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Practice variability exists in the management of high-grade pediatric pancreatic trauma

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Abstract

Purpose

Management of high-grade pancreatic trauma in children is controversial, although recent evidence supports early operation. We sought to evaluate whether practice variability exists regarding the management of these rare and complex injuries.

Methods

A study group of pediatric trauma centers within the Pediatric Trauma Society completed a survey following a query of their institutional database. Results are presented using descriptive statistics.

Results

Over a 3-year period (2012–2014), 123 pancreatic injuries (grades II–IV) were reported from 19 pediatric trauma centers (median 6, range 1–22). Sixty-two injuries involving injury to the pancreatic duct (clear/suspected) were reported (median 1, range 0–9). Of these, 49 % were managed with non-operative management (NOM) and 51 % with operative management. Surgeons at the majority (63 %) of institutions used both approaches. Of the operative cases, 21 % were laparoscopic. There was wide variability in clinical management of NOM patients: the most common feeding strategy was reported by 52 % of centers, percutaneous drainage of traumatic pseudocyst by 42 % and ERCP (early/after pseudocyst) by 72 %.

Conclusion

Wide practice variability exists among North American pediatric surgeons regarding both the initial approach to high-grade pancreatic injury and non-operative management. These results highlight the need for a prospective trial to determine the optimal strategy for these patients.

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Acknowledgments

Members of the PTS (Pediatric Trauma Society) Pancreatic Trauma Study Group and the centers whose data contributed to this survey: Richard Falcone MD—Cincinnati Children’s Hospital, Cincinnati, OH. David Mooney MD—Boston Children’s Hospital, Boston, MA. Stephen Fenton MD—Primary Children’s Hospital, Salt Lake City, UT. Adam Vogel MD—St. Louis Children’s Hospital, St. Louis, MO. Jeffrey Upperman MD and Rita Burke PhD—Children’s Hospital of Los Angeles, Los Angeles, CA. Robert Russell MD—Children’s Hospital of Alabama, Birmingham, AL. Randall Burd MD—Children’s National Hospital, Washington, DC. Brendan Campbell MD—Connecticut Children’s Hospital, Hartford, CT. David Gourlay MD—Children’s Hospital of Wisconsin, Milwaukee, WI. David Gibbs MD—Children’s Hospital of Orange County, Orange, CA. Marianne Beaudin MD—CHU Sainte Justine, Montreal, Quebec, Canada. Shahab Abdessalam MD—Children’s Hospital of Omaha, Omaha, NE. Ankush Gosain MD—American Family Children’s Hospital, Madison, WI. Devin Puapong MD—Kapiolani Medical Center for Women and Children, Honolulu, HI. Nathaniel Kreykes MD—Minnesota Children’s Hospital. David Jacobs MD—Carolinas Medical Center, Charlotte, NC. Chad Hamner MD—Cook Children’s Medical Center, Fort Worth, TX. Heather Kulp MD—Nemours/duPont Hospital for Children, Orlando, FL.

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Authors and Affiliations

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

    Bindi Naik-Mathuria

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  1. Bindi Naik-Mathuria
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Correspondence to Bindi Naik-Mathuria.

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On behalf of the PTS (Pediatric Trauma Society) Pancreatic Trauma Study Group.

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Naik-Mathuria, B. Practice variability exists in the management of high-grade pediatric pancreatic trauma. Pediatr Surg Int 32, 789–794 (2016). https://doi.org/10.1007/s00383-016-3917-y

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