nach oben

Erschienen in:

13.11.2018 | Original Article

Variability in the evalution of pediatric blunt abdominal trauma

verfasst von: Adam M. Vogel, Jingwen Zhang, Patrick D. Mauldin, Regan F. Williams, Eunice Y. Huang, Matthew T. Santore, Kuojen Tsao, Richard A. Falcone, M. Sidney Dassinger, Jeffrey H. Haynes, Martin L. Blakely, Robert T. Russell, Bindi J. Naik-Mathuria, Shawn D. St Peter, David Mooney, Jeffrey S. Upperman, Christian J. Streck

Erschienen in: Pediatric Surgery International | Ausgabe 4/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To describe the practice pattern for routine laboratory and imaging assessment of children following blunt abdominal trauma (BAT).

Methods

Children (age < 16 years) presenting to 14 pediatric trauma centers following BAT over a 1-year period were prospectively identified. Injury, demographic, routine laboratory and imaging utilization data were collected. Descriptive, comparative, and correlation analysis was performed.

Results

2188 children with a median age of 8 (4,12) years were included and the median injury severity score was 5 (1,10). There were significant differences in activation status, injury severity, and mechanism across centers; however, there was no correlation of level of activation, injury severity, or severe mechanism with test utilization. Routine laboratory and imaging utilization for hematocrit, hepatic enzymes, pancreatic enzymes, base deficit urine microscopy, chest and pelvis X-ray, and abdominal computed tomography (CT) varied significantly among centers. Only obtaining a hematocrit had a moderate correlation with CT use. There was no correlation between centers that were high or low frequency laboratory utilizers with CT use.

Conclusions

Wide variability exists in the routine initial laboratory and imaging assessment in children following BAT. This represents an opportunity for quality improvement in pediatric trauma.

Level of evidence

Level II.

Larson DB, Johnson LW, Schnell BM et al (2011) Rising use of CT in child visits to the emergency department in the United States, 1995–2008. Radiology 259:793–801CrossRefPubMed

Tillou A, Gupta M, Baraff LJ et al (2009) Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. J Trauma 67:779–787CrossRefPubMed

Holmes JF, Mao A, Awasthi S et al (2009) Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma. Ann Emerg Med 54:528–533CrossRefPubMed

Streck CJ, Vogel AM, Zhang J et al (2017) Identifying children at very low risk for blunt intra-abdominal injury in whom ct of the abdomen can be avoided safely. J Am Coll Surg 224(4):449–458CrossRefPubMed

Capraro AJ, Mooney D, Waltzman ML (2006) The use of routine laboratory studies as screening tools in pediatric abdominal trauma. Pediatr Emerg Care 22:480–484CrossRefPubMed

Keller MS, Coln CE, Trimble JA et al (2004) The utility of routine trauma laboratories in pediatric trauma resuscitations. Am J Surg 188:671–678CrossRefPubMed

Cotton BA, Beckert BW, Smith MK et al (2004) The utility of clinical and laboratory data for predicting intraabdominal injury among children. J Trauma 56:1068–1074 (discussion 1074–1065) CrossRefPubMed

Golden J, Dossa A, Goodhue CJ et al (2015) Admission hematocrit predicts the need for transfusion secondary to hemorrhage in pediatric blunt trauma patients. J Trauma Acute Care Surg 79:555–562CrossRefPubMed

Hershkovitz Y, Naveh S, Kessel B et al (2015) Elevated white blood cell count, decreased hematocrit and presence of macrohematuria correlate with abdominal organ injury in pediatric blunt trauma patients: a retrospective study. World J Emerg Surg 10:41CrossRefPubMedPubMedCentral

10.

Hennes HM, Smith DS, Schneider K et al (1990) Elevated liver transaminase levels in children with blunt abdominal trauma: a predictor of liver injury. Pediatrics 86:87–90PubMed

11.

Karam O, La Scala G, Le Coultre C et al (2007) Liver function tests in children with blunt abdominal traumas. Eur J Pediatr Surg 17:313–316CrossRefPubMed

12.

Adamson WT, Hebra A, Thomas PB et al (2003) Serum amylase and lipase alone are not cost-effective screening methods for pediatric pancreatic trauma. J Pediatr Surg 38:354–357 (discussion 354–357) CrossRefPubMed

13.

Herman R, Guire KE, Burd RS et al (2011) Utility of amylase and lipase as predictors of grade of injury or outcomes in pediatric patients with pancreatic trauma. J Pediatr Surg 46:923–926CrossRefPubMed

14.

Mahajan A, Kadavigere R, Sripathi S et al (2014) Utility of serum pancreatic enzyme levels in diagnosing blunt trauma to the pancreas: a prospective study with systematic review. Injury 45:1384–1393CrossRefPubMed

15.

