title: Image-guided prediction of pseudocyst formation in pediatric pancreatic trauma.
abstract: BACKGROUND
  To determine if there is an effective alternative to the current standard of computed tomography (CT) grading of pediatric pancreatic injuries. We hypothesized that the Wong grading scale, which is based on the depth and location of the pancreatic laceration, is more predictive of pseudocyst formation than the American Association for the Surgery of Trauma (AAST) scale after nonoperative management of traumatic pancreatic injury in children.
  
  
  METHODS
  A retrospective review of children admitted for pancreatic trauma to two level 1 pediatric trauma centers between 2000 and 2012 was conducted. Patients who underwent primary operation were excluded. Initial CT scans were reviewed by two radiologists blinded to clinical outcomes, and injury grades from both scales were assigned. The primary outcome was pseudocyst formation.
  
  
  RESULTS
  Fifty-three patients (ages 7 mo-17 y) were included. As per the Wong scale, pseudocysts occurred in 0/20 patients with grade A injuries, 2/17 (12%) with BI/CI injuries, and 9/15 (60%) with BII/CII injuries. Using the AAST scale, pseudocysts developed in 2/27 (7%) patients with grade I/II injuries, 7/20 (35%) patients with III/IV/V injuries, and 1/6 (17%) patients with a scan that was indeterminate between grades II and III. Positive Predictive value, negative predictive value, sensitivity, and specificity for pseudocyst formation were all higher using the Wong scale (AAST/Wong: Positive Predictive value 42%/50%, negative predictive value 91%/94%, sensitivity 80%/82%, and specificity 65%/77%).
  
  
  CONCLUSIONS
  The Wong CT grading scale may be superior to the AAST scale for early risk stratification for pseudocyst development after nonoperative management of pediatric pancreatic trauma; however, a larger study is needed for verification of these findings.
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
authors.forename: Fariha
authors.initials: F
authors.lastname: Sheikh
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
authors.forename: Sara
authors.initials: S
authors.lastname: Fallon
authors.affiliation: Division of Radiology, Edward B Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, Texas.
authors.forename: George
authors.initials: G
authors.lastname: Bisset
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Daniel
authors.initials: D
authors.lastname: Podberesky
authors.affiliation: Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Jicui
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Division of Radiology, Edward B Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, Texas.
authors.forename: Robert
authors.initials: R
authors.lastname: Orth
authors.affiliation: Texas Children's Hospital Outcomes & Impact Service, Houston, Texas.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Falcone
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas. Electronic address: bnaik@bcm.edu.
authors.forename: Bindi
authors.initials: B
authors.lastname: Naik-Mathuria
mesh_terms: D000007:Abdominal Injuries / Q000150:complications*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010179:Pancreas / Q000000981:diagnostic imaging / Q000293:injuries*; D010192:Pancreatic Pseudocyst / Q000209:etiology*; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: AAST; CT scan; Diagnosis; Pancreatic trauma; Pediatric trauma; Wong classification