Journal of pediatric surgery · 2026
Outcomes of pediatric blunt liver and spleen injury in 1029 patients using the ATOMAC+ pediatric trauma research network guideline.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Notrica David M, Maxson Todd, Stottlemyre Rachael L, Cohen Aaron S, Bundrant Nikkida, Lawson Karla A, Eubanks James W, Ryan Mark, Letton Robert W, Bhatia Amina, Wyrick Deidre, St Peter Shawn D, Leys Charles, Ponsky Todd, Williams Regan F, Johnson Jeremy J
Аннотация
BACKGROUND: The ATOMAC + guideline is an evidence-based guideline for management of pediatric blunt liver and/or spleen injury (BLSI) based on clinical signs of bleeding on arrival.
METHODS: A prospective multi-institutional study of children aged ≤18 years with BLSI was conducted at 10 pediatric trauma centers. Unstable patients without computed tomography were added retrospectively. Demographic data, interventions, and outcomes were analyzed.
RESULTS: Of 1029 children (median age 10.2 years) with BLSI, 713 (69%) had no signs of clinically significant bleeding upon arrival, and no initially stable patients required surgery for bleeding; 13 (1.8%) required abdominal surgery for other reasons. Of 316 patients with clinical signs of recent bleeding or ongoing bleeding on arrival, 10 patients died in the ED and 17 non-responders underwent surgery directly. Among 168 patients responding initially to transfusion, 22 underwent angiography and 60 went to surgery (9 after angiography). Of the 44 stabilized patients who received >40 mL/kg blood products, only 5 (11%) survived without intervention. Additionally, 37 (32%) transfused patients not meeting this threshold also underwent abdominal intervention. Overall mortality was 3.4% including 21% of 42 patients transfused >40 mL/kg or 4 units of blood.
CONCLUSION: The frequency of laparotomy or laparoscopy in children with BLSI was 8.2%. Children with no clinical signs of bleeding upon arrival did not later bleed, but 1.6% of these patients ultimately required abdominal surgery for other injuries. Transfusion >40 mL/kg was strongly associated with intervention or death, but a substantial number of children who received less blood also required intervention.
METHODS: A prospective multi-institutional study of children aged ≤18 years with BLSI was conducted at 10 pediatric trauma centers. Unstable patients without computed tomography were added retrospectively. Demographic data, interventions, and outcomes were analyzed.
RESULTS: Of 1029 children (median age 10.2 years) with BLSI, 713 (69%) had no signs of clinically significant bleeding upon arrival, and no initially stable patients required surgery for bleeding; 13 (1.8%) required abdominal surgery for other reasons. Of 316 patients with clinical signs of recent bleeding or ongoing bleeding on arrival, 10 patients died in the ED and 17 non-responders underwent surgery directly. Among 168 patients responding initially to transfusion, 22 underwent angiography and 60 went to surgery (9 after angiography). Of the 44 stabilized patients who received >40 mL/kg blood products, only 5 (11%) survived without intervention. Additionally, 37 (32%) transfused patients not meeting this threshold also underwent abdominal intervention. Overall mortality was 3.4% including 21% of 42 patients transfused >40 mL/kg or 4 units of blood.
CONCLUSION: The frequency of laparotomy or laparoscopy in children with BLSI was 8.2%. Children with no clinical signs of bleeding upon arrival did not later bleed, but 1.6% of these patients ultimately required abdominal surgery for other injuries. Transfusion >40 mL/kg was strongly associated with intervention or death, but a substantial number of children who received less blood also required intervention.