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.
J Trauma Acute Care Surg. 2024 Sep 1;97(3):365-370. doi: 10.1097/TA.0000000000004270. Epub 2024 Jan 29.
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.
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.
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.
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.
Therapeutic/Care Management; Level IV.
创伤质量改进计划（TQIP）数据库已经确定了美国外科创伤协会器官损伤分级 III 和 IV 级胰腺损伤患者的管理策略和结果，并表明非手术治疗（NOM）是这些损伤的可行选择。然而，儿童胰腺损伤的管理策略存在差异，这些中/高级别损伤的结果尚未得到充分研究。我们的目的是使用 TQIP 描述 III 和 IV 级胰腺损伤的管理和结果。我们假设，中/高级别损伤的儿科患者可以安全地接受 NOM 治疗。
本研究纳入了 2013 年至 2021 年期间在 TQIP 登记的因钝性创伤导致 III 或 IV 级胰腺损伤的所有儿科患者（年龄小于 18 岁）。比较了不同胰腺损伤治疗策略（NOM 与引流和/或胰腺切除术）之间的患者人口统计学、临床特征、并发症和住院死亡率。
共确定了 580 名符合纳入标准的患者。共有 416 名儿科患者发生 III 级胰腺损伤；79%（n = 332）接受 NOM，7%（n = 27）接受引流，14%（n = 57）接受胰腺切除术。另有 164 名患者发生 IV 级胰腺损伤；77%（n = 126）接受 NOM，11%（n = 18）接受引流，12%（n = 20）接受胰腺切除术。治疗组之间的总体损伤严重程度或人口统计学数据无差异。不同管理策略之间的住院死亡率无差异。接受引流的患者住院时间较长。
大多数美国外科创伤协会器官损伤分级 III 和 IV 级胰腺损伤的儿童接受非手术治疗。NOM 是这些损伤的合理策略，与胰腺引流或切除相比，具有相似的住院不良结局，且住院时间更短。
治疗/护理管理；IV 级。
