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Professional practice assessment: establishment of an institutional procedure to treat blunt abdominal trauma in emergency pediatric department

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Objective

The clinical process for the diagnosis of intra-abdominal lesion due to blunt abdominal trauma in children is not consistent. The goal of the present study was to assess the efficiency of our institutional procedure to manage hemodynamically stable pediatric patients with benign abdominal trauma and to select patients who need a radiological examination in an emergency pediatric department.

Material and methods

This was a prospective cohort study from June 2008 to June 2010 in a pediatric emergency department. Pediatric patients with benign abdominal trauma and with stable hemodynamic parameters were included in the study. We conducted first clinical examination and clinical laboratory assessment for blood count, platelet count, hematocrit, serum glutamo-oxalacétique transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), lipase and urine. A second clinical examination was performed 2 h later. Patients with biological abnormalities and/or with persistent pain underwent a computerized tomography (CT) of the abdomen. Our main criterion for judging was the presence of intra-abdominal lesion as revealed by the scan, which was considered as the gold standard. At the second clinical examination, patients without pain and with normal results for clinical laboratory assessment were sent home. A telephone call was made to the children 48 h after the visit to the hospital emergency department. The secondary criterion for judging was the absence of complication in children who did not undergo the scan.

Results

A total of 111 children were included. Seventy-five children underwent the complete procedure. Thirty-four scans were performed. The scan revealed that 22 patients had an intra-abdominal lesion. Multivariate analysis indicated that SGOT higher than 34 IU/L and the persistence of pain for more than 2 h from the initial evaluation of trauma favored the development of intra-abdominal lesion. On the basis of these two criteria, we developed a predictive diagnostic score for post-traumatic intra-abdominal injuries with a high negative predictive value. For children who were sent home without a radiological examination, no complications were observed at 48 h after the visit to the emergency department.

Conclusion

The present protocol is a good approach to identify children at risk for intra-abdominal lesion who need a radiological examination and those who do not require any complementary examinations. The predictive diagnostic score could help young hospital doctors to assess blunt abdominal trauma.

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References

  1. Heron M. Deaths: Leading Causes for 2015. Natl Vital Stat Rep Cent Dis Control Prev Natl Cent Health Stat Natl Vital Stat Syst. 2017;66:1–76.

    Google Scholar 

  2. Hoonakker PLT, Wooldridge AR, Hose BZ, Carayon P, Eithun B, Brazelton TB, et al. Information flow during pediatric trauma care transitions: things falling through the cracks. Intern Emerg Med. 2019;14(5):797–805.

    Article  Google Scholar 

  3. Poletti PA, Mirvis SE, Shanmuganathan K, Takada T, Killeen KL, Perlmutter D, et al. Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography? J Trauma. 2004;57:1072–81.

    Article  Google Scholar 

  4. Jaffe D, Wesson D. Emergency management of blunt trauma in children. N Engl J Med. 1991;324:1477–82.

    Article  CAS  Google Scholar 

  5. Brenner DJ, Elliston CD, Hall EJ, Berdon WE. Estimated risks of radiation-induced fatal cancer from pediatric CT. Am J Roentgenol. 2001;176:289–96.

    Article  CAS  Google Scholar 

  6. Brody AS, Frush DP, Huda W, Brent RL, American Academy of Pediatrics Section on Radiology. Radiation risk to children from computed tomography. Pediatrics. 2007;120:677–82.

  7. Sharples A, Brohi K. Can clinical prediction tools predict the need for computed tomography in blunt abdominal? A systematic review. Injury. 2016;47:1811–8.

    Article  Google Scholar 

  8. Linard C, Germouty I, David C-H, Pecquery R, Le Rouzic-Dartoy C, Fenoll B, et al. Traumatisme abdominal mineur de l’enfant : protocole de prise en charge aux urgences. J Eur Urgences Réanimation. 2012;24:2–8.

    Article  Google Scholar 

  9. Karam O, Sanchez O, Chardot C, La Scala G. Blunt abdominal trauma in children: a score to predict the absence of organ injury. J Pediatr. 2009;154:912–7.

    Article  Google Scholar 

  10. Emery CA. Risk factors for injury in child and adolescent sport: a systematic review of the literature. Clin J Sport Med. 2003;13:256.

    Article  Google Scholar 

  11. Miele V, Piccolo CL, Trinci M, Galluzzo M, Ianniello S, Brunese L. Diagnostic imaging of blunt abdominal trauma in pediatric patients. Radiol Med (Torino). 2016;121:409–30.

    Article  Google Scholar 

  12. Afaq A, Harvey C, Aldin Z, Leen E, Cosgrove D. Contrast-enhanced ultrasound in abdominal trauma. Eur J Emerg Med. 2012;19:140.

    Article  Google Scholar 

  13. Kim KH, Kim JS, Kim W-W. Outcome of children with blunt liver or spleen injuries: experience from a single institution in Korea. Int J Surg Lond Engl. 2017;38:105–8.

    Article  Google Scholar 

  14. Veger HTC, Jukema GN, Bode PJ. Pediatric splenic injury: nonoperative management first! Eur J Trauma Emerg Surg. 2008;34:267–72.

    Article  Google Scholar 

  15. Lynn KN, Werder GM, Callaghan RM, Sullivan AN, Jafri ZH, Bloom DA. Pediatric blunt splenic trauma: a comprehensive review. Pediatr Radiol. 2009;39:904–16.

    Article  Google Scholar 

  16. Hynick NH, Brennan M, Schmit P, Noseworthy S, Yanchar NL. Identification of blunt abdominal injuries in children. J Trauma Acute Care Surg. 2014;76:95–100.

    Article  Google Scholar 

  17. Notrica DM1, Eubanks JW 3rd, Tuggle DW, Maxson RT, Letton RW, Garcia NM, Alder AC, Lawson KA, St Peter SD, Megison S, Garcia-Filion P. Nonoperative management of blunt liver and spleen injury in children: evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg. 2015;79(4):683–93.

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

    Article  Google Scholar 

  19. Holmes JF, Sokolove PE, Brant WE, Palchak MJ, Vance CW, Owings JT, et al. Identification of children with intra-abdominal injuries after blunt trauma. Ann Emerg Med. 2002;39:500–9.

    Article  Google Scholar 

  20. Karaduman D, Sarioglu-Buke A, Kilic I, Gurses E. The role of elevated liver transaminase levels in children with blunt abdominal trauma. Injury. 2003;34:249–52.

    Article  Google Scholar 

  21. Jacombs ASW, Wines M, Holland AJA, Ross FI, Shun A, Cass DT. Pancreatic trauma in children. J Pediatr Surg. 2004;39:96–9.

    Article  CAS  Google Scholar 

  22. Sessa B, Trinci M, Ianniello S, Menichini G, Galluzzo M, Miele V. Blunt abdominal trauma: role of contrast-enhanced ultrasound (CEUS) in the detection and staging of abdominal traumatic lesions compared to US and CE-MDCT. Radiol Med (Torino). 2015;120:180–9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Brest, Hôpital Augustin Morvan, 4 Avenue Foche, 29200, Brest, France

    Ianis Cousin, Lucile Hardouin, Caroline Linard, Isabelle Germouty & Philine de Vries

  2. Laboratoire Intéraction Epithélium Neurones, Université de Bretagne Occidentale, 6 rue Colbert, 29200, Brest, France

    Ianis Cousin & Philine de Vries

  3. Department of Pediatry, Centre Hospitalier Universitaire de Rennes, 16 Boulevard de Bulgarie, 35200, Rennes, France

    Elie Cousin

  4. Pediatric Emergency Department, Centre Hospitalier Régional Universitaire de Brest, Hôpital Augustin Morvan, 4 Avenue Foch, 29200, Brest, France

    Lydie Abalea

  5. Department of Pneumology, Centre Hospitalier Régional Universitaire de Brest, Hôpital de La Cavale Blanche, Boulevard Tanguy Prigent, 29200, Brest, France

    Francis Couturaud

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  1. Ianis Cousin
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  2. Lucile Hardouin
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  3. Caroline Linard
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  4. Elie Cousin
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  5. Isabelle Germouty
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  7. Francis Couturaud
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  8. Philine de Vries
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Correspondence to Ianis Cousin.

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Cousin, I., Hardouin, L., Linard, C. et al. Professional practice assessment: establishment of an institutional procedure to treat blunt abdominal trauma in emergency pediatric department. Eur J Trauma Emerg Surg 47, 105–112 (2021). https://doi.org/10.1007/s00068-019-01214-1

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  • DOI: https://doi.org/10.1007/s00068-019-01214-1

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