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A Prospective Multicenter Evaluation of Acute Procedural Interventions in Pediatric Blunt Abdominal Trauma: Who, What, Where, When, Why, and How
Christian J. Streck, Jr., MD1, Chase Arbra, MD1, Adam M. Vogel, MD2, Eunice Y. Huang, MD3, Kate B. Savoie, MD3, MS, Matthew T. Santore, MD4, KuoJen Tsao, MD5, Tiffany G. Ostovar-Kermani, MD, MPH5, Richard Falcone, MD6, Suzanne Moody6, M. Sidney Dassinger, MD7, John Recicar, MD7, Jeffrey H. Haynes, MD8, Martin L. Blakely, MD9, Robert T. Russell, MD, MPH10, Bindi J. Naik-Mathuria, MD11, Shawn D. St. Peter, MD12, David P. Mooney, MD13, Chinwendu Onwubiko, MD13, Jeffrey S. Upperman, MD14, J Zagory, MD14, Jingwen Zhang1, Patrick D. Mauldin, PhD1. 1The Medical University of South Carolina, Charleston, SC, USA, 2Washington University in St. Louis School of Medicine, Saint Louis Children's Hospital, St. Louis, MO, USA, 3University of Tennessee-Memphis Health Science Center, Memphis, TN, USA, 4Children's Healthcare of Atlanta, Emory School of Medicine, Atlanta, GA, USA, 5McGovern Medical School, The University of Texas Health Science Center, Houston, TX, USA, 6Cincinnati Children's Hospital, Cincinnati, OH, USA, 7Arkansas Children's Hospital, Little Rock, AK, USA, 8Children's Hospital of Richmond at VCU, Richmond, VA, USA, 9Vanderbilt Children's Hospital, Nashville, TN, USA, 10Children's Hospital of Alabama, Birmingham, AL, USA, 11Texas Children's Hospital, Houston, TX, USA, 12Children's Mercy Hospital, Kansas City, MO, USA, 13Boston Children's Hospital, Boston MA, USA, 14Children's Hospital Los Angeles, Los Angeles, CA, USA.

Background: Pediatric intraabdominal injuries (IAI) from blunt abdominal trauma (BAT) rarely require emergent intervention. For those children undergoing procedural intervention, we aim to understand the timing and indications for operation and angioembolization.

Methods: We prospectively enrolled children <16 years following BAT at 14 Level-One Pediatric Trauma Centers over a 1-year period. Patients were excluded who presented >6 hours after injury, underwent abdominal CT scan before transfer, or had isolated head or extremity injury.

Results: 261 of 2188 patients (11.9%) had IAI. 45 patients (2.1%) received an acute procedural intervention (38 operations, 7 angioembolizations). The median age for patients requiring intervention was 7[4,9] years and not different from the population. Injury, clinical information, and outcomes can be seen in Table 1. Most patients had an abnormal abdominal physical exam finding (89%). All patients underwent CT scan prior to intervention. Operations consisted of laparotomy (n=21), laparoscopy converted to open (n=11), and laparoscopy alone (n=6). The most common surgical indications were hollow viscus injury (HVI) (11 small bowel, 10 colon, 6 small bowel/colon, 2 duodenum). All interventions for solid organ injury(SOI) occurred within 8 hours of arrival and many had hypotension and received a transfusion. Post-operative mortality from IAI was 2.6%.

Conclusions: Acute procedural interventions for children with IAI from BAT are rare, predominantly for HVI, are performed early in the hospital course, and have excellent clinical outcomes.

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