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Non-Operative Management of High-Grade Pediatric Pancreatic Injuries: Contemporary Trends
Bindi Naik-Mathuria, MD1, Eric Rosenfeld, MD1, Robert Russell, MD2, Ilan Maizlin, MD2, Adam Vogel, MD3, Mauricio Escobar, MD4, Adam Pattyn, MD4, Richard Falcone, MD5, Suzanne Moody, RN5, David Juang, MD6, Shawn St Peter, MD6, David Mooney, MD7, Lindsey Bendure, MD7, Rajan Thakkar, MD8, Jonathan Groner, MD8, Denise Klinkner, MD9, Stephanie Polities, MD9, Ankush Gosain, MD, PhD10, Pranit Chotai, MD10, Stephen Fenton, MD11, Austin Stevens, MD11, Marianne Beaudin, MD12, Laurence Carmant, MD12, Barbara Gaines, MD13, Dominic Papandria, MD12. 1Baylor College of Medicine Texas and Children's Hospital, Houston, TX, USA, 2Children's Hospital of Alabama, Birmingham, AL, USA. 3Washington University, St Louis Children's Hospital, St. Loius, MO, USA, 4MaryBridge Children's Health Center, Tacoma, WA, USA, 5Cincinnati Children's Hospital, Cincinnati, OH, USA, 6Children's Mercy Hospital, Kansas City, Kansas City, MO, USA, 7Boston Children's Hospital, Boston, MA, USA, 8Nationwide Children's Hospital, Columbus, OH, USA, 9Mayo Clinic, Rochester, MN, USA, 10University of Tennessee Memphis, Memphis, TN, USA, 11University of Utah, Salt Lake City, UT, USA, 12CHU Sainte-Justine, Montréal, QC, Canada, 13University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Background: Guidelines for the non-operative management of high-grade pancreatic injuries in children have not been established as they have for liver/splenic injuries. The purpose of this study was to assess practice variability and determine contemporary management strategies of these complex pancreatic injuries across multiple pediatric trauma centers.

Methods: Following IRB approval, a multicenter, retrospective review was conducted of high-grade pancreatic injuries treated non-operatively between 2010-15. Data were analyzed using descriptive statistics.

Results: Forty-eight patients treated at thirteen pediatric trauma centers (median age 7 years, range 0.75-16) had 34 AAST grade III and 14 grade IV injuries during the 5-year period. Median time from injury was 12 hours and median ISS 16. Management trends are demonstrated in the attached figure. Clear liquids were started at median 6.5 days (range 1-55) and regular diet at median 10 days (range 1-54, n=31). Median initial hospitalization length was 15 days (range 1-88). Peripancreatic collection/pseudocyst was identified in 71% at median 9.5 days (n=39). Management of these included: observation 50%, percutaneous drain 28.5%, surgery 11% and endoscopic stent 11%. No fistulas were reported.

Conclusions: High-grade pancreatic injuries in children are rare and significant variability exists in management strategies, which may affect outcomes and effective resource utilization. The common trends identified by this study will be used to create consensus-based guidelines regarding non-operative management for these injuries.

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