AAP PapersThe management of pancreatic injuries in children: operate or observe
Section snippets
Methods
The Trauma Committee of the American Pediatric Surgical Association solicited its members to submit data on all children diagnosed with a pancreatic injury from 2003 to 2008. Institutional Review Board approval was obtained at each institution. Demographic information, mechanism of injury, diagnostic modality, grade of pancreatic injury, management of injury, and clinical outcomes were accrued.
Outcome measures included hospital length of stay (LOS), number of days requiring total parenteral
Results
Data were accrued for 131 patients treated at 1 of 7 hospitals over the 5-year period, or fewer than 4 patients per year (Table 1). There were 47 patients with a grade II or grade III pancreatic injury identified, or fewer than 1.4 patients per hospital per year. Forty-three patients had sufficient outcome documentation to be included in analysis. Grading of pancreatic injury was based on computed tomographic (CT) findings in all 23 NOM patients. The pancreatic injury diagnosis was made by CT
Discussion
The rarity of pancreatic injury in children has made it difficult to critically analyze management strategies and outcomes, and the choice of OM or NOM appears to vary depending upon institutional bias. Small series of patients have analyzed the outcome of either treatment strategy; but few, if any, have compared OM with NOM [2], [3], [5], [7], [11]. This study uses data acquired from several pediatric trauma centers over a 5-year period, allowing the analysis of subgroups of patients based on
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