Matsuno WC, Huang CJ, Garcia NM et al (2009) Amylase and lipase measurements in paediatric patients with traumatic pancreatic injuries. Injury 40:66–71CrossRefPubMed

16.

Buckley JC, McAninch JW (2004) Pediatric renal injuries: management guidelines from a 25-year experience. J Urol 172:687–690 (discussion 690) CrossRefPubMed

17.

Buckley JC, McAninch JW: The diagnosis, management, and outcomes of pediatric renal injuries. Urol Clin North Am 33:33–40 (vi, 2006)

18.

Nance ML, Lutz N, Carr MC et al (2004) Blunt renal injuries in children can be managed nonoperatively: outcome in a consecutive series of patients. J Trauma 57:474–478 (discussion 478) CrossRefPubMed

19.

Thorp AW, Young TP, Brown L (2011) Test characteristics of urinalysis to predict urologic injury in children. West J Emerg Med 12:168–172PubMedPubMedCentral

20.

Holmes JF, Sokolove PE, Brant WE et al (2002) A clinical decision rule for identifying children with thoracic injuries after blunt torso trauma. Ann Emerg Med 39:492–499CrossRefPubMed

21.

Soundappan S, Smith NF, Lam LT et al (2006) A trauma series in the injured child: do we really need it? Pediatr Emerg Care 22:710–716CrossRefPubMed

22.

Isaacman DJ, Scarfone RJ, Kost SI et al (1993) Utility of routine laboratory testing for detecting intra-abdominal injury in the pediatric trauma patient. Pediatrics 92:691–694PubMed

23.

Karam O, Sanchez O, Chardot C et al (2009) Blunt abdominal trauma in children: a score to predict the absence of organ injury. J Pediatr 154:912–917CrossRefPubMed

24.

Streck CJ Jr, Jewett BM, Wahlquist AH et al (2012) Evaluation for intra-abdominal injury in children after blunt torso trauma: can we reduce unnecessary abdominal computed tomography by utilizing a clinical prediction model? J Trauma Acute Care Surg 73:371–376 (discussion 376) CrossRefPubMed

25.

Christensen MC, Ridley S, Lecky FE et al (2008) Outcomes and costs of blunt trauma in England and Wales. Crit Care 12:R23CrossRefPubMedPubMedCentral

26.

Myers SR, Branas CC, French B et al (2016) A national analysis of pediatric trauma care utilization and outcomes in the United States. Pediatr Emerg Care. https://doi.org/10.1097/PEC.0000000000000902 PubMedCrossRef

27.

Willenberg L, Curtis K, Taylor C et al (2012) The variation of acute treatment costs of trauma in high-income countries. BMC Health Serv Res 12:267CrossRefPubMedPubMedCentral

28.

Holmes JF, Lillis K, Monroe D et al (2013)Identifying children at very low risk of clinically important blunt abdominal injuries. Ann Emerg Med 62:107–116 (e102) CrossRefPubMed

29.

Appleby J (2011) Variations in health care: the good, the bad, and the inexplicable. The King’s Fund, London

30.

James BC, Hammond ME (2000) The challenge of variation in medical practice. Arch Pathol Lab Med 124:1001–1003PubMed

31.

Wennberg JE (1987) The paradox of appropriate care. JAMA 258:2568–2569CrossRefPubMed

32.

Westert GP, Groenewegen PP (1999) Medical practice variations: changing the theoretical approach. Scand J Public Health 27:173–180CrossRefPubMed

33.

Heron M (2016) Deaths: leading causes for 2014. Natl Vital Stat Rep 65:1–96PubMed

34.

Lanzarotti S, Cook CS, Porter JM et al (2003) The cost of trauma. Am Surg 69:766–770PubMed

35.

Holmes JF, Sokolove PE, Land C et al (1999) Identification of intra-abdominal injuries in children hospitalized following blunt torso trauma. Acad Emerg Med 6:799–806CrossRefPubMed

36.

Holmes JF, Sokolove PE, Brant WE et al (2002) Identification of children with intra-abdominal injuries after blunt trauma. Ann Emerg Med 39:500–509CrossRefPubMed

Titel: Variability in the evalution of pediatric blunt abdominal trauma
verfasst von: Adam M. Vogel
Jingwen Zhang
Patrick D. Mauldin
Regan F. Williams
Eunice Y. Huang
Matthew T. Santore
Kuojen Tsao
Richard A. Falcone
M. Sidney Dassinger
Jeffrey H. Haynes
Martin L. Blakely
Robert T. Russell
Bindi J. Naik-Mathuria
Shawn D. St Peter
David Mooney
Jeffrey S. Upperman
Christian J. Streck
Publikationsdatum: 13.11.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 4/2019
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-018-4417-z

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Variability in the evalution of pediatric blunt abdominal trauma