title: Management of blunt pancreatic trauma in children: Review of the National Trauma Data Bank.
abstract: OBJECTIVE
  This study aims to examine the current management strategies and outcomes after blunt pancreatic trauma in children using a national patient registry.
  
  
  METHODS
  Using the National Trauma Data Bank (NTDB) from 2007-2011, we identified all patients ≤18years old who suffered blunt pancreatic trauma. Patients were categorized as undergoing nonoperative pancreatic management (no abdominal operation, abdominal operation without pancreatic-specific procedure, or pancreatic drainage alone) or operative pancreatic management (pancreatic resection/repair). Patient characteristics, operative details, clinical outcomes, and factors associated with operative management were examined.
  
  
  RESULTS
  Of 610,402 pediatric cases in the NTDB, 1653 children (0.3%) had blunt pancreatic injury and 674 had information on specific location of pancreatic injury. Of these 674 cases, 514 (76.3%) underwent nonoperative pancreatic management. The groups were similar in age, gender, and race; however, pancreatic injury grade>3, moderate to severe injury severity, and bicycle accidents were associated with operative management in multivariable analysis. Children with pancreatic head injuries or GCS motor score<6 were less likely to undergo pancreatic operation. Overall morbidity and mortality rates were 26.5% and 5.3%, respectively. Most outcomes were similar between treatment groups, including mortality (2.5% vs. 6.7% in operative vs. nonoperative cohorts respectively; p=0.07).
  
  
  CONCLUSIONS
  Although rare, blunt pancreatic trauma in children continues to be a morbid injury. In the largest analysis of blunt pancreatic trauma in children, we provide data on which to base future prospective studies. Operative management of pancreatic trauma occurs most often in children with distal ductal injuries, suggesting that prospective studies may want to focus on this group.
authors: Department of Surgery, Duke University Medical Center, Durham, NC, United States. Electronic address: brian.englum@duke.edu.
authors: Brian R
authors: BR
authors: Englum
authors: Department of Surgery, Duke University Medical Center, Durham, NC, United States.
authors: Brian C
authors: BC
authors: Gulack
authors: Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, United States.
authors: Henry E
authors: HE
authors: Rice
authors: Division of Trauma, Duke University Medical Center, Durham, NC, United States.
authors: John E
authors: JE
authors: Scarborough
authors: Division of Pediatric Surgery, Duke University Medical Center, Durham, NC, United States.
authors: Obinna O
authors: OO
authors: Adibe
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010179:Pancreas / Q000293:injuries* / Q000601:surgery; D010180:Pancreatectomy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*
keywords: Blunt trauma; Management; Outcomes; Pancreas; Surgery