Contemporary management and outcomes of blunt traumatic American Association for the Surgery of Trauma Organ Injury Scale grades III and IV pancreatic injuries in children: A Trauma Quality Improvement Program analysis

Authors

Jessica L. Rauh, From the Department of General Surgery, and Section of Pediatric Surgery (L.P.N.), Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina; Department of Orthopedic Surgery (M.P.F.), Orebro University Hospital; School of Medical Sciences (M.P.F.), Orebro University, Sweden; Pontifical Catholic University of São Paulo (M.A.F.R.); Khalifa University and Gulf Medical University (M.A.F.R.); Department of Surgery (M.A.F.R.), Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates; Center of Trauma and Critical Care (B.S.), George Washington University, Washington, DC; Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery (S.M.), Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates; and School of Medical Sciences (S.M.), Orebro University, Sweden.
Lucas P. Neff
Maximilian Peter Forssten
Marcelo A. Ribeiro
Babak Sarani
Shahin Mohseni

Document Type

Journal Article

Publication Date

9-1-2024

Journal

The journal of trauma and acute care surgery

Volume

97

Issue

3

DOI

10.1097/TA.0000000000004270

Abstract

BACKGROUND: The Trauma Quality Improvement Program (TQIP) database has delineated management strategies and outcomes for adults with American Association for the Surgery of Trauma Organ Injury Scale grades III and IV pancreatic injuries and suggests that nonoperative management (NOM) is a viable option for these injuries. However, management strategies vary for children following significant pancreatic injuries and outcomes for these intermediate/high-grade injuries have not been sufficiently studied. Our aim was to describe the management and outcomes for grades III and IV pancreatic injuries using TQIP. We hypothesize that pediatric patients with intermediate/high-grade injuries can be safely managed with NOM. METHODS: All pediatric patients (younger than 18 years) registered in TQIP between 2013 and 2021 who suffered a grade III or IV pancreatic injury due to blunt trauma were included in the current study. Patient demographics, clinical characteristics, complications, and in-hospital mortality were compared between the different treatment strategies for pancreatic injury: NOM versus drainage and/or pancreatic resection. RESULTS: A total of 580 patients meeting the inclusion criteria were identified. A total of 416 pediatric patients suffered a grade III pancreatic injury; 79% (n = 332) were NOM, 7% (n = 27) received a drain, and 14% (n = 57) underwent a pancreatic resection. A further 164 patients suffered a grade IV pancreatic injury; 77% (n = 126) were NOM, 11% (n = 18) received a drain, and 12% (n = 20) underwent a pancreatic resection. No differences in overall injury severity or demographical data were observed between the treatment groups. No difference in in-hospital mortality was detected between the different management strategies. Patients who received a drain had a longer hospital length of stay. CONCLUSION: The majority of children with American Association for the Surgery of Trauma Organ Injury Scale grades III and IV pancreatic injuries are managed nonoperatively. Nonoperative management is a reasonable strategy for these injuries and results in equivalent in-hospital adverse outcome profiles as pancreatic drainage or resection with a shorter hospital length of stay. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

APA Citation

Rauh, Jessica L.; Neff, Lucas P.; Forssten, Maximilian Peter; Ribeiro, Marcelo A.; Sarani, Babak; and Mohseni, Shahin, "Contemporary management and outcomes of blunt traumatic American Association for the Surgery of Trauma Organ Injury Scale grades III and IV pancreatic injuries in children: A Trauma Quality Improvement Program analysis" (2024). GW Authored Works. Paper 5745.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5745

Department

Surgery