Delay in diagnosis and treatment of blunt intestinal perforation does not adversely affect prognosis in the pediatric trauma patient.
BACKGROUND
Blunt intestinal injury (BII) requiring surgical intervention in the pediatric trauma population remains difficult to diagnose. We sought to analyze whether delay in treatment in the event of perforation had an adverse affect on patient outcome.


METHODS
A multi-institutional retrospective chart review by the members of the American Pediatric Surgical Association Committee on Trauma was initiated after the approval of Institutional Review Board at each of the 18 institutions. All children <or=15 years of age diagnosed with a BII were identified and only those with BII noted during surgery or autopsy from January, 2002, through December, 2007, were included. The data form was designed and approved before chart review and all data were combined into one database.


RESULTS
Three hundred fifty-eight patients were accrued into the study. Two hundred fourteen patients had sufficient data to analyze the interval between injury and operation. These were divided into six groups (<6 hours, 6-12 hours, and >12 hours) based on time from injury to intervention and whether they had perforation or not. Early and late complications as well as hospital days, injury severity score, and time to full feeds were compared in each group. There were two deaths from an abdominal source in the <6-hour nonperforation group, one in the 6-hour perforation group, and one in the 6-hour to 12-hour nonperforation group. Injury severity score was significantly greater in the <6-hour intervention group regardless of perforation status. There was no correlation between time to surgery and complication rate nor was there a significant increase in hospital days.


CONCLUSIONS
These data suggest that delay in operative intervention does not have a significant effect on prognosis after pediatric blunt intestinal perforation. Appropriate observation and serial examination rather than repeat computed tomography and/or urgent exploration would appear adequate when the diagnosis is in question.
Letton
Robert W
RW
Section of Pediatric Surgery, Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA. robertletton@ouhsc.edu
Worrell
Veronica
V
Tuggle
David W
DW
D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D001344:Autopsy; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D007422:Intestines / Q000293:injuries* / Q000601:surgery*; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D010360:Patient Transfer; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000601:surgery