title: Practice variability exists in the management of high-grade pediatric pancreatic trauma.
abstract: OBJECTIVE
  Management of high-grade pancreatic trauma in children is controversial, although recent evidence supports early operation. We sought to evaluate whether practice variability exists regarding the management of these rare and complex injuries.
  
  
  METHODS
  A study group of pediatric trauma centers within the Pediatric Trauma Society completed a survey following a query of their institutional database. Results are presented using descriptive statistics.
  
  
  RESULTS
  Over a 3-year period (2012-2014), 123 pancreatic injuries (grades II-IV) were reported from 19 pediatric trauma centers (median 6, range 1-22). Sixty-two injuries involving injury to the pancreatic duct (clear/suspected) were reported (median 1, range 0-9). Of these, 49 % were managed with non-operative management (NOM) and 51 % with operative management. Surgeons at the majority (63 %) of institutions used both approaches. Of the operative cases, 21 % were laparoscopic. There was wide variability in clinical management of NOM patients: the most common feeding strategy was reported by 52 % of centers, percutaneous drainage of traumatic pseudocyst by 42 % and ERCP (early/after pseudocyst) by 72 %.
  
  
  CONCLUSIONS
  Wide practice variability exists among North American pediatric surgeons regarding both the initial approach to high-grade pancreatic injury and non-operative management. These results highlight the need for a prospective trial to determine the optimal strategy for these patients.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1210, Houston, TX, 77030, USA. bnaik@texaschildrens.org.
authors.forename: Bindi
authors.initials: B
authors.lastname: Naik-Mathuria
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data; D000072700:Conservative Treatment; D004322:Drainage / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric; D006801:Humans; D015601:Injury Severity Score; D009656:North America; D010179:Pancreas / Q000293:injuries* / Q000601:surgery*; D010192:Pancreatic Pseudocyst / Q000209:etiology / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014193:Trauma Centers
keywords: Non-operative management; Pancreatic trauma; Pediatrics; Practice variability; Pseudocysts; Survey