Retrospective Review of Angioembolization in Traumatic Blunt High-Grade Liver Injuries in Adolescent Age Children
Samara Lynn Lewis1, Kenneth E. Stewart2, Zooona Sarwar2, Ryan Kennedy2, *Jeremy J. Johnson1
1Oklahoma Children's Hospital, Oklahoma City, OK; 2University of Oklahoma Health Science Center, Oklahoma City, OK
Background (issue):Non-operative management (NOM) of blunt traumatic liver injuries (BTLI) is the current standard of practice for both adults and pediatric patients, with a higher success rate in pediatric patients due, in part, to their ability to remain hemodynamically stable with larger volume of blood loss. Angioembolization (AE) is an adjunct to NOM that has shown success in adult management of blunt organ injuries, but its utilization in pediatric patients is limited. Adolescent age children are a unique group of trauma patients due to their adult size and mechanism of injury (MOI), while maintaining pediatric physiology. The goal of this study was to identify if outcomes differed for adolescent age children with high grade BTLI treated with AE as compared to standard NOM.
Methods: A retrospective review of the National Trauma Data Bank (2017-2019) of adolescent age children (age 12-17) was performed. Children with BTLI of OIS ≥ 4 were dived into those that underwent NOM management versus those who underwent AE. These patients were further divided by hemodynamically stability (Shock Index, Pediatric Age-Adjusted (SIPA) of 0.9). Primary outcome was mortality.
Findings:There were 701 adolsecents with OIS of ≥4 of which 645 underwent NOM and 56 underwent AE. Within the AE group, 29 had SIPA >0.9 and 257 patients within the NOM group had a SIPA >0.9. Age and MOI were similar between all 4 groups. Higher frequency of AE occurred at adult trauma centers (63% stable and 65.5% unstable p=0.019). The highest rate of mortality was identified in the patients who were unstable on arrival with those managed with NOM having higher mortality than those who underwent AE (8.2% vs 6.9% p=0.003).
Conclusions (implications for practice):Adolescents with high-grade blunt liver injuries who are hemodynamically unstable on arrival have increased unadjusted mortality when managed with NOM as compared to AE.
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