title: Non-operative management of high-grade pancreatic trauma: is it worth the wait?
abstract: BACKGROUND
  Whether children with pancreatic trauma should be managed non-operatively or operatively is controversial. We reviewed outcomes of high-grade pancreatic injuries at two high-volume pediatric surgical centres comparing non-operative and operative management strategies.
  
  
  METHODS
  All pancreatic traumas presenting from January 1993 to July 2010 were reviewed. Patients with high-grade pancreatic injuries were stratified based on early operative or non-operative therapy. Baseline characteristics and outcomes were compared. Regression analyses were performed to assess complication rates, length of stay, and TPN duration while controlling for injury severity score and associated injuries.
  
  
  RESULTS
  Of 77 patients with pancreatic injuries, 39 were grade 3 or higher. The mean ISS was 19.2 ± 10.8. Nineteen patients (50%) had associated injuries. Fifteen patients (38%) were managed operatively. Baseline characteristics were similar between groups other than ISS (p=0.03). Duration of hospitalization (p=0.01), days of TPN (p=0.003), and overall complications (p=0.007) were higher in non-operative patients. Controlling for both ISS and any associated injury, non-operative management was associated with more complications (OR 8.11; 95% CI 1.60-41.23) and was a significant predictor of prolonged TPN (13 days longer; p=0.024).
  
  
  CONCLUSIONS
  Primary non-operative management of high-grade pancreatic injuries is associated with a significant increase in complications and TPN dependency. Early operative intervention should be pursued whenever feasible.
authors.affiliation: The Hospital for Sick Children, Division of General and Thoracic Surgery, University of Toronto, Toronto ON, Canada.
authors.forename: Alana L
authors.initials: AL
authors.lastname: Beres
authors.forename: Paul W
authors.initials: PW
authors.lastname: Wales
authors.forename: Emily R
authors.initials: ER
authors.lastname: Christison-Lagay
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: McClure
authors.forename: Mary E
authors.initials: ME
authors.lastname: Fallat
authors.forename: Mary E
authors.initials: ME
authors.lastname: Brindle
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery / Q000628:therapy*; D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000628:therapy; D006801:Humans; D022125:Lacerations / Q000601:surgery / Q000628:therapy; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009104:Multiple Trauma; D010179:Pancreas / Q000293:injuries* / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods / Q000706:statistics & numerical data; D010183:Pancreatic Ducts / Q000293:injuries / Q000601:surgery; D010185:Pancreatic Fistula / Q000209:etiology; D010192:Pancreatic Pseudocyst / Q000209:etiology; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000601:surgery / Q000628:therapy; D014950:Wounds, Penetrating / Q000150:complications / Q000601:surgery / Q000628:therapy