Advertisement

Pediatric Surgery International

, Volume 35, Issue 4, pp 479–485 | Cite as

Variability in the evalution of pediatric blunt abdominal trauma

  • Adam M. VogelEmail author
  • 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
Original Article

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.

Keywords

Pediatric Blunt abdominal trauma Variability 

Notes

Author contributions

Study conception and design: CJS, AMV, JZ, EYH, MSD, RTR, MLB. Acquisition of data: AMV, RFW, EYH, MTS, KT, RAF, MSD, JHH, MLB, RTR, BJN-M, SDSP, DM, JSU, CJS. Analysis and interpretation of data: CJS, AMV, JZ, PDM. Drafting of manuscript: CJS, AMV. Critical revision of the Manuscript: AMV, RFW, EYH, MTS, KT, RAF, MSD, JHH, MLB, RTR, BJN-M, SDSP, DM, JSU, CJS.

Funding

This study did not receive funding.

Compliance with ethical standards

Conflict of interest

Adam M. Vogel, MD declares that he has no conflict of interest. Jingwen Zhang, MS declares that he has no conflict of interest. Patrick D. Mauldin, PhD declares that he has no conflict of interest. Regan F. Williams, MD declares that she has no conflict of interest. Eunice Y. Huang, MD, MS declares that she has no conflict of interest. Matthew T. Santore, MD declares that he has no conflict of interest. Kuojen Tsao, MD declares that he has no conflict of interest. Richard A. Falcone, MD, MPH declares that he has no conflict of interest. M Sidney Dassinger, MD declares that he has no conflict of interest. Jeffrey H. Haynes, MD declares that he has no conflict of interest. Martin L. Blakely, MD, MS declares that he has no conflict of interest. Robert T. Russell, MD, MPH declares that he has no conflict of interest. Bindi J. Naik-Mathuria, MD, MPH declares that she has no conflict of interest. Shawn D. St Peter, MD declares that he has no conflict of interest. David Mooney, MD, MPH declares that he has no conflict of interest. Jeffrey S. Upperman, MD declares that he has no conflict of interest. Christian J. Streck, MD declares that he has no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. IRB approval was obtained at each participating institution.

Informed consent

As a prospective, observational study, the study was deemed minimal risk and the need for informed consent was waived by participating center IRBs.

References

  1. 1.
    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 259:793–801CrossRefPubMedGoogle Scholar
  2. 2.
    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 67:779–787CrossRefPubMedGoogle Scholar
  3. 3.
    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 54:528–533CrossRefPubMedGoogle Scholar
  4. 4.
    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):449–458CrossRefPubMedGoogle Scholar
  5. 5.
    Capraro AJ, Mooney D, Waltzman ML (2006) The use of routine laboratory studies as screening tools in pediatric abdominal trauma. Pediatr Emerg Care 22:480–484CrossRefPubMedGoogle Scholar
  6. 6.
    Keller MS, Coln CE, Trimble JA et al (2004) The utility of routine trauma laboratories in pediatric trauma resuscitations. Am J Surg 188:671–678CrossRefPubMedGoogle Scholar
  7. 7.
    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) CrossRefPubMedGoogle Scholar
  8. 8.
    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 79:555–562CrossRefPubMedGoogle Scholar
  9. 9.
    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 10:41CrossRefPubMedPubMedCentralGoogle Scholar
  10. 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 86:87–90PubMedGoogle Scholar
  11. 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 17:313–316CrossRefPubMedGoogle Scholar
  12. 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) CrossRefPubMedGoogle Scholar
  13. 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 46:923–926CrossRefPubMedGoogle Scholar
  14. 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 45:1384–1393CrossRefPubMedGoogle Scholar
  15. 15.
    Matsuno WC, Huang CJ, Garcia NM et al (2009) Amylase and lipase measurements in paediatric patients with traumatic pancreatic injuries. Injury 40:66–71CrossRefPubMedGoogle Scholar
  16. 16.
    Buckley JC, McAninch JW (2004) Pediatric renal injuries: management guidelines from a 25-year experience. J Urol 172:687–690 (discussion 690) CrossRefPubMedGoogle Scholar
  17. 17.
    Buckley JC, McAninch JW: The diagnosis, management, and outcomes of pediatric renal injuries. Urol Clin North Am 33:33–40 (vi, 2006) Google Scholar
  18. 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) CrossRefPubMedGoogle Scholar
  19. 19.
    Thorp AW, Young TP, Brown L (2011) Test characteristics of urinalysis to predict urologic injury in children. West J Emerg Med 12:168–172PubMedPubMedCentralGoogle Scholar
  20. 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 39:492–499CrossRefPubMedGoogle Scholar
  21. 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 22:710–716CrossRefPubMedGoogle Scholar
  22. 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 92:691–694PubMedGoogle Scholar
  23. 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 154:912–917CrossRefPubMedGoogle Scholar
  24. 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) CrossRefPubMedGoogle Scholar
  25. 25.
    Christensen MC, Ridley S, Lecky FE et al (2008) Outcomes and costs of blunt trauma in England and Wales. Crit Care 12:R23CrossRefPubMedPubMedCentralGoogle Scholar
  26. 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 PubMedGoogle Scholar
  27. 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 12:267CrossRefPubMedPubMedCentralGoogle Scholar
  28. 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) CrossRefPubMedGoogle Scholar
  29. 29.
    Appleby J (2011) Variations in health care: the good, the bad, and the inexplicable. The King’s Fund, LondonGoogle Scholar
  30. 30.
    James BC, Hammond ME (2000) The challenge of variation in medical practice. Arch Pathol Lab Med 124:1001–1003PubMedGoogle Scholar
  31. 31.
    Wennberg JE (1987) The paradox of appropriate care. JAMA 258:2568–2569CrossRefPubMedGoogle Scholar
  32. 32.
    Westert GP, Groenewegen PP (1999) Medical practice variations: changing the theoretical approach. Scand J Public Health 27:173–180CrossRefPubMedGoogle Scholar
  33. 33.
    Heron M (2016) Deaths: leading causes for 2014. Natl Vital Stat Rep 65:1–96Google Scholar
  34. 34.
    Lanzarotti S, Cook CS, Porter JM et al (2003) The cost of trauma. Am Surg 69:766–770PubMedGoogle Scholar
  35. 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 6:799–806CrossRefPubMedGoogle Scholar
  36. 36.
    Holmes JF, Sokolove PE, Brant WE et al (2002) Identification of children with intra-abdominal injuries after blunt trauma. Ann Emerg Med 39:500–509CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Adam M. Vogel
    • 1
    Email author
  • Jingwen Zhang
    • 2
  • Patrick D. Mauldin
    • 2
  • Regan F. Williams
    • 3
  • Eunice Y. Huang
    • 3
  • Matthew T. Santore
    • 4
  • Kuojen Tsao
    • 5
  • Richard A. Falcone
    • 6
  • M. Sidney Dassinger
    • 7
  • Jeffrey H. Haynes
    • 8
  • Martin L. Blakely
    • 9
  • Robert T. Russell
    • 10
  • Bindi J. Naik-Mathuria
    • 1
  • Shawn D. St Peter
    • 11
  • David Mooney
    • 12
  • Jeffrey S. Upperman
    • 13
  • Christian J. Streck
    • 2
  1. 1.Baylor College of MedicineTexas Children’s HospitalHoustonUSA
  2. 2.Medical University of South CarolinaCharlestonUSA
  3. 3.University of Tennessee Health Science Center at MemphisMemphisUSA
  4. 4.Emory University School of MedicineAtlantaUSA
  5. 5.University of Texas Health Science Center at HoustonHoustonUSA
  6. 6.Cincinnati Children’s HospitalCincinnatiUSA
  7. 7.Arkansas Children’s HospitalLittle RockUSA
  8. 8.Virginia Commonwealth UniversityRichmondUSA
  9. 9.Vanderbilt University School of MedicineNashvilleUSA
  10. 10.University of Alabama Birmingham School of MedicineBirminghamUSA
  11. 11.Children’s Mercy Kansas CityKansas CityUSA
  12. 12.Boston Children’s HospitalBostonUSA
  13. 13.Children’s Hospital Los AngelesLos AngelesUSA

Personalised recommendations