Pediatric Trauma Society

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Patient Characteristics Associated with Emergent Management of Pediatric Abdominal Trauma
Robert A. Swendiman, MD, MPP1; Matthew A. Goldshore, MD PhD MPH1; Thane A. Blinman, MD2; Michael L. Nance, MD2
1University of Pennsylvania Health System, Philadelphia, PA; 2Children's Hospital of Philadelphia, Philadelphia, PA

Background: Use of laparoscopy has increased in management of pediatric abdominal trauma. We sought to determine patient characteristics associated with its utilization.

Methods: The National Trauma Data Bank was queried (2010 - 2014) for encounters involving patients ? 14 years who underwent an open or laparoscopic abdominal operation within 48 hours of emergency department (ED) arrival. Patient and injury characteristics associated with each approach were identified.

Results: A total of 4,612 children met inclusion criteria. Laparoscopy comprised 7.8% (n = 360) of all abdominal trauma operations. Patients undergoing laparoscopy were statistically more likely to be of older age, lower Injury Severity Score, higher Glasgow Coma Scale rank, and experience a penetrating mechanism than those undergoing open laparotomy. Initial disposition from the ED varied, with open procedures more likely to go directly to the OR from the ED than laparoscopic procedures (67.4% vs. 58.6%, respectively, p < 0.001). Laparoscopic patients had a shorter length of hospital stay (0.4 vs. 2.5 days, p < 0.001) but longer time to the OR (8.6 hours vs. 6.0 hours, p < 0.001) than their open counterparts. The percentage of cases managed laparoscopically increased from 6.2% in 2010 to 10.1% in 2014 (p = 0.013).

Conclusions: The use of laparoscopy in pediatric abdominal trauma increased over time, with utilization occurring in a less severely injured cohort, perhaps as a diagnostic adjunct.

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