Arbra Chase A, Vogel Adam M, Zhang Jingwen, Mauldin Patrick D, Huang Eunice Y, Savoie Kate B, Santore Matthew T, Tsao KuoJen, Ostovar-Kermani Tiffany G, Falcone Richard A, Dassinger M Sidney, Recicar John, Haynes Jeffrey H, Blakely Martin L, Russell Robert T, Naik-Mathuria Bindi J, St Peter Shawn D, Mooney David P, Onwubiko Chinwendu, Upperman Jeffrey S, Streck Christian J
From the Department of Surgery, Division of Pediatric Surgery (C.A.A., J.Z., P.D.M., C.J.S.), Medical University of South Carolina, Charleston, South Carolina; Department of Surgery, Division of Pediatric Surgery, Washington University in St Louis (A.M.V.), St. Louis, Missouri; Department of Surgery, Division of Pediatric Surgery, Le Bonheur Children's Hospital (E.Y.H., K.B.S.), University of Tennessee, Memphis, Tennessee; Department of Surgery, Division of Pediatric Surgery, Emory University School of Medicine (M.T.S.), Atlanta, Georgia; Department of Surgery, Division of Pediatric Surgery, University of Texas Health Science Center (K.T., T.G.O.-K.), Houston, Texas; Department of Surgery, Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center (R.A.F.), Cincinnati, Ohio; Department of Surgery, Division of Pediatric Surgery, Arkansas Children's Hospital (M.S.D., J.R.), Little Rock, Arkansas; Department of Surgery, Division of Pediatric Surgery, Virginia Commonwealth University (J.H.H.), Richmond, Virginia; Department of Pediatric Surgery, Vanderbilt University Medical Center (M.L.B.), Nashville, Tennessee; Department of Surgery, Division of Pediatric Surgery, Children's Hospital of Alabama (R.T.R.), Birmingham, Alabama; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital (B.J.N.-M.), Baylor College of Medicine, Houston, Texas; Department of Surgery, Division of Pediatric Surgery, Children's Mercy Hospital (S.D.S.P.), Kansas City, Missouri; Department of Pediatric Surgery, Boston Children's Hospital (D.P.M., C.O.), Boston, Massachusetts; and Department of Surgery, Division of General Pediatric Surgery, Children's Hospital Los Angeles (J.S.U.), Los Angeles, California.
J Trauma Acute Care Surg. 2017 Oct;83(4):597-602. doi: 10.1097/TA.0000000000001533.
Pediatric intra-abdominal injuries (IAI) from blunt abdominal trauma (BAT) rarely require emergent intervention. For those children undergoing procedural intervention, our aim was to understand the timing and indications for operation and angiographic embolization.
We prospectively enrolled children younger than 16 years after BAT at 14 Level I Pediatric Trauma Centers over a 1-year period. Patients with IAI who received an intervention (IAI-I) were compared with those who did not receive an intervention using descriptive statistics and univariate analysis; p less than 0.05 was considered significant.
Two hundred sixty-one (11.9%) of 2,188 patients had IAI. Forty-five (17.2%) IAI patients received an acute procedural intervention (38 operations, seven angiographic embolization). The mean age for patients requiring intervention was 7.1 ± 4.1 years and not different from the population. Most patients (88.9%) with IAI-I were normotensive. IAI-I patients were significantly more likely to have a mechanism of motor vehicle collision (66.7% vs. 38.9%), more likely to present as a Level I activation (44.4% vs. 26.9%), more likely to have a Glascow Coma Scale less than 14 (31.1% vs. 15.5%), and more likely to have an abnormal abdominal physical examination (93.3% vs. 65.7%) than patients that did not require acute intervention. All patients underwent computed tomography scan before intervention. Operations consisted of laparotomy (n = 21), laparoscopy converted to open (n = 11), and laparoscopy alone (n = 6). The most common surgical indications were hollow viscus injury (HVI) (11 small bowel, 10 colon, 6 small bowel/colon, 2 duodenum). All interventions for solid organ injury, including seven angioembolic procedures, occurred within 8 hours of arrival; many had hypotension and received a transfusion. Procedural interventions were more common for HVI than for solid organ injury (59.2% vs. 7.6%). Postoperative mortality from IAI was 2.6%.
Acute procedural interventions for children with IAI from BAT are rare, predominantly for HVI, are performed early in the hospital course and have excellent clinical outcomes.
Prognostic/epidemiologic study, level III; therapeutic study, level IV.
钝性腹部创伤（BAT）所致小儿腹腔内损伤（IAI）很少需要紧急干预。对于那些接受手术干预的儿童，我们的目的是了解手术及血管造影栓塞的时机和指征。
在1年的时间里，我们前瞻性地纳入了14家一级小儿创伤中心16岁以下BAT患儿。采用描述性统计和单变量分析对接受干预的IAI患者（IAI-I）和未接受干预的患者进行比较；p<0.05被认为具有统计学意义。
2188例患者中有261例（11.9%）发生IAI。45例（17.2%）IAI患者接受了急性手术干预（38例手术，7例血管造影栓塞）。需要干预的患者平均年龄为7.1±4.1岁，与总体人群无差异。大多数IAI-I患者血压正常。与不需要急性干预的患者相比，IAI-I患者更有可能发生机动车碰撞（66.7%对38.9%），更有可能表现为一级激活（44.4%对26.9%），更有可能格拉斯哥昏迷量表评分低于14分（31.1%对15.5%），更有可能腹部体格检查异常（93.3%对65.7%）。所有患者在干预前均接受了计算机断层扫描。手术包括剖腹手术（n=21）、腹腔镜中转开腹手术（n=11）和单纯腹腔镜手术（n=6）。最常见的手术指征是中空脏器损伤（HVI）（11例小肠、10例结肠、6例小肠/结肠、2例十二指肠）。所有实体器官损伤的干预措施，包括7例血管栓塞术，均在到达后8小时内进行；许多患者有低血压并接受了输血。HVI的手术干预比实体器官损伤更常见（59.2%对7.6%）。IAI术后死亡率为2.6%。
BAT所致IAI患儿的急性手术干预很少见，主要针对HVI，在病程早期进行，临床效果良好。
预后/流行病学研究，三级；治疗性研究，四级。
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