Recent Changes in the Management of High-Grade Blunt Pancreatic Injury in Children: A Nationwide Trend Analysis

Morihiro Katsura; Tatsuyoshi Ikenoue; Makoto Aoki; Akira Kuriyama; Kyosuke Takahashi; Morgan Schellenberg; Matthew J Martin; Kenji Inaba; Kazuhide Matsushima

doi:10.1097/XCS.0000000000001033

Recent Changes in the Management of High-Grade Blunt Pancreatic Injury in Children: A Nationwide Trend Analysis

J Am Coll Surg. 2024 Feb 7. doi: 10.1097/XCS.0000000000001033. Online ahead of print.

Authors

Morihiro Katsura¹, Tatsuyoshi Ikenoue², Makoto Aoki³, Akira Kuriyama⁴, Kyosuke Takahashi¹, Morgan Schellenberg¹, Matthew J Martin¹, Kenji Inaba¹, Kazuhide Matsushima¹

Affiliations

¹ Department of Surgery, University of Southern California, Los Angeles, CA.
² Data Science and AI Innovation Research Promotion Center, Shiga University, Shiga, Japan.
³ Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan.
⁴ Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

PMID: 38323622
DOI: 10.1097/XCS.0000000000001033

Abstract

Background: The optimal management of pediatric patients with high-grade blunt pancreatic injury (BPI) involving the main pancreatic duct remains controversial. This study aimed to assess the nationwide trends in the management of pediatric high-grade BPI at pediatric (PTC), mixed (MTC), and adult trauma centers (ATC).

Methods: This is a retrospective observational study of the National Trauma Data Bank. We included pediatric patients (age ≤16 years) sustaining high-grade BPI (Abbreviated Injury Scale ≥3) from 2011-2021. Patients who did not undergo pancreatic operation were categorized into the non-operative management (NOM) group. Trauma centers were defined as PTC (level I/II pediatric only), MTC (level I/II adult and pediatric), and ATC (level I/II adult only). Primary outcome was the proportion of patients undergoing NOM, and secondary outcomes included the use of endoscopic retrograde cholangiopancreatography (ERCP) and in-hospital mortality. A Cochran-Armitage test was used to analyze the trend.

Results: A total of 811 patients were analyzed. The median age was 9 years (interquartile range [IQR]: 6-13), 64% were male, and the median injury severity score was 17 (IQR: 10-25). During the study period, there was a significant upward linear trend in the use of NOM and ERCP among the overall cohort (range 48%-66%; Ptrend =0.033, range 6.1%-19%; Ptrend =0.030, respectively). The significant upward trend for NOM was maintained in the subgroup of patients at PTC and MTC (Ptrend =0.037), while no significant trend was observed at ATC (Ptrend =0.61). There was no significant trend in in-hospital mortality (Ptrend =0.38).

Conclusion: For the management of pediatric patients with high-grade BPI, this study found a significant trend toward increasing use of NOM and ERCP without mortality deterioration, especially at PTC and MTC.