Notrica David M, Sussman Bethany L, Garcia Nilda M, Leys Charles M, Maxson R Todd, Bhatia Amina, Letton Robert W, Ponsky Todd, Lawson Karla A, Eubanks James W, Alder Adam C, Greenwell Cynthia, Ostlie Daniel J, Tuggle David W, St Peter Shawn D
Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ, USA 85016.
Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ, USA 85016.
J Pediatr Surg. 2019 Feb;54(2):340-344. doi: 10.1016/j.jpedsurg.2018.08.060. Epub 2018 Sep 16.
APSA guidelines do not recommend routine reimaging for pediatric blunt liver or spleen injury (BLSI). This study characterizes the symptoms, reimaging, and outcomes associated with a selective reimaging strategy for pediatric BLSI patients.
A planned secondary analysis of reimaging in a 3-year multi-site prospective study of BLSI patients was completed. Inclusion required successful nonoperative management of CT confirmed BLSI without pancreas or kidney injury and follow up at 14 or 60 days. Patients with re-injury after discharge were excluded.
Of 1007 patients with BLSI, 534 (55%) met inclusion criteria (median age: 10.18 [IQR: 6, 14]; 62% male). Abdominal reimaging was performed on 27/534 (6%) patients; 3 of 27 studies prompting hospitalization and/or intervention. Abdominal pain was associated with reimaging, but decreased appetite predicted imaging findings associated with readmission and intervention.
Selective abdominal reimaging for BLSI was done in 6% of patients, and 11% of studies identified radiologic findings associated with intervention or re-hospitalization. A selective reimaging strategy appears safe, and even reimaging symptomatic patients rarely results in intervention. Reimaging after 14 days did not prompt intervention in any of the 534 patients managed nonoperatively.
Level II, Prognosis.
美国小儿外科医师协会（APSA）指南不建议对小儿钝性肝或脾损伤（BLSI）进行常规再次影像学检查。本研究描述了小儿BLSI患者采用选择性再次影像学检查策略时的症状、再次影像学检查及结果。
对一项为期3年的多中心BLSI患者前瞻性研究中的再次影像学检查进行了计划中的二次分析。纳入标准要求对CT确诊的无胰腺或肾脏损伤的BLSI患者成功进行非手术治疗，并在14天或60天进行随访。排除出院后再次受伤的患者。
1007例BLSI患者中，534例（55%）符合纳入标准（中位年龄：10.18[四分位间距：6，14]；62%为男性）。27/534例（6%）患者进行了腹部再次影像学检查；27项检查中有3项提示住院和/或干预。腹痛与再次影像学检查相关，但食欲减退可预测与再次入院和干预相关的影像学检查结果。
6%的BLSI患者进行了选择性腹部再次影像学检查，11%的检查发现了与干预或再次住院相关的影像学检查结果。选择性再次影像学检查策略似乎是安全的，即使对有症状的患者进行再次影像学检查也很少导致干预。在534例接受非手术治疗的患者中，14天后的再次影像学检查均未提示进行干预。
二级，预后。
