauma Involving Duct Injury in Pediatric Patients

Background: In pediatric patients with blunt pancreatic body transection, variability exists regarding management with early distal pancreatectomy or non-operative management. Current literature does not adequately answer the question of which strategy leads to superior outcomes. Furthermore, we have previously demonstrated that there is wide variability in how non-operatively managed patients are managed across centers, and have developed a standard clinical non-operative management pathway in order to provide more direct comparison of outcomes across centers.

Hypothesis: Early distal pancreatectomy, compared to non-operative management, results in improved morbidity in children with blunt pancreatic body transection (AAST grade III injury).

Specific Aim 1: To demonstrate which management strategy, operative or non-operative, results in fewer complications in children with AAST grade III blunt pancreatic injury.

Using a prospective, observational study design, children with acute AAST grade III pancreatic injuries will be identified and enrolled across multiple trauma centers. Complications related to pancreatic duct disruption including symptomatic pseudocyst formation, pancreatic fistula, wound infection, small bowel obstruction, and pancreatic insufficiency will be identified and compared by primary management strategy.

Specific Aim 2: To demonstrate which management strategy, operative or non-operative, results in shorter recovery time in children with AAST grade III blunt pancreatic injury.

In aim 2, the same methodology described in aim 1 will be used to investigate recovery time, as related to time to tolerate a normal diet, number of additional hospitalizations or interventions, time to school return, and time to symptom resolution.