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J Pediatr Surg. 2019 Aug;54(8):1519-1526. doi: 10.1016/j.jpedsurg.2019.01.012. Epub 2019 Jan 31.

Non-operative management of solid organ injuries in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review.

Author information

1
University of South Carolina School of Medicine - Greenville, Greenville, SC.
2
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY.
3
Department of Surgery, Boston Children's Hospital, Boston, MA.
4
Division of Pediatric Surgery, Children's Hospital of Colorado, Aurora, CO.
5
Division of Pediatric Surgery, Naval Medical Center Portsmouth, Portsmouth, VA.
6
University of Missouri - Kansas City School of Medicine, Department of Surgery, Children's Mercy Hospital, Kansas City, MO.
7
University of California - Irvine, Division of Pediatric and Thoracic Surgery, Children's Hospital of Orange County, Irvine, CA.
8
Division of Pediatric Surgery, University of Tennessee Health Science Center, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN.
9
Department of Pediatric General and Thoracic Surgery, The British Columbia Children's Hospital, Vancouver, BC, Canada.
10
Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
11
Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA.
12
Department of Pediatric Surgery, Nationwide Children's Hospital and The Ohio State University, Columbus, OH.
13
Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL.
14
Department of Pediatric Surgery, McGovern School of Medicine, University of Texas at Houston, Houston, TX.
15
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
16
Division of Pediatric Surgery, Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville, Louisville, KY.
17
Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA.
18
Wake Forest University School of Medicine, Childress Institute for Pediatric Trauma, Winston-Salem, NC.
19
Department of Surgery, Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY.
20
Division of Pediatric Surgery, University of Tennessee Health Science Center, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN. Electronic address: rfwillia@uthsc.edu.

Abstract

PURPOSE:

The American Pediatric Surgical Association (APSA) guidelines for the treatment of isolated solid organ injury (SOI) in children were published in 2000 and have been widely adopted. The aim of this systematic review by the APSA Outcomes and Evidence Based Practice Committee was to evaluate the published evidence regarding treatment of solid organ injuries in children.

METHODS:

A comprehensive search strategy was crafted and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Four principal questions were examined based upon the previously published consensus APSA guidelines regarding length of stay (LOS), activity level, interventional radiologic procedures, and follow-up imaging. A literature search was performed including multiple databases from 1996 to 2016.

RESULTS:

LOS for children with isolated solid organ injuries should be based upon clinical findings and may not be related to grade of injury. Total LOS may be less than recommended by the previously published APSA guidelines. Restricting activity to grade of injury plus two weeks is safe but shorter periods of activity restriction have not been adequately studied. Prophylactic embolization of SOI in stable patients with image-confirmed arterial extravasation is not indicated and should be reserved for patients with evidence of ongoing bleeding. Routine follow-up imaging for asymptomatic, uncomplicated, low-grade injured children with abdominal blunt trauma is not warranted. Limited data are available to support the need for follow-up imaging for high grade injuries.

CONCLUSION:

Based upon review of the recent literature, we recommend an update to the current APSA guidelines that includes: hospital length of stay based on physiology, shorter activity restrictions may be safe, minimizing post-injury imaging for lower injury grades and embolization only in patients with evidence of ongoing hemorrhage.

TYPE OF STUDY:

Systematic Review.

LEVELS OF EVIDENCE:

Levels 2-4.

KEYWORDS:

Liver injury; Pediatric trauma; Renal injury; Spleen injury; Systematic review

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