title: Management of children with solid organ injuries after blunt torso trauma.
abstract: BACKGROUND
  Management of children with intra-abdominal solid organ injuries has evolved markedly. We describe the current management of children with intra-abdominal solid organ injuries after blunt trauma in a large multicenter network.
  
  
  METHODS
  We performed a planned secondary analysis of a prospective, multicenter observational study of children (<18 years) with blunt torso trauma. We included children with spleen, liver, or kidney injuries identified by computed tomography, laparotomy/laparoscopy, or autopsy. Outcomes included disposition and interventions (blood transfusion for intra-abdominal hemorrhage, angiography, laparotomy/laparoscopy). We performed subanalyses of children with isolated injuries.
  
  
  RESULTS
  A total of 12,044 children were enrolled; 605 (5.0%) had intra-abdominal solid organ injuries. The mean (SD) age was 10.7 (5.1) years, and injured organs included spleen 299 (49.4%), liver 282 (46.6%), and kidney 147 (24.3%). Intraperitoneal fluid was identified on computed tomography in 461 (76%; 95% confidence interval [CI], 73-80%), and isolated solid organ injuries were present in 418 (69%; 95% CI, 65-73%). Treatment included therapeutic laparotomy in 17 (4.1%), angiographic embolization in 6 (1.4%), and blood transfusion in 46 (11%) patients. Laparotomy rates for isolated injury were 11 (5.4%) of 205 (95% CI, 2.7-9.4%) at non-freestanding children's hospitals and 6 (2.8%) of 213 (95% CI, 1.0-6.0%) at freestanding children's hospitals (difference, 2.6%; 95% CI, -7.1% to 12.2%). Dispositions of the 212 children with isolated Grade I or II organ injuries were home in 6 (3%), emergency department observation in 9 (4%), ward in 114 (54%), intensive care unit in 73 (34%), operating suite in 7 (3%), and transferred in 3 (1%) patients. Intensive care unit admission for isolated Grade I or II injuries varied by center from 9% to 73%.
  
  
  CONCLUSIONS
  Most children with solid organ injuries are managed with observation. Blood transfusion, while uncommon, is the most frequent therapeutic intervention; angiographic embolization and laparotomy are uncommon. Emergency department disposition of children with isolated Grade I to II solid organ injuries is highly variable and often differs from published guidelines.
  
  
  METHODS
  Prognostic/epidemiologic study, level III; therapeutic study, level IV.
authors.affiliation: From the Departments of Surgery (D.H.W.), and Emergency Medicine (N.K., J.F.H.), University of California-Davis, Sacramento, California; Department of Surgery (A.C.), Columbia University, New York; Department of Surgery (J.M.) University of Maryland, Baltimore, Maryland; Department of Surgery (P.E.) University of Michigan, Ann Arbor, Michigan; Department of Emergency Medicine (J.K.) Helen DeVos Children's Hospital, Grand Rapids, Michigan; Department of Pediatrics (P.M.) Wayne State University, Detroit, Michigan; Department of Pediatrics (L.L.) Harvard University, Boston, Massachusetts; Department of Pediatrics (L.J.C.) University of Utah, Salt Lake City, Utah; Department of Pediatrics (K.Y.) Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Pediatrics (K.L.) State University of New York, Buffalo, Buffalo, New York.
authors.forename: David H
authors.initials: DH
authors.lastname: Wisner
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
authors.forename: Arthur
authors.initials: A
authors.lastname: Cooper
authors.forename: Jay
authors.initials: J
authors.lastname: Menaker
authors.forename: Peter
authors.initials: P
authors.lastname: Ehrlich
authors.forename: Josh
authors.initials: J
authors.lastname: Kooistra
authors.forename: Prashant
authors.initials: P
authors.lastname: Mahajan
authors.forename: Lois
authors.initials: L
authors.lastname: Lee
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Cook
authors.forename: Kenneth
authors.initials: K
authors.lastname: Yen
authors.forename: Kathy
authors.initials: K
authors.lastname: Lillis
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007668:Kidney / Q000293:injuries*; D008099:Liver / Q000293:injuries*; D008297:Male; D011446:Prospective Studies; D013154:Spleen / Q000293:injuries*; D060726:Torso / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000628:therapy*