Skip to main content

Advertisement

SpringerLink
Log in

Variability in the evalution of pediatric blunt abdominal trauma

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  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 259:793–801

    Article  PubMed  Google Scholar 

  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 67:779–787

    Article  PubMed  Google Scholar 

  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 54:528–533

    Article  PubMed  Google Scholar 

  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):449–458

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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 79:555–562

    Article  PubMed  Google Scholar 

  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 10:41

    Article  PubMed  PubMed Central  Google Scholar 

  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 86:87–90

    PubMed  CAS  Google Scholar 

  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 17:313–316

    Article  PubMed  CAS  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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 46:923–926

    Article  PubMed  Google Scholar 

  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 45:1384–1393

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  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 39:492–499

    Article  PubMed  Google Scholar 

  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 22:710–716

    Article  PubMed  Google Scholar 

  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 92:691–694

    PubMed  CAS  Google Scholar 

  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 154:912–917

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  25. Christensen MC, Ridley S, Lecky FE et al (2008) Outcomes and costs of blunt trauma in England and Wales. Crit Care 12:R23

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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 12:267

    Article  PubMed  PubMed Central  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

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

    Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  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 6:799–806

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

Download references

Funding

This study did not receive funding.

Author information

Authors and Affiliations

  1. Baylor College of Medicine, Texas Children’s Hospital, 6701 Fannin Street, Suite 1210, Houston, TX, 77030, USA

    Adam M. Vogel & Bindi J. Naik-Mathuria

  2. Medical University of South Carolina, Charleston, SC, USA

    Jingwen Zhang, Patrick D. Mauldin & Christian J. Streck

  3. University of Tennessee Health Science Center at Memphis, Memphis, TN, USA

    Regan F. Williams & Eunice Y. Huang

  4. Emory University School of Medicine, Atlanta, GA, USA

    Matthew T. Santore

  5. University of Texas Health Science Center at Houston, Houston, TX, USA

    Kuojen Tsao

  6. Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Richard A. Falcone

  7. Arkansas Children’s Hospital, Little Rock, AR, USA

    M. Sidney Dassinger

  8. Virginia Commonwealth University, Richmond, VA, USA

    Jeffrey H. Haynes

  9. Vanderbilt University School of Medicine, Nashville, TN, USA

    Martin L. Blakely

  10. University of Alabama Birmingham School of Medicine, Birmingham, AL, USA

    Robert T. Russell

  11. Children’s Mercy Kansas City, Kansas City, MO, USA

    Shawn D. St Peter

  12. Boston Children’s Hospital, Boston, MA, USA

    David Mooney

  13. Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Jeffrey S. Upperman

Authors
  1. Adam M. Vogel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jingwen Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick D. Mauldin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Regan F. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eunice Y. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matthew T. Santore
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kuojen Tsao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Richard A. Falcone
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. Sidney Dassinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jeffrey H. Haynes
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Martin L. Blakely
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Robert T. Russell
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Bindi J. Naik-Mathuria
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Shawn D. St Peter
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. David Mooney
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Jeffrey S. Upperman
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Christian J. Streck
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Corresponding author

Correspondence to Adam M. Vogel.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vogel, A.M., Zhang, J., Mauldin, P.D. et al. Variability in the evalution of pediatric blunt abdominal trauma. Pediatr Surg Int 35, 479–485 (2019). https://doi.org/10.1007/s00383-018-4417-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-018-4417-z

Keywords

Search

Navigation