Outcomes from pediatric solid organ injury: role of standardized care guidelines.
OBJECTIVE
Recent advances in the delivery of trauma and critical care in children have resulted in improved outcome following major injuries. It is imperative that physicians who treat injured children familiarize themselves with current treatment algorithms for abdominal trauma. Important contributions have been made in the diagnosis and treatment of children with abdominal injury by radiologists and endoscopists.


RESULTS
This report examines the impact of consensus guidelines in the treatment of blunt abdominal solid organ injuries. Consensus guidelines for treatment of children with isolated spleen and liver injury are reviewed demonstrating conformity of care and significant reduction of resource utilization without adverse sequelae. Review of large datasets indicate contrasting rates of splenectomy depending on the expertise of the institution, emphasizing the need for wide dissemination of guidelines.


CONCLUSIONS
Clinical experience and published reports addressing specific concerns about the nonoperative treatment of children with solid organ injuries and recent radiologic and endoscopic contributions have made pediatric trauma care increasingly nonoperative. Although the trend is in this direction, the pediatric surgeon should remain the physician-of-record in the multidisciplinary care of critically injured children.
Stylianos
Steven
S
Department of Surgery and Pediatrics, Columbia University College of Physicians and Surgeons, Children's Hospital of New York, New York 10032, USA. ss128@columbia.edu
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D001510:Bed Rest; D002648:Child; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D010179:Pancreas / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D017410:Practice Guidelines as Topic; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000601:surgery*