title: Pancreatic trauma in children.
abstract: OBJECTIVE
  To document the demographics, mechanisms and outcome of traumatic pancreatitis in children at a single large tertiary referral centre in Australia.
  
  
  METHODS
  We undertook a 10-year retrospective audit of children admitted to the Royal Children's Hospital, Melbourne, Australia with a hospital coded diagnosis which included pancreatic injury between 1993 and 2002. Data included patient demographics, source of admission, mechanism of injury, pancreatic complications, associated injuries, intensive care unit admission, results of any operative findings, results of any acute computed tomography and/or ultrasound imaging of pancreas, selected laboratory findings and length of stay.
  
  
  RESULTS
  We identified two distinct groups of patients in the 91 documented cases of pancreatic trauma (median age 8.0 years, range 0.6-15.8 years; M:F 2.5:1.0): 59 had a history of abdominal trauma and elevated serum lipase but no CT or ultrasound evidence of pancreatic injury (Group A); 32 had a history of abdominal trauma, elevated serum lipase but also had CT scan and/or ultrasound evidence of pancreatic injury (Group B). Patients with "less severe" injury based on normal imaging had a lower initial lipase level [Group A, median 651 U/L (interquartile range 520-1,324) vs. Group B, 1,608 U/L (interquartile range 680-3,526); p = 0.005] and shorter admission time [Group A, 9.0 days (interquartile range 5.5-15.5) vs. Group B, 13.4 days (interquartile range 6.8-23.8); p = 0.04]. There were no differences with respect to mortality (Group A, 13.5% vs. Group B, 12.5%), but patients with evidence of injury on imaging were more likely to have surgical intervention (p = 0.0001). The single most important overall cause of pancreatic trauma was involvement in a motor vehicle accident as a passenger or pedestrian. However, in children with high-grade ductal injury, bicycle handlebar injuries were most common. Associated injuries were common in both groups.
  
  
  CONCLUSIONS
  Significant pancreatic injury can occur in the absence of abnormality on medical imaging. Pancreatic trauma commonly occurs in the context of multiple injuries after motor vehicle accidents in children and bicycle handlebar injuries, especially in boys. Most children can be treated conservatively, with surgical intervention being limited to high-grade ductal injury.
authors.affiliation: Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Sutherland
authors.forename: Oren
authors.initials: O
authors.lastname: Ledder
authors.forename: Joe
authors.initials: J
authors.lastname: Crameri
authors.forename: Andrew
authors.initials: A
authors.lastname: Nydegger
authors.forename: Anthony
authors.initials: A
authors.lastname: Catto-Smith
authors.forename: Timothy
authors.initials: T
authors.lastname: Cain
authors.forename: Mark
authors.initials: M
authors.lastname: Oliver
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D001642:Bicycling; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008049:Lipase / Q000097:blood; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology; D010179:Pancreas / Q000293:injuries*; D012189:Retrospective Studies; D014739:Victoria / Q000453:epidemiology
chemical_list: D008049:Lipase
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