Eur J Trauma Emerg Surg. 2023 Oct;49(5):2249-2256. doi: 10.1007/s00068-022-01990-3. Epub 2022 Jun 21.
To compare the reported and observed management of UK children with blunt liver or spleen injury (BLSI) to the American Pediatric Surgical Association (APSA) 2019 BLSI guidance.
UK Paediatric Major Trauma Centres (pMTCs) undertook 1 year of prospective data collection on children admitted to or discussed with those centres with BLSI and an online questionnaire was distributed to all consultants who care for children with BLSI in those centres.
All 21/21 (100%) pMTCs participated; 131 patients were included and 100/152 (65%) consultants responded to the survey. ICU care was reported and observed to be primarily determined using haemodynamic status or concomitant injuries rather than injury grade, in accordance with APSA guidance. Bed rest was reported to be determined by grade of injury by 63% of survey respondents and observed in a similar proportion of patients. Contrary to APSA guidance, follow-up radiological assessment of the injured spleen or liver was undertaken in 44% of patients before discharge and 32% after discharge, the majority of whom were asymptomatic.
UK management of BLSI differs from many aspects of APSA guidance. A shift towards using clinical features to determine ICU admission and readiness for discharge is demonstrated, in line with a strong evidence base. However, routine bed rest and re-imaging after BLSI is common, contrary to APSA guidance. This disparity may exist due to concern that evidence around the incidence, presentation and natural history of complications after conservatively managed BLSI, particularly bleeding from pseudoaneurysms, is weak.
将英国儿童钝性肝或脾损伤（BLSI）的报告和观察管理与美国儿科学会（APSA）2019 年 BLSI 指南进行比较。
英国儿科主要创伤中心（pMTC）对收入或讨论过 BLSI 的中心的儿童进行了为期 1 年的前瞻性数据收集，并向所有在这些中心照顾 BLSI 儿童的顾问分发了在线问卷。
所有 21/21（100%）pMTC 均参与；纳入 131 名患者，100/152（65%）顾问对调查做出了回应。根据 APSA 指南，ICU 护理的报告和观察主要是根据血流动力学状态或伴随损伤来确定，而不是根据损伤程度。63%的调查受访者报告说卧床休息是根据损伤程度来决定的，而观察到的患者比例相似。与 APSA 指南相反，44%的患者在出院前和 32%的患者在出院后接受了受伤的脾脏或肝脏的随访放射学评估，其中大多数患者无症状。
英国 BLSI 的管理与 APSA 指南的许多方面存在差异。研究表明，朝着使用临床特征来确定 ICU 入院和出院准备的方向发生了转变，这与强有力的证据基础一致。然而，在 BLSI 后常规卧床休息和再次成像很常见，与 APSA 指南相反。这种差异可能是由于人们担心有关保守治疗 BLSI 后并发症（特别是假性动脉瘤出血）的发生率、表现和自然史的证据较弱。
