AAP Papers
The management of pancreatic injuries in children: operate or observe

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Abstract

Purpose

The critical management decision in pediatric pancreatic injuries involves whether or not to operate on patients with grade II or III injuries. Because of the rarity of these injuries, no one hospital cares for enough patients to determine the outcome of this decision. Given this, the American Pediatric Surgical Association accrued a series of patients with pancreatic injuries from the members of its Trauma Committee.

Methods

A retrospective review of concurrent pancreatic injuries from 9 level 1 pediatric trauma centers was performed.

Results

Data on 131 children were submitted. Forty-three patients suffered grade II or grade III injuries. Twenty patients underwent an operation, and 23 were observed. Patients who underwent an operation had an average length of stay of 16.1 days compared with 14.2 days. Two in the operative group received total parenteral nutrition compared with 12 in the nonoperative group. Eight in the nonoperative group developed a pseudocyst compared with 3 in the operative group.

Conclusions

Children with grade II or grade III pancreatic injuries managed nonoperatively had a higher rate of pseudocyst, lower rate of reoperation, and a comparable length of stay compared with those who underwent surgery. These data will be used to help design a prospective study of pancreatic injury management.

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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