Utility of radiographic hepatic injury grade in predicting outcome for children after blunt abdominal trauma.
OBJECTIVE
The American Association for the Surgery of Trauma (AAST) liver injury grading system has been adopted in the management of pediatric hepatic injuries. However, the usefulness of this grading system in children remains undefined. The authors, therefore, examined the validity of AAST grading in the management of pediatric blunt liver injury.


METHODS
The authors identified 152 patients, ages 0 to 18 years, with blunt hepatic injury treated at our pediatric trauma center between 1995 and 2000. Radiographic AAST grade was assigned retrospectively by 2 radiologists. Variables analyzed included age, gender, Glasgow Coma Score (GCS), Injury Severity Score (ISS), and associated injuries. Outcome measures were mortality rate and length of stay (LOS). Statistical analysis was performed using analysis of variance or linear regression.


RESULTS
Computed tomography (CT) scans were available for 95 patients. Radiographic injury grade did not correlate with mortality rate, hospital LOS or intensive care unit (ICU) LOS. ISS and associated injury, but not age, gender, or GCS, were predictive of LOS. Grade did not correlate with mortality rate, ICU LOS, or hospital LOS.


CONCLUSIONS
Radiographic liver grading does not predict outcome reliably in children and should not be the main parameter utilized to guide clinical decision making. A role for scoring systems that utilize factors such as associated injuries and ISS is indicated.
Hackam
David J
DJ
Division of Pediatric Surgery, Benedum Trauma Program, The Department of Radiology Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
Potoka
Douglas
D
Meza
Manuel
M
Pollock
Avrum
A
Gardner
Mary
M
Abrams
Peter
P
Upperman
Jeffrey
J
Schall
Laura
L
Ford
Henri
H
D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008099:Liver / Q000000981:diagnostic imaging* / Q000293:injuries*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*