Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Traumatic Liver Injury in Pediatric Patients

소아 환자에서의 외상성 간 손상

  • Koo, Byung Han (Department of Surgery, Wonju College of Medicine, Yonsei University) ;
  • Park, Joon Beom (Armed Forces Wonju Hospital) ;
  • Bae, Keum Seok (Department of Surgery, Wonju College of Medicine, Yonsei University) ;
  • Kang, Sung Joon (Department of Surgery, Wonju College of Medicine, Yonsei University)
  • 구병한 (연세대학교 원주의과대학 외과학교실) ;
  • 박준범 (국군원주병원 외과) ;
  • 배금석 (연세대학교 원주의과대학 외과학교실) ;
  • 강성준 (연세대학교 원주의과대학 외과학교실)
  • Received : 2009.10.09
  • Accepted : 2009.12.05
  • Published : 2009.12.30
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Abstract

Purpose: Trauma is an important cause of death in children. In particular, the liver is the second most commonly organ injured by blunt abdominal trauma. Treatment of patients with liver injury is has changed, and non-operative treatment is the major treatment method at present. In this study, we reviewed traumatic liver injury in pediatric patients. Methods: Seventy-seven patients younger than 16 years of age with traumatic liver injury were assessed for 10 years from July 1999 to June 2009 at Wonju Christian hospital. Records of the patients were reviewed retrospectively. Demographic and clinical data were analyzed. Results: The median age was 6 years, and the male-to-female ratio was 1.2 : 1. The most common injury grade was grade I. The majority of injuries were caused by was traffic accidents, and the second most common cause of injuries was falls. Twenty-four patients had liver injuries alone, and the most common accopaning injury was a lung injury. The average hospital stay was 20.7 days, and the average ICU stay was 4.8 days. Four patients died (5.2%). There were 6 patients with under 10 points on the Glasgow coma scale (GCS). Among these patients, three died. All mortality cases had over 16 points on the Injury Severity Score (ISS). Two patients were treated surgically, one of whom died. Of the 75 patients with non-operative management, three died due to associated injuries. Conclusion: Most pediatric patients with liver injury have good results with non-operative management. Associated injuries and hemodynamic instability are predictive of patient outcome, and those with isolated liver injuries can be successfully managed non-operatively.

Keywords

References

  1. Ramenofsky ML. Infants and children as accident victims and their emergency management. In: O'Neill JA, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG, eds. Pediatric Surgery. 5th ed. St Louis, Missouri: Mosby-Year Book; 1998: 235-43
  2. Stylianos S, Pearl RH. Abdominal trauma. In: Grosfeld JL, O'Neill JAJ, Fonkalsrud EW, Coran AG, eds. Pediatric Surgery. 6th ed. Philadelphia: Mosby-Elsevier; 2006: 295-316
  3. Potoka DA, Schall LC, Ford HR. Development of a Novel age-specific pediatric trauma score. Journal of Pediatric Surgery. 2001;36(1):106-12 https://doi.org/10.1053/jpsu.2001.20023
  4. Kwon SI. Clinical Analysis of Traumatic Hepatic Injury in Pediatric Patients. J Korean Soc Traumatol. 1996;9:1-9
  5. Karp MP, Cooney DR, Pros GA, Newman BM, Jewett TC, Jr. The nonoperative management of pediatric hepatic trauma. J Pediatr Surg. 1983 Aug;18(4):512-8 https://doi.org/10.1016/S0022-3468(83)80211-5
  6. Tataria M, Nance ML, Holmes JHt, Miller CC, 3rd, Mattix KD, Brown RL, et al. Pediatric blunt abdominal injury: age is irrelevant and delayed operation is not detrimental. J Trauma. 2007 Sep;63(3):608-14 https://doi.org/10.1097/TA.0b013e318142d2c2
  7. Tepas JJ, 3rd, Ramenofsky ML, Mollitt DL, Gans BM, DiScala C. The Pediatric Trauma Score as a predictor of injury severity: an objective assessment. J Trauma. 1988 Apr;28(4):425-9 https://doi.org/10.1097/00005373-198804000-00001
  8. Lim KS, Kang SJ, Yoo SY, Kim HJ. The Pediatric Trauma Score as a Predictor of Injury Severity in the Injured Child. Kor J Emergency Medicine. 1990;1(1):150-5
  9. Chang J, Choi K-j. Analysis of the Management of Children with Abdominal Solid Organ Injuries. J Korean Surg Soc. 2009 Apr;76(4):252-8 https://doi.org/10.4174/jkss.2009.76.4.252
  10. Gaines BA, Ford HR. Abdominal and pelvic trauma in children. Crit Care Med. 2002 Nov;30(11 Suppl):S416-23 https://doi.org/10.1097/00003246-200211001-00006
  11. Bond SJ, Eichelberger MR, Gotschall CS, Sivit CJ, Randolph JG. Nonoperative management of blunt hepatic and splenic injury in children. Ann Surg. 1996 Mar;223(3):286-9 https://doi.org/10.1097/00000658-199603000-00009
  12. Cogbill TH, Moore EE, Jurkovich GJ, Feliciano DV, Morris JA, Mucha P. Severe hepatic trauma: a multicenter experience with 1,335 liver injuries. J Trauma. 1988 Oct;28(10):1433-8 https://doi.org/10.1097/00005373-198810000-00004
  13. Richardson JD. Changes in the management of injuries to the liver and spleen. J Am Coll Surg. 2005 May;200(5):648-69 https://doi.org/10.1016/j.jamcollsurg.2004.11.005
  14. Pachter HL, Knudson MM, Esrig B, Ross S, Hoyt D, Cogbill T, et al. Status of nonoperative management of blunt hepatic injuries in 1995: a multicenter experience with 404 patients. J Trauma. 1996 Jan;40(1):31-8 https://doi.org/10.1097/00005373-199601000-00007
  15. Pachter HL, Spencer FC, Hofstetter SR, Liang HG, Coppa GF. Significant trends in the treatment of hepatic trauma. Experience with 411 injuries. Ann Surg. 1992 May;215(5):492-500; discussion -2 https://doi.org/10.1097/00000658-199205000-00012
  16. Pachter HL, Hofstetter SR. The current status of nonoperative management of adult blunt hepatic injuries. Am J Surg. 1995 Apr;169(4):442-54 https://doi.org/10.1016/S0002-9610(99)80194-9
  17. Jobst MA, Canty TG, Sr., Lynch FP. Management of pancreatic injury in pediatric blunt abdominal trauma. J Pediatr Surg. 1999 May;34(5):818-23; discussion 23-4 https://doi.org/10.1016/S0022-3468(99)90379-2
  18. Nance ML, Lutz N, Carr MC, Canning DA, Stafford PW. Blunt renal injuries in children can be managed nonoperatively: outcome in a consecutive series of patients. J Trauma. 2004 Sep;57(3):474-8; discussion 8 https://doi.org/10.1097/01.TA.0000141022.01878.C2
  19. Stylianos S. Outcomes from pediatric solid organ injury: role of standardized care guidelines. Curr Opin Pediatr. 2005 Jun;17(3):402-6
  20. Anderson R, Bengmark S. Conservative treatment of liver trauma. World journal of surgery. 1985;14:483 https://doi.org/10.1007/BF01658672
  21. Stylianos S. Compliance with evidence-based guidelines in children with isolated spleen or liver injury: a prospective study. J Pediatr Surg. 2002 Mar;37(3):453-6 https://doi.org/10.1053/jpsu.2002.30860