J. E. McMillan1,3, T. F. Boulden2, A. Gosain1, J. W. Eubanks1, R. F. Williams1 1University Of Tennessee Health Science Center,Surgery And Pediatrics,Memphis, TN, USA 2University Of Tennessee Health Science Center,Pediatric Radiology,Memphis, TN, USA 3University Of Tennessee Health Science Center,College Of Medicine,Memphis, TN, USA
Introduction:
A standardized method for classifying blunt solid organ injury in adults has existed for nearly three decades. However, there is not a standard approach for pediatric patients and management varies widely among centers. We hypothesize that radiologic findings in pediatric abdominal trauma can be used to predict the need for intervention.
Methods:
Following IRB-approval, a retrospective study was performed at an ACS-verified Level 1 Pediatric Trauma Center for 134 children (<18 years) who had sustained liver injuries. Radiologic findings were extracted from CT reports or, when missing, measured from original imaging. Radiologic variables included liver laceration size, number of Couinaud segments involved, presence of hemoperitoneum, hepatic vessel involvement, lobe involvement, and the presence of subcapsular or pericapsular hematoma. Interventions included surgical intervention, angiography, or blood transfusion. Continuous variables were compared with a t-test, and a chi-square analysis was used for categorical variables.
Results:
The mean age was 7.5 +/- 5.2 years with 59% male and 52% African-American. Hemoperitoneum, length of liver laceration and number of Couinaud segments involved predicted the need for intervention in children with blunt liver injuries (table). Normalizing continuous variables by age did not change the significance. However, the presence of hematoma and the proximity of the injury to the major hepatic vessels, important variables in the adult grading system, did not predict the need for intervention in children.
Conclusions:
Pediatric patients who present with liver injury from abdominal trauma with hemoperitoneum, larger laceration and more liver segments involved are more likely to require intervention. Contrary to the adult trauma guidelines, hematoma and proximity to the major hepatic vessels did not predict the need for intervention in children. These findings build upon the expanding literature indicating the need for pediatric-specific guidelines for trauma management.